Haemorrhoids are swollen blood vessels in or around the anus and rectum. The haemorrhoidal veins are located in the lowest part of the rectum and the anus. Sometimes they swell so that the vein walls become stretched, thin, and irritated by passing bowel movements.

1. Hemorrhoids
(Piles)
S.S Hotchandani
4th year BDS Student at Bibi Aseefa Dental College, SMBBMU, Larkana, Sindh, Pakistan.

2. Introduction
Greek word..
Haim; Blood
Rhoos; Flowing
Latin Word
Pila; Ball

3. Introduction
Prevalence of
Asymptomatic Piles is
greater than
Symptomatic Piles.

5. Internal Hemorrhoids
 Piles inside Anus…
 Occur in Anal Cushions, usually at 3, 7 & 11 o'clock Position.
 AKA, Symptomatic Anal Cushions
 Called as Secondary if they occur in b/w Primary masses…

6. Causes of PRIMARY Internal Hemorrhoids
There are some misconceptions
about the anatomy of vascular
system of anal canal and these
misconceptions has led to give
many theories about the
Development of Primary Internal
Hemorrhoids…

7. PORTAL HYPERTENSION &
VERICOSE VEINS
 Man’s upright or standing posture contribute to hemorrhoids formation, though
there are no any cases of hemorrhoids in Animals!!
 Portal venous system does not contain any valves and this causes backward flow
and dilate Anal cushions’ blood vessels & cause piles.
 Increased abdominal pressure contribute to formation of anal varicosity
resulting piles.
 Note; Prevalence of Ano rectal varices is greater than Piles in
Patients of Portal Hypertension..

8. Other Theories or Causes told by Some Scholars!!
Hemangioma
Infection
Diet & Stool
Anal Hypertonia
Ageing

9. New Concept about Development of Piles.
Shearing forces which act on anus causes
displacement of anal cushions caudally
and also mucosal trauma..
With time, fragmentation of supporting
structures causes loss of elasticity of
cushion and they do not retract back
after defecation

10. Causes of Secondary Internal Hemorrhoids (LOCAL)

11. Causes of Secondary Internal Hemorrhoids
(Abdominal)

12. Causes of Secondary Internal Hemorrhoids
(Neurological)

13. Causes of Secondary Internal Hemorrhoids (Pelvic)

14. Clinical
Features

18. Medical & Surgical

19. Conservative Treatment
Exclude other cause of bleeding from anus
Normalize bowel and defecation habits.
Only evacuating stool when natural desire
appears
Adopting defecation position so that minimal
straining occur during defecation
Use of stool softener and bulking agents.

20. Surgical
Management

21. THANKS!
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