Piles

Last modified on January 26th, 2019

Piles

 

DISEASES OF THE ANUS AND RECTUM by J.G. GILCHRIST, M.D.

HAEMORRHOIDS.

Piles are painful tumours found situated either without or within the sphincters, differing somewhat in structure, as they are acute or chronic and known, with reference to their locations, as external or internal. Some writers make a further distinction between the blind and bleeding piles, but as these symptoms depend upon location, and not on any other peculiarity the distinction has been gradually lost.

External haemorrhoids, occur as small, hard tubercles, situated without the sphincter and are undoubtedly caused, in the first instance, by an enlargement of one or more veins, similar to varix, which ultimately give way, and the blood is poured out into the cellular tissue, soon becoming entirely absorbed, or remaining coagulated in a distinct adventitious sheath. In acute cases, absorption is the rule; but when frequent attacks have occurred the tissues are thickened, the blood is not absorbed, and a permanent tumour remains, hard, not particularly sensitive but liable to sudden attacks of inflammation, when the pain becomes excessive, and strong men become greatly prostrated from its violence. Frequent attacks of this kind results in the continued growth of tumours, which may become of such a size that much annoyance and interference with defecation may result. When inflamed the tumours are some what florid, not very sensitive, and apart from the straining necessary at stool, and the pain attending that process, are not very troublesome , unless of unusual size and in numbers. When inflamed, from any cause, the tumours become hard of a bluish or livid colour, very sensitive to the touch, and cause the most exquisite pain and suffering.

The causes are both exciting and predisposing. The predisposing causes are of two kinds; one dependant upon causes that determines an increased amount of blood to the neighbourhood of the anus, and so frequently repeated that the operation may be considered permanent. Under this head we include all habits, of avocation or otherwise, that induce either determination of blood, or that impedes the return through the veins-as sedentary pursuits, or long standing, as hair-dressers, dentists, school- teachers, and the like; as well as mechanical impediments, such as habitual constipation, tumours, pregnancy, or morbid processes of various kinds.

The other class of predisposing causes, are of a more constitutional character, as hepatic derangements, or any impediment to the portal circulation; and a peculiar hereditary tendency, which is either due to a similarity of pursuits or to causes of a more vital character, dependant upon some functional peculiarity.

The exciting causes are very various. Among them we may include exposure to cold or damp; cathartic medication; frequent employment of enemata; violent exercise on horse back; immoderate sexual indulgence, or in the pleasure of the table. In short any continued habit that either interferes with venous circulation, or produces increased determination of blood to the parts. In acute cases the first attack may be the last, but when there is a constitutional or hereditary predisposition, slight provocation will induce subsequent attacks, which become more severe, last longer, with each recurrence.

Internal haemorrhoids, in every way, are quite different from the external variety. It has been thought that this form of piles is rather more frequent than the preceding, at all events from the greater local and constitutional trouble, and the alarm, occasioned by the frequent haemorrhages, such cases are oftener brought to the attention of the surgeon. The causes are about the same as mentioned above, and need not be repeated here. The symptoms, however, are widely different. The first symptoms observed will usually be a pruritis of the anus and perineum, which is very annoying at night particularly, and from the irritation produced by scratching and rubbing the integument and mucous membrane soon becomes thickened and covered with a squamous eruption, caused by the destruction of the epithelium. Later there will be frequent haemorrhages from the rectum, sometimes very profuse, long lasting, and arterial in colour; and at others not so copious or protracted and of a venous character. There will be pain on going to stool, and the act can only be accomplished after much straining and then with a feeling of incompleteness. The rectum will feel filled up, and there will be much weight and tenesmus, with no defecation on attempting relief. The pain soon becomes more continuous, independent of defecation, and the general health begins to suffer; the patient complains of indigestion, pains in the abdomen are of frequent occurrence, the face looks pale and balanced; he becomes listless and application to business or study requires an especial effort. The sphincter requires an especial effort. The sphincter is now observed to be frequently spasmodically contracted, and when the patient is a woman, the sufferings are not unfrequently “referred to that prolific store-house of morbid phenomena, the womb”. The piles now frequently protrude, at first only when straining at stool; but later on slight provocation, as when walking; sometimes they become strangulated by the constriction of the sphincter, and cause intense suffering, becoming even gangrenous and sloughing off, thus inducing a spontaneous cure. Finally, the volume of the tumours become so great, the pain so excessive, and the bleeding so frequent, violent, and exhausting, that the sufferer applies for surgical relief.

On examining such a case it will be more satisfactory if it occurs immediately after an attempt at stool, when the piles are either completely extruded, or brought down close to the verge of the anus. The appearances vary very much in different cases. In some the tumours are of a blue colour, composed of pouch-like dilatations of the veins; sometimes with effusion into the sub- mucoid cellular tissue; the mucous membrane being attenuated, and spread out over the tumours; or else is spread out over the tumours; or else is much thickened, ulcerated, or roughened. The tumours may be sessile or pedunculated, or like a cluster of grapes. At other times, they will be of a bright crimson colour, bleeding at the slightest touch, and evidently composed of enlarged capillaries and veins, the blood escaping in jets, like from an artery, and of an arterial colour.

In old cases, there is much thickening of the mucous membrane, and occasionally an oedematous condition, with pouching or a `flap-like’ appearance about the anus externally. While the masses of piles are usually closely approximated, and confined to a somewhat restricted area, there are cases in which distinct rows are formed, rarely exceeding three, disposed about half an inch apart, one above the other.

The treatment presents many indications, instrumental, hygienic and mechanical. As regards instrumental, our space, and the plan of our work, will not admit of its consideration at this place, but experience has demonstrated its absolute necessity in many cases.

Common sense would dictate an abstinence from anything that would have a tendency to increase or maintain the causes operating either as exciting or predisposing; and sexual indulgence, immoderate indulgence in the pleasure of the table, use of alcoholic stimulants, and anything of either a stimulating or debilitating nature must be avoided. Cathartics must be avoided, and if proper medication, with careful selection of diet fails to relieve the constipation, the piles must be removed. Sedentary people should take exercise and change their habits of life; and those who are suffering from opposites causes, must take rest. In short a removal of the cause must be the first indication. When a gravid uterus is at fault, the best must be made of the condition until it is removed by natural means; but this I think, constitutes the only instance where no attempt should be made to remove the cause; nevertheless, in exceptionally severe cases, those that may either threaten life or cause its continuance to be almost undesirable, artificial labour may be induced, after due consultation, and careful, enlightened, and serious consideration of the question in all its bearings.

Remedies, to my mind, in all ordinary cases at least, should first occupy our attention, after the removal of the causes as far as possible. In old cases, it is true, the action must be slow and tedious, and the tumours may demand removal, as to all intents and purposes they are neoplastic, and resorption requires much time, more than the sufferings and functional disturbance will warrant us in taking. After removal, however, with a continuance of the same exciting causes or hereditary predisposition, remedies must be given to prevent a recurrence of the tumours. In acute cases I should rely entirely upon the well selected remedy; and in chronic cases, when the tumours are small, the sufferings not intense, and the exacerbations infrequent, medicinal treatment will be attended by results that none unfamiliar with our system of therapeutics can realize or conceive as possible,

While Nux vomica, Sulphur, and a few other remedies are of the first importance in this malady, the list of those proved curative is large, and will repay study.

Aconite.-Bleeding piles; stinging and pressure in the anus; abdomen feels full, with tensive pressure, and colicky pains; bruised feeling in the back and sacrum.

Aesculus hip.- Large, firm haemorrhoidal tumours, with severe pains across the back and hips, as if they would break in two.

Aloe socot.-Heaviness, heat, pressing, and burning in the rectum; mucus and blood in the faeces; itching. burning, pulsating pain, as from a fissure in the anus; constant bearing down, low in the rectum; large volumes of wind precede the stool; haemorrhoidal tumours protrude like bunches of grapes, and are very painful, sore, tender and hot; increased secretion of urine, especially at night, constant rumbling in the abdomen, with feeling as if he must have stool, but no evacuation following the effort. Jelly like, bloody stool. Worse in the afternoon; also when standing up or sitting still. Better from cold water.

