HAEMORRHOIDS.-The veins at the extremity of the lower bowel are very apt to become varicose. The tissues are loose, and the veins have very little support, and consequently, when they lose their vitality from any cause, they become distended. These distended or varicose veins, with their mucous covering, constitute what is known as “Piles.” Piles are sometimes “external,” that is, arising from the skin outside the margin of the anus; sometimes “internal, arising from the mucous membrane of the lower bowel inside the anus. Or they may be between the two, and spring from the margin itself. Anything that interferes with the circulation in the abdomen may give rise to piles. The commonest causes are constipation and congestion of the liver. The blood that circulates in the abdomen has to pass through the liver on its way to the heart. Anything that interferes with the action of the liver is apt to impede the circulation, and throw pressure upon the veins, and cause piles. In some cases piles arise from general weakness of the whole system of veins in patients who have varicose veins elsewhere as well. They are often present during pregnancy.
Piles do not remain of the same size always, but increase and bleed at times, then pass away, so that they are hardly, if at all, perceptible. When they are bad, patients say they have an “attack of piles” after the bleeding is over, the patient usually feels greatly relieved.
Besides the inconvenience of the swelling, piles often give pain, varying in degree from very little to agonising. There is also much irritation, burning, pricking sensation. In general the pains are aggravated during stool;if they are internal they come down then, and have to be replaced.
Some piles do not bleed at all.
General Treatment.- In severe cases absolute rest in bed will be necessary, and in all cases the patient should walk as little as he can help, and should lie down as much as possible. Much sitting is bad; a hard chair, or cane-bottomed chair, is preferable to a soft-cushioned one. The diet should be light and unstimulating. No fat or rich food likely to upset the liver should be taken, and nothing that has a constipating tendency; no alcoholic drinks of any kind, and no pepper. The bowels should be attended to regularly; after every stool the parts should be washed with cold water, and any protrusion should be returned. If there is bleeding a lotion of Hamamelis 0 (ten drops to the half pint) should be used instead of plain water for washing. An ointment of Hamamelis 0 (sixty drops to the ounce of prepared lard) should be applied to the anus on a piece of soft linen at night. If there is much irritation an ointment of Verbascum 0 (sixty drops to the ounce of lard) must be used instead.
Medicines.-(Three times a day)
Hamamelis3 -Bleeding piles, with open or loose bowels.
Nux v. 3.
-When there is constipation, and during pregnancy; in sedentary persons, irritable, passionate, who feel worse in the morning. Burning, pricking in the tumours, discharge of light-coloured blood after each stool, constant disposition to go to stool.
Sulph. 6.
-Does well after Nux. Bleeding or blind piles; constant, ineffectual desire for stool, or thin motions mixed with blood; soreness or burning at the anus; stiffness and pains in the back; smarting on passing water.
Aescul. hip.3.
-Blind piles, with constipation, stools apt to be lumpy, great pain in the back.
Pulsatilla3
-Much blood and mucus discharged with stool, pains in the back; pale countenance; disposition to faint.
