Hemorrhoids

Hemorrhoid are enlarged rectal pillows that become abnormal and contain arteriovenous
anastomosis (Anmol Chugh et al, 2014). Hemorrhoid is a normal anatomical structure in the
channel in the form of a vascular form between the sexes of all ages. There are several factors as
the etiology of the emergence of hemorrhoid that includes constipation and extension of tension.
The muscular fibers of the anal canal and anal sphincters lie within the connective tissue matrix.
Studies have shown that, this matrix muscle ratio changes with age, showing an increase in
connective tissue with age. This leads to a loss of elasticity, allowing the anchoring muscle fibers
that give support to the anal cushions and sphincter complex to fragment resulting in prolapse of
hemorrhoidal tissue. Other risk factors are constipation, straining and also diarrhea.

Types of Hemorrhoids
1. External
If not thrombosed, external hemorrhoids may cause few problems. However, when thrombosed,
hemorrhoids may be very painful. Nevertheless, this pain typically resolves in 2–3 days. The
swelling may, however, take a few weeks to disappear.
2. Internal
Internal hemorrhoids usually present with painless, bright red rectal bleeding during or following
a bowel movement. The blood typically covers the stool (a condition known as hematochezia), is
on the toilet paper, or drips into the toilet bowl.
Doctors classify Internal piles into four types :
a. Grade 1 piles are swollen cushions that always remain within the anal canal; these are painless
and the usual symptom is that of bleeding, although in most people they are symptom-free.
b. Grade 2 piles are pushed down (prolapsed) when faeces are passed, but spontaneously return
to their starting position afterwards.
c. Grade 3 piles are pushed down (prolapsed) when faeces are passed, or come down at other
times. They do not go back by themselves but can be pushed back in.
d. Grade 4 piles are the same but cannot be pushed back in.

The hemorrhoidal plexus has an interesting ability in physiologic dilatation as the blood
fill up the venous lumen during the act of defecation. The dilatation occursparticularly during
prolonged straining. It has been suggested that the principle cause of hemorrhoidal disease seems
to be a chronic congestion of the internal hemorrhoidal plexus as a result of failure to empty
rapidly during defecation.
In addition, the act of straining constricts the vein drainage by prolonged abdominal pressure.
The chronic dilatation is possibly thought to cause stretching and weakening of the supporting
ligament that enable the dilated vein plexus to prolapse during and after defecation. Predisposing
factors of dilatation are sedentary living, hot spicy diet, low-fiber diet, smoking, bowel habit,
stressful life, hemorrhoidal family history, aging degeneration, overweight.
Dietary and lifestyle modification
A meta-analysis of 7 clinical trials comprising of 378 patients with hemorrhoids showed
that fiber supplement had a consistent benefit of relieving symptom and minimizing risk of
bleeding by approximately 50%. Although there is relatively little information of the efficacy of
dietary and lifestyle modification on the treatment of hemorrhoids, many physicians include
advice on dietary and lifestyle modification as a part of conservative treatment of hemorrhoids
and as a preventive measure. The advice usually includes increasing the intake of dietary fiber
and oral fluid, having regular exercise, refraining from straining and reading on the toilet, and
avoiding drug causing constipation or diarrhea.
Medical treatment
The main goal of medical treatment is to control acute symptoms of hemorrhoids rather
than to cure the underlying hemorrhoids. There are several modern drugs and traditional
medicine used which are available in a variety of format including pill, suppository, cream and
wipes.
1. Office-based procedures
2. Operative treatment
Thrombosis of external hemorrhoid is a common acute complication of the piles. There will be
tense and tender swelling in peri anal region and this condition can be compared with the
Pachyamana Vrana site. Usually it resolves within five days, but there is an every chance of
suppuration, bursting and fibrosis. In this condition application of leech helps to improve the
circulation by sucking the liquid blood and interstitial fluid from inflammatory swelling and
there will be an immediate reduction in the size of swelling, pain and tenderness. Leech therapy
is an effective, safe, simple and is cost effective too.
Specific Consideration
1. Acutely thrombosed or strangulated internal hemorrhoids
2. Acutely thrombosed external hemorrhoids
3. Hemorrhoids in pregnancy
4. Hemorrhoids in immunocompromised patients
5. Hemorrhoids in patients with cirrhosis or portal hypertension
6. Hemorrhoids in patients having anticoagulant or antiplatelet drugs
 DAFTAR PUSTAKA

Agarwal, PN. Chugh, Anmol . Singh Rajdeep . (2014) . Management Of Hemorrhoids . Indian
Journal Of Clinical Practice . Vol 25 . 577-580
AG, Ravishantan . MS, Krishnamurthy. P, Subrahmanya. Rao S, Ravi. TS, Mahesh . (2013) .
Leech On External Thrombosed Hemorrhoids . International Research Journal Of Pharmacy .
Vol 4 . 50-52

Lohsiriwat, Varut . (2015) . Treatment Of Hemorrhoids . World Journal Of Gastroenterology .

Vol 21 . 9246-9252

Ruparkar, Pratik. Velani, Yogesh . (2015) . Unknown Facts Of Haemorrhoids: A Literature

Review. European Journal Of Pharmaceutical And Medical Research . Vol 2 . 143-151

Yuwono, Hendro Sudjono . (2014) . Medical Treatment of Primary Internal Hemorrhoidal and
External Hemorrhoidal Disease . Global Journal of Surgery . Vol 2 . 45-48