Alumina.-During evacuation blood spurts out of the rectum, followed by soreness all along the rectum; stool hard and dry, shaped like laurel berries blood passes away from the haemorrhoidal tumours when walking; tumours always burn; perineum sweats, and is tender to the touch. Worse in the evening; also when walking and on being touched Better after night’s rest.

Ambra gris.-Itching, smarting and stinging at the anus; increase secretion of urine, much more than the fluid drank. Worse in the evening; also when lying in a warm place and on awakening. Better from slow motion in the open air, and when lying or pressing upon the painful part.

Ammonium mur-Bleeding from the rectum, with lancinating pains in the perineum, especially in the evening; stinging and itching in the rectum, during and before the stool; piles surrounded by inflamed pustules.

Antim crud. -Continual discharge of mucus from the bowels; alternate diarrhoea and constipation; increased and frequent discharge of urine at night, with discharge of mucus, burning in the urethra, and pain in the small of the back. Worse at night; also, after bathing, and from the heat of the fire. Better during rest,or in the open air.

Arnica mont.- Painful pressure in the rectum; stools small and frequent, consisting only of slime; crampy sensation in the rectum; running in the rectum when standing, tenesmus in the rectum; pain pricking and burning. Worse in the morning, evening and at night; also , when moving, when being touched, and from cold. Better from pressure.

Arsenicum alb.-Burning and soreness in the rectum and anus; haemorrhoidal tumours with burning pain; the rectum is pushed out spasmodically, with great pain, it remains protruded after haemorrhage from the rectum; smaller and painful haemorrhoids; varices which burn like fire, at night, stinging during the day particularly when walking; burns so that he threatens to tear them to pieces. Worse at night; also from cold. Better from warmth.

Belladonna.- Spasmodic stricture of the rectum; paralysis of the sphincter ani; stinging pain in the rectum; contortive pain in the rectum; violent itching, and constrictive sensation in the anus; urine scanty, fiery red, dark, turbid.

Worse in the evening, and at night; also, on moving, or when touching the parts.

Better while standing, or when lying down.

Berberis vulg.-Fistula ani with great soreness and pain throughout the entire back, from sacrum upwards, greatly increased when the patient performs any labour.

Bryonia alb.-Hard, tough stool, with protrusion of the rectum;long lasting burning in the rectum after hard stool;sharp burning pain in the rectum with soft stool, white and turbid urine; sensation of constriction in the urethra when urinating. Worse in the morning; also from motion, and from heat. Better while lying down, or on getting warm in bed.

Calcarea carb.-Discharge of blood from the rectum; prolapsus ani, with constipation; itching of the anus; varices smaller, protruding, and burning violent pressure in the rectum; burning in the rectum; pricking of the rectum as if from ascarides; grape-like eruption around the anus, painful and burning; frequent micturition also at night; during micturition burning in the urethra.

Calcarea phos.-Fistula ani, in persons who have pains in the joints, with every spell of cold, stormy weather. Fissures of the anus, in tall, slim, light complexioned children, and who form none and teeth slowly.

Carbo veg.-Constipation, with hard, tough and scanty stool; the stool, if soft, is passed with difficulty; discharge of blood from the rectum; burning varices, burning at the anus, after stool; soreness of, and oozing of moisture from the perineum; frequent and anxious urging to pass urine; copious emission of light yellow urine; great burning and itching at the anus, with swelling of the tumours, and lancinating pain in the thighs.

Causticum.-Haemorrhoids sore and painful when walking; piles impede the passage of faeces; for clergymen who have an attack after every effort to preach.

Chamomilla.-Constipation from inactivity of the anus; inflamed varices, with ulcerated rhagades of the anus; itching pain at the anus; ineffectual urging, with anguish during micturition; smarting pain in the urethra during micturition. Worse at night; also, while lying down. Better from warmth,

China off.-Difficult passage of faeces, even when soft, as from inactivity of the bowels; stitches in the rectum, also during stool; tingling in the anus, as if from ascarides; discharge of mucus from the rectum: bleeding piles; urine is dark, turbid and scanty; frequent micturition. Worse at night; also, from touching the parts softly. Better in the house.

Colchicum.- Stool scanty, discharged only by hard straining, even of the soft stool, with pain in the small of the back; extremely painful stool; ineffectual pressing to stool, he feels the faeces in the rectum, yet cannot expel them; during stool, sensation as if the sphincter ani were torn to pieces; burning at the anus; spasms of the sphincter ani, frequent micturition, Worse in the evening, and at night; also, from cold, when walking, and from being touched. Better while sitting, or lying down.

Colocynth.-Constriction of the rectum during stool; discharges of blood from the rectum with stinging, burning pain in the small of the back and anus, Worse in the afternoon, and in the evening; also during rest, Better from motion.

Ferrum met.-Contractive spasm in the rectum; protrusion of large varices at the anus; painless diarrhoea; involuntary micturition, particularly in the day time. Worse in the morning, and at night; also when at rest, Better from slow motion.

Graphites.-Constipation, with hard, knotty stools, in lumps, united by a thread of mucus; burning of the rectum, with sour- smelling stool; itching and sore feeling of the anus; varices of the rectum, and between them burning rhagades at the anus; prolapsus recti with the varices, as if the rectum were paralyzed; frequent micturition, particularly at night; hardness in region of liver; moist humid eruptions about the head and ears. Worse at night; also, from cold. Better from warmth, and in getting warm in bed.

Hamamelis virg- This remedy, I am sorry to say, has always been used by me empirically; it has, however, since I commenced using it, rarely failed to cure any case of haemorrhoids. I use it topically. Anal fissure.

Hepar sulph.-Constipation, with hard, dry stool; even when the faeces are not hard, they are expelled with great difficulty; haemorrhage from the rectum, with soft stool; soreness of the rectum after stool, with ichor; burning at the rectum; protrusion of the varices; perspiration on the perineum; the urine is passed slowly, and with difficulty. Worse at night; also from cold air, from pressure and from touching the parts. Better from warmth.

Ignatia am.-The stool is of too large size, soft, but very difficulty to discharge; stitches from the anus, up the rectum; itching and creeping in the rectum as from ascarides; prolapsus ani, with smarting pain from slight pressure to stool; constriction of the anus after stool; frequent discharge of watery urine; sudden sharp stitches in rectum, upwards into the body. Worse in the evening, and in the morning; also, after lying down. Better when lying on the back.

Kali carb.- Constipation with difficult emission of too large sized faeces; retarded stool, from inactivity of the rectum; smarting pain at the anus, with diarrhoea; continual burning at the anus after stool; discharge of blood with the stool; itching and tingling of the anus; ulcerated pimples at the anus’; protrusion and distension of the varices during stool, with pricking and burning; protrusion of the varices during micturition, emitting first blood, then white mucus; inflammation, soreness, stitches, and tingling, as from ascarides in the varices; frequent micturition, with discharge of small quantities of fiery urine; the urine is discharged slowly; feeling of fissure in anus; cannot convince him to the contrary; stinging, burning, tearing, itching, screwing, biting, follows each stool, setting him almost crazy; walks the floor for relief, cannot sleep from sufferings; difficult stool, from great bulk of piles. Worse in the morning; also, when at rest, from cold, and when lying on the side. Better on getting warm.

Kreosote.-Constipation, the stool being hard, dry, and only expelled with difficulty; stitches in the rectum extending towards the left groin; diminished secretion of urine, although he drinks much. Worse in the morning; also in the open air. Better from warmth.

Lachesis.-Constipation, with effectual desire to evacuate; constriction of the rectum or sensation as of a plug in the anus, stitch in the rectum when laughing or sneezing; haemorrhoids protrude after the stool, with constriction of the sphincter; foaming urine; sensation as if a ball were rolling in the bladder. Worse in the evening; also, in the open air, and from cold . Better from warmth, or in the house or room.

Lycopodium.-Constipation, hard stool with ineffectual desire to evacuate; desire for stool, followed by painful constriction of the rectum or anus; haemorrhage from the rectum, even after a soft stool; feeling of fullness in the rectum, which continues after a copious stool; contractive pain in the perineum, after scanty hard stool; stitches in the rectum; itching and tension in the anus; itching eruption of the anus, painful to the touch; painful closing of the anus; protrusion of the varices; distension of the varices of the rectum; narrowing of the rectum which produces piles; tearing pain in the rectum arresting the breath; piles surrounded by itching eruption painful to the touch; feeling of great fatigue after stool; haemorrhoids are the most painful when sitting; frequent desire to urinate, copious emission; sandy sediment in the urine. Worse in the afternoon; also , when lying down, or sitting, and from the pressure of the clothes. Better from cold.

Mercurius.-Constipation, stool tenacious or crumbling, can only be discharged after violent straining; discharge of blood before, during and after stool; burning pain in the anus with a loose stool discharge if mucus from the rectum; after the stool prolapsus ani, or when straining and pressing to stool; the rectum is black, discharging blood; frequent and violent desire to urinate, with scanty discharge and feeble stream. Worse in the evening, and at night; also. from the heat of the bed, and when exercising. Better when at rest, or while lying down.

Muriatic acid.-(See Nitric acid. The same symptoms when they occur in light complexioned people). Prolapsus ani when urinating.

Natrum mur.-Constipation, stools difficult to discharge, hard, dry, crumbling, like sheep’s dung; difficult stool, with stitches in the rectum; passes blood with the stool; during and after stool burning in the anus and rectum; piles with stinging pain; soreness at the anus, and around it, when walking; tetter at the anus; frequent and strong desire to urinate, with profuse discharge. Worse in the afternoon; also from any exertion. Better when lying on the back or right side and after lying down.

Nitric acid.-Anal fissure, or haemorrhoids with painful burning in the rectum, after stool; and after micturition, excessive irritation; anxiety and general uneasiness after stool. Bleeding of the piles, and of the anus during stool; swelling and almost continuous protrusion of the varices; almost daily contraction of the anus; in persons of dark complexion; sharp stitching pains after each evacuation; constant weight and pressure in the rectum, aggravated by exercise; in women, throbbing in the nape of the neck, and small of the back, just before the catamenia.

Nux vomica-Constipation, stools insufficient, black, hard, often streaked with blood, as from inactivity of the intestines; stools like pitch; painful blind piles; shocks in the small of the back, with bruising pain so that the patient is unable to rise up; stinging, burning, and itching of the anus; discharge of blood and mucus; painful, ineffectual urging to urinate. Worse in the morning; also on motion, and on being lightly touched. Better from strong pressure.

Opium.-Constipation, from inactivity of the intestines; the stools are retained spasmodically; suppression of urine, as from contraction or paralysis of the bladder. Worse in the night; also after sleep, and on becoming heated. Better from motion.

Paeonia.-Painful ulcer at the anus with exudation of a foetid moisture extending toward the perineum.

Petroleum.-Have cured several cases with the following symptoms: Haemorrhoids, internal, with puffy tender swelling at the posterior verge of the anus; intense itching from the coccyx upwards, also in the nates on either side; attacks preceded by weeks of intense itching-biting of the anus, and perineum with widespread redness around the anus; the margin of the areolar surrounded by a herpetic eruption, scaling off; itching changing to burning with moisture after scratching; at night on getting into bed, the itching is intolerable for hours with great moisture of the perineum, with mucus discharge from the anus; the itching changes place on scratching or rubbing. Worse at night; also from heat , heat of the bed, and rubbing or scratching.

Better from cold, cold water, and pinching the parts. Sulphur is sometimes needed to complete a cure, and in one cases Kali-c.

Phosphorus.-Constipation, small-shaped, hard stool, and expelled with great difficulty; discharge of blood from the rectum, also during stool; spasms in the rectum; paralysis of the lower intestines and the sphincter ani; discharge of mucus out of the wide-open anus; stinging or itching at the anus; easily bleeding piles; increased secretion or watery pale urine; involuntary discharge of urine. Worse in the evening and at night; also when lying on the back, or left side. Better when lying on the right side, from rubbing and after sleeping.

Platina.-Itching, tingling and tenesmus at the anus, in the evening; frequent micturition, with slow flow of urine. Worse in the evening, also when at rest. Better during motion.

Podophylum.-Constipation, with flatulence and headache; faeces hard and dry, and voided only with difficulty; prolapsus ani, with diarrhoea; descent of the rectum from a little exertion, followed by stool, or by thick and transparent mucus, mixed with blood; urine suppressed, or involuntary urination during sleep.

Pulsatilla.-Difficult soft stool, with straining and backache; during stool congestion of blood to the anus; piles with great soreness; incontinence of urine; scanty red-brown urine. Worse in the evening; also from heat. Better from cold.

Rhus tox.- Sore haemorrhoids, protruding after stool; frequent urging to urinate day and night, with increased secretions; involuntary discharge of urine at night, or while sitting. Worse at night; also, from cold and pressure. Better from warmth.

Ruta grav.-Prolapsus ani with every stool, either soft or hard; frequent unsuccessful urging to stool, with prolapsus ani; soft stool. which from inactivity of the bowels, is discharged with difficulty; frequent desire to micturate, with scanty emissions. Worse in the afternoon; also, during wet, and from cold. Better from motion.

Sarsaparilla.-Difficult and painful stool, with fainting attacks; stool retarded, hard, and insufficient; frequent inefficient urging to urinate, with diminished secretion. Worse in the afternoon; also, from cold. Better from warmth. Sepia.-Insufficient stool, with straining and tenesmus; discharge of blood with the stool; pain in the rectum as from contraction; itching, burning, and stinging in the rectum and anus; sensation of a leaden ball in the rectum oozing from the rectum; discharge of mucus from the rectum, with stinging and tearing; frequent micturition. Worse in the forenoon, and in the evening; also, when at rest. Better from warmth, and when violently exercising.

Silicea.-Constipation; difficult hard stool, which is large, and if partly expelled slips back again, as if there was not power enough to expel it; even the soft stool is expelled with much difficulty; itching in the anus and rectum, also during stool; piles protrude during stool and become strangulated; intense pain, with even slight protrusion; a cramping pain from the anus and rectum to the testicle; anus constantly damp; violent sharp stitches in the rectum when walking; pains chiefly burning and cutting; continuous urging to urinate, with scanty discharge. Worse in the night; also, from cold. Better from warmth.

Spigelia.-Frequent, though inefficient, urging to stool; discharge of large lumps of mucus without faeces; itching and tickling at the anus, and in the rectum; frequent micturition, with profuse discharge. Worse in the forenoon, and at night; also, on bending down, from movement, or on touching the parts. Better after lying down.

Sulphur.-Constipation; frequent unsuccessful desire for stool; stool hard, knotty, insufficient; during the stool, discharge of blood, pain in the small of the back, palpitation of the heart, congestion to the head, prolapsus recti (especially during a hard stool); itching, burning and stinging at the anus, and in the rectum; after stool, tenesmus, constriction of the anus, swelling of, with soreness and stitching in the anus, frequent micturition, with small emission; burning, tearing, itching, in the rectum and anus, with feeling of fullness; cannot bear to have the piles washed with water; inclination to scratch the part; scratching increases burning and itching. Worse in the evening, and at night; also, on getting warm in bed, from bodily exertion, while at rest, and from touching the parts. Better from motion, and from heat.

Sulphuric acid.-Varices always feel damp and are painful to touch; itch violently; pain at stool like sheep’s dung; piles in hard drinkers.

Zincum met.-Constipation; stool hard and dry, inefficient, only expelled by hard pressing; sensation of soreness, and violent itching at the anus; tingling at the anus, as if from ascarides; violent desire to urinate; retention of urine when beginning to urinate. Worse in the afternoon, and in the evening; also when in a warm room. Better in the open air.

About the author

J.G. Gilchrist

JAMES G. GILCHRIST (1842-1906), A.M., M.D. PROFESSOR OF SURGERY, HOMEOPATHIC MEDICAL DEPARTMENT, UNIVERSITY
OF IOWA, CHICAGO. Author of - The homoeopathic treatment of surgical diseases, Published 1873. Surgical emergencies and accidents, Published 1884. The elements of surgical pathology : with therapeutic hints, Published 1896. Surgical diseases and their homoeopathic therapeutics, Published 1880.

Leave a Comment

Your email address will not be published. Required fields are marked *