Piles, or HÆMORRHOIDS, are small tumours situated either within or on the verge of the anus. The first step in their development is the dilatation of one or more veins in this region. They consist of folds of skin or mucous membrane, with the subjacent tissues in an inflamed, infiltrated, or permanently thickened condition, and usually contain enlarged veins, though these sometimes become obliterated. There are several varieties of these tumours. Sometimes the pile is mainly composed of a little knot of varicose veins; in this case it is readily emptied by pressure of the fluid blood contained in it, which, however, returns when the pressure is removed. Sometimes the blood coagulates, either in a dilated vein, or, if this has given way, around it, forming a solid tumour surrounded by tissues thickened in consequence of inflammation; or the tumour may consist of a kind of erectile tissue formed by an abnormal condition of the vessels of the mucous membrane; this variety is especially liable to bleed. These tumours are divided into bleeding and blind piles, according as they are or are not accompanied with hæmorrhage; and into internal and external piles, according as they are within or without the sphincter muscle of the anus.
The following are the general symptoms of this affection. The patient, after having experienced for a varying time a feeling of heat, fullness, and dull pain about the lower part of the bowel, becomes conscious of a sensation as if there were a foreign body in the anus, and on examination after an evacuation discovers a small tumour, usually about the size of a grape, which either remains outside or is retracted, according as it originated without or within the sphincter. This tumour gradually increases, and others form around it, until a mass at length results as large as a pigeon's egg, or larger. In its ordinary indolent state the tumour has little sensibility, and occasions comparatively little annoyance; but when it is inflamed (from strangulation by the sphincter muscle, or from any other cause) it is exquisitely tender to the touch, and is the seat of burning and stinging sensations, rendering the evacuation of the bowels (and sometimes of the bladder also) difficult and painful. In women an inflamed pile may cause pain in the back, irritation of the womb, with mucous discharge, and many other anomalous symptoms. In severe cases the patient can neither stand nor sit with comfort, and only finds relief in the horizontal position. In internal piles the most important symptom, sometimes the first to be noticed, is hæmorrhage, which may be so profuse or so often repeated as to threaten the patient's life.
Piles may be caused by any circumstances which cause congestion in the lower bowel, such as luxurions and sedentary habits of life, pregnancy, and such diseases of the liver as tend to check the return of blood from the veins of the rectum. Moreover, anything that causes irritation of the rectum, such as excessive use of purgatives, dysentery, inflammation of the prostate gland, &c., may cause piles. But of all causes constipation is probably the most frequent; it operates in producing them partly by the pressure of the accumulated and hardened faeces upon the veins carrying the blood away from the rectum, and partly by the straining and irritation such faeces occasion during their evacuation.
In the treatment of piles it is expedient to relieve the congested state of the lower bowel by one or two doses of sulphate of magnesia, and a cooling vegetable diet, after which the continued use of mild laxatives should be resorted to. A teaspoonful of an electuary, consisting of an ounce of confection of senna, half an ounce of cream of tartar, and half an ounce of sulphur, if taken in the middle of the day, usually acts gently about bedtime, which is far the best time for the bowels of patients of this kind to act, as the parts irritated by the passage of the evacuation become quieted during the night. In long-standing cases, in which there is general relaxation of the mucous membrane, the confection of pepper in doses of a drachm may be given thrice daily with advantage, or a scruple of common pitch may be taken at bedtime in the form of pills or in capsules. Preparations of witch-hazel (Hamamelis virginica) are also useful. Amongst the milder forms of local treatment must be mentioned (1) the injection of the rectum with cold water both before and after the motion; (2) washing the anus with yellow soap and water after each evacuation—this should never be omitted by any one who suffers from piles; (3) the application of gall ointment or of other astringents; and (4) the injection of astringent lotions, as, for instance, of sulphate of iron, in the proportion of a grain to an ounce of water. When the piles are inflamed, leeches to the anus (but not applied directly to the tumours) are sometimes required; but the inflammation generally subsides under the influence of rest in the horizontal position, fomentations, poultices, and low diet. In severe and prolonged cases operative interference becomes necessary. For external piles removal with scissors is usually employed. In certain forms of internal piles the application of caustics, especially nitric acid, sometimes suffices. Where their removal is required it may be effected either by ligature or by cauterisation.
The treatment of the hæmorrhage that frequently accompanies piles requires a few words. If the bleeding is moderate in quantity, and has continued for some time without inducing weakness or any other bad symptom, it is not expedient to interfere with it. When, however, it obviously requires checking, the effect of cold water injected into the rectum, as already recommended, should be tried, and, in case of its failing, astringent injections should be had recourse to. At the same time the patient should remain in the horizontal position, and take the medicines usually prescribed for internal hæmorrhage, amongst which may be especially mentioned witch-hazel, oil of turpentine, in doses of twenty drops three or four times a day, or ergot of rye in divided doses to the extent of a drachm daily. In rare cases it is necessary to tie a vessel, or to touch it with a red-hot wire (through the speculum), or to plug the anus.