STAGE, EXAMINATION AND DIAGNOSE OF PILES

THE STAGE OF PILES

The stage of pile consists of:
First stage: small protrude of internal mucous of piles or small mass of external piles like polyp, while or after defecation.
Second: protrude of piles larger mass of internal mucous but can reduced spontaneously after defecation; Slight or profuse bright red bleeding, usually at stool with protrusion following defecation, at first reduced spontaneously but later requiring manual replacement; soreness, sense of incomplete evacuation and lumbar discomfort.
Third: protruded or prolapsed of larger mass and can not spontaneously reduced but the piles can be pushed back to above ano-rectal line.
Fourth stage: larger mass protruded and can not be push manually into abdomen above ano-rectal line, it need emergency treatment to prevent strangulation and putrefaction.

EXAMINATION AND DIAGNOSE

Inspection, palpation and proctoscopy for non protruded piles reveal a globular expansible mass covered by mucous membrane. Protