2. Presented by group I DR . Amany Gamal
Hemorrhoids ( piles )
Presented by group I
DR . Amany Gamal

3. Objectives :- Definition of Hemorrhoids . Anatomy . Types .
Pathophysiology .
Symptoms .
Causes .
Signs and Tests .
Complications .
Treatment .
Hemorrhoid Surgery .
Prevention .

4. What Are Hemorrhoids? Alternative Names Rectal Lump Piles
Lump in the Rectum

5. Definition
Dilated or enlarged veins in the lower portion of the rectum or anus.
Hemorrhoids (Piles) are blood vessels located in the smooth muscles of the walls of the rectum and anus.

6. ANATOMY right anterior, right posterior and left lateral positions .
those originating above the dentate line which are termed internal .
those originating below the dentate line which are termed external .

8. Types of Hemorrhoids Two Types: Grades: Internal- Under the skin
External- Around the anus
Grades:
I- Hemorrhoids only bleed
II- Prolapse and reduce spontaneously
III- Require replacement
!V- Permanently Prolapsed

10. Pathophysiology
represent engorgement or enlargement of the normal fibro vascular cushions lining the anal canal.
chronic straining secondary to constipation or occasionally diarrhea
fibro vascular cushions lose their attachment to the underlying rectal wall.

11. Cont. prolapse of internal hemorrhoidal tissue through the anal canal.
the overlying mucosa becomes more friable and the vasculature increases.
With overlying thinning of the mucosa and vascular engorgement, subsequent rectal bleeding occurs.

12. Symptoms Rectal Bleeding Bright red blood in stool
Pain during bowel movements
Anal Itching
Rectal Prolapse
Thrombus

13. Causes Pressure Constipation Diarrhea
Sitting or standing for long periods of time
Obesity
Heavy Lifting
Pregnancy

15. Signs and Tests Rectal Examination Tests Visual Digital
Stool Guaiac (FOBT)
Sigmoidoscopy
Anaoscopy
Proctoscopy

16. Complications
The blood in the enlarged veins may form clots and the tissue surrounding the hemorrhoids can die (Necrosis)
This causes painful lumps in the anal area.
Severe bleeding can occur causing iron deficiency anemia.

18. Treatment Non-surgical
Mild cases are controlled by:
Preventing constipation
Drinking Fluids
High-fiber diet
Use of Fiber supplements
Stool softeners

19. Cont. Apply and OTC cream or suppository containing hydrocortisone
Keep anal area clean
Soak in a warm bath
Apply ice packs or compresses x 10min

20. Cont. If prolapses, gently push back into anal canal
Use a sitz bath with warm water
Use moist towelettes or wet toilet paper instead of dry toilet paper.

21. Treatments For painful or persistent hemorrhoids:
Tying off a hemorrhoid
Sclerotherapy
Infrared Light
Laser Therapy
Freezing
Electrical Current
Surgery

22. Hemorrhoid Surgery Alternative Name: Hemorrhoidectomy
Hemorrhoid surgery is the removal of enlarged veins around the anus

23. Surgical Treatment of Hemorrhoids
The triangular shaped hemorrhoid is excised down to the underlying sphincter muscle.
Wound can be closed or left open
stapled hemorrhoidectomy has been developed as an alternative to standard hemorrhoidectomy

24. Cont. Indications Persistent itching Anal bleeding Pain Blood clots
Infection

25. Cont. Risks Reactions to medications of anestesia Bleeding Infection
Narrowing of the anus
*The outcome is usually very good in the majority of cases.

26. Prevention Eat high fiber diet Drink Plenty of Liquids
Fiber Supplements
Exercise
Avoid long periods of standing or sitting
Don’t Strain
Go as soon as you feel the urge

27. We hope that you will have benefited
Best wishes
Group ( 1 )

28. آية المغاورى
أحمد حسني
إبراهيم رمضان
أماني زاهر
أحمد عاشور
Group ( 1 )
أسماء رخا
أحمد الجمل
أحمد إسماعيل
آية نجيب
أنغام
أحمد الشربيني
آيات راغب
إبراهيم الأشرم
أبانوب عماد