Hemorrhoids, also known as piles, are swollen veins in the rectum and anus. They can be internal, located above the dentate line, or external, located below the dentate line. Common causes include straining during bowel movements, obesity, pregnancy, and aging. Symptoms may include painless bleeding, prolapse, itching and discomfort. Diagnosis is usually based on medical history and physical exam. Treatment options range from lifestyle and diet changes to over-the-counter creams and suppositories for mild cases, and procedures like banding or surgery for more severe cases.

1. Hemorrhoids ( piles )
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2. What is Hemorrhoids ?
• Hemorrhoids are varicose veins (swollen
veins) that appear in the rectal area
• condition in which the veins around the
anus or lower rectum are swollen and
inflamed
• Refer to abnormally large, bulging,
dilated blood vessels
• hemorrhoids represent downward
displacement of anal cushions that
contain arteriovenous anastomoses.
Although hemorrhoids are considered a
minor medical problem
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3. Types of Hemorrhoids
1-Internal Hemorrhoids
First degree
Second degree
Third degree
Fourth degree
2-External Hemorrhoids
3-Mixed Hemorrhoids
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4. 1-Internal Hemorrhoids
exaggerated vascular cushions
located above the dentate line and covered with mucous membrane
Second degreeFirst degree
 descend with defecation but returns
spontaneously with relaxation
 mild discomfort and bleeding
does not descend or prolapsed during
straining on defecation.
Painless bleeding is present.
Fourth degreeThird degree
 is permanently prolapsed and cannot
be manipulated manually.
Thrombosis often occur.
requires manual replacement into the
rectum after prolapsed.
 Pain, bleeding, and discharge of mucus
are present.
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5. 2-External Hemorrhoids
• is a dilated vein of the inferior hemorrhoid plexus
located below the dentate line
3-Mixed Hemorrhoids
• exhibit simultaneous characteristics of internal
and external hemorrhoids
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6. Dentate line
Line which divides the upper 2/3rds of the anal canal
And lower 1/3rds of the anal canal
Internal Hemorrhoid located above dentate line
External Hemorrhoid located below dentate line
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7. Causes
1-Common cases
 irregular bowel habits (constipation or diarrhea)
 Nutritional factors (low- Fibers diets)
 heavy lifting
 increased intra-abdominal pressure
(prolonged straining , pregnancy )
 increased pressure in the veins of your anus or rectum
 Genetics
 Aging
 Obesity
 Chronic cough
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8. 2-Diet that may cause Hemorrhoid
-ALCOHOL
-SALTY FOODS
such as French fries, potato chips, pretzels, canned soups and
salted nuts
-FATTY FOODS
like sausage, beef, fried chicken, ham and lamb
-SUGARY FOODS
sugary foods such as muffins, doughnuts, cakes, cookies,
sodas, candy and ice cream
-SPICY FOODS
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9. 3-Rare causes
In patients with liver disease, varices may occur
because of the dual blood supply to the
rectum.
When viewed Endoscopically, rectal varices
occur in the rectum and hemorrhoids are
located in the anus. In such cases, treatment
of the liver disease and portal system
decompression is the primary goal
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10. Pregnancy & Hemorrhoids
During pregnancy, pressure from the fetus on the
abdomen and hormonal changes cause the
hemorrhoidal vessels to enlarge. Delivery also leads
to increased intra-abdominal pressures
Pregnant women rarely need surgical treatment, as
symptoms usually resolve after delivery.
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11. Symptoms
1. Painless bleeding (the most common sign/symptom).
The blood is usually bright red an d may be visible on the
stool
2. Prolapsed(the second most common sign/symptom)
3. Pain is unusual unless thrombosis involving external
tissue is present
4. Discomfort, Pruritis, swelling
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12. Tests and diagnosis
The diagnosis of hemorrhoids is
based on a medical
history and physical exam.
A digital rectal
exam and anoscopy may be
the only tests needed at first.
Your doctor will decide which
tests to use.
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13. • To make sure nothing else (like colon cancer) is
causing your symptoms, you may need other tests,
such as:
Flexible sigmoidoscopy. This test allows a doctor to
look inside the anus,rectum, and lower part of the
large intestine (colon) for abnormal growths or
other signs of disease.
 Barium enema.
 Colonoscopy.
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14. Conditions like Hemorrhoids
• Proper diagnosis is important, because there are a
number of conditions that like hemorrhoids in symptoms
like:
1. An anal abscesses: usually staphylococcus infection
2. An anal fissures :is an unnatural crack or tear in the skin of
the anal canal
3. An anal fistula :is an abnormal connection between the
epithelialised surface of the anal canal and (usually) the
perianal skin
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15. Conditions like Hemorrhoids
4. Inflammatory bowel diseases
5. Polyps: begnin tumor of the large intestine.
6. Colorectal cancer
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16. Treatment
1-Non-Pharmacological
• Most hemorrhoids can be treated with simple
changes to diet and bowel habits. Most do not require
surgery or other treatment unless
the hemorrhoids are very large and painful.
• Acquiring enough fiber is the first step inside your
hemorrhoid treatment. Fiber helps keep clean your
bowel and could make bowel movement less difficult
• carbonated drinks as we as alcohol.
• have a large quantity of water as your hemorrhoid
treatment.
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17. High Fibers Diet
The American Dietetic Association recommends 20 to 35 grams of fiber each
day. Over 35 grams of fiber a day may cause excess bowel gas
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18. 1-Non-Pharmacological
• Drink a lot of fruit juice and after that
vegetable juice also, as each of these contain
Vitamin C that can empower your immune
system, that will aid inside your restoration.
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19. 1-Non-Pharmacological
• Take warm sitz-baths :
a bath where the pelvic region is immersed in warm water. It is
recommended for 15 minute three or four times daily.
prolonged bath should be avoided
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20. 1-Non-Pharmacological
• Lastly, you possibly can begin using an ice pack
on top of the painful region for your
hemorrhoid treatment.
The ice would probably cool-down the
aggravation, forcing the puffiness to decline
and relieving you of the pain and rawness
connected with hemorrhoids.
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21. First & second-degree internal
hemorrhoids treatment
a. Reduce straining and downward pressure
b. Correction of constipation
c. Sitz baths
d. OTC hemorrhoidal ointments, creams,
foams, suppositories
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22. Higher degree internal hemorrhoids
treatment
a. Hemorrhoid banding: is a procedure in which
the physician puts a tight band around the
hemorrhoid to control bleeding
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23. Higher degree internal hemorrhoids
treatment
b. Infrared photocoagulation: infrared light is
focused at the base of hemorrhoids thereby
cutting off the blood supply to the hemorrhoids
and destroying them.
Video to show it
ttps://www.youtube.com
/watch?v=0aNTFMQrthE
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24. Higher degree internal hemorrhoids
treatment
c. Sclerotherapy: injection of a sclerosing agent
into the hemorrhoids
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25. Higher degree internal hemorrhoids
treatment
d. Cryotherapy: freezing the hemorrhoids
e. Surgical hemorrhoidectomy:
(surgical remove of hemorrhoides)
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26. What to treat hemorrhoids during
pregnancy?
• Soak in warm water.
• Try witch hazel.
• Use ice.
• Keep anal area clean.
• Avoid sitting for long periods of time
• Drink plenty of liquids.
• Eat foods high in fiber.
• Don't gain too much weight.
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27. Medications to treat Hemorrhoids
1-Local Anesthetises
Like: (benzocine , dibucaine , lidocaine , benzyl alcohol )
Not to be used for more than 7 days
Not to be applied to broken skin
Should be used for pain , itching & burning in the anal canal
(not in the rectum because the rectum contains no
sensory pain receptors
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28. 2-Vasoconstrictors
-For a temporary relief of itching and irritation, these agents
have a local anesthetic effect of unknown mechanism.
-agents Like: (Ephedrine , Epinephrine , Phenylephrine )
-Care should be taken to patients with cardiovascular disease,
high blood pressure, hyperthyroidism, diabetes, and prostate
enlargement.
-high doses may cause: nervousness, tremors, sleeplessness,
nausea, and loss of appetite. Cardiac arrhythmias, irregular
heart rate, and elevation of blood pressure are potentially
serious effects, but less likely at recommended doses.
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29. 3-Protectants
-Provide a protective coating over skin or mucous membranes.
-They prevent irritation of anorectal tissue and prevent water loss from the stratum
corneum.
-Agents like :
aluminum hydroxide gel
cocoa butter
lanolin
hard fat
mineral oil
shark liver oil
cod liver oil
white petrolatum
glycerine( external use only)
zinc oxide
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30. 4-Astringents
-Protect underlying tissue through protein
coagulation.
provide temporary relief of itching, discomfort,
irritation, and burning.
Agents like : (calamine & zinc oxide )
5-Keratolytics
Cause desquamation of the surface cells of the
epidermis
provide temporary relief of discomfort and itching.
Agents like : (Resorcinol )
for external use only.
Resorcinol should not be used on an open wound
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31. 6-analgesics , anesthetics
& antipruitics ( inhibit itching )
-temporary relief of burning, discomfort and pain.
-The FDA classified them as counterirritants.
-agent like : (menthol , juniper tar ,Camphor )
- These agents should not be used to treat internal hemorrhoids
7-Wound healing agents :
-Live cell yeast derivative (LYCD: skin respiratory factor)
- FDA removed them from the list of safe and effective
ingredients
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32. 8-Hydrocortisone
-used to reduce itching, inflammation and discomfort.
- Adverse effects: it may mask bacterial and fungal infections
promoting their progress.
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33. How To Get Rid Of Hemorrhoids
| Self Healing Techniques Series
First find most painful points on areas
corresponding to the rectum
according to figure 1.
Now find a little stick with a not too
sharp edge Press these points with a
moderate effort and begin a slow
rotation of the stick in two
directions. Carry out this massage
for several minutes. See figure 2.
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34. Hemorrhoids bleeding treatment
Diosmin and Hesperidin is used ( Daflon tab ® )
For more information read this article
http://www.life-enhancement.com/magazine/article/472-
no-more-bleeding-hemorrhoids
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35. Products used in Egyptian market
1-Anusol ® (Zinc oxide , Bisthmus subgallate ,
balsam peru , bisthmus oxide )
balsam peru is demulcent
Bisthmus subgallate is astrigents
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36. Products used in Egyptian market
• Anuso-HC ® (Anusol ® + Hydrocortisone )
• Faktu ® (Policresulen and cinchocaine )
Policresulen as antiseptic
Cinchocaine as local anesthetic
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37. I hope that you got a total idea about
Hemorrhoids and will understand it as a
pharmacist
Forgive me if I missed anything !
Thanks for your kindly watching !!
Dedicated by : Ibrahim Gomaa’
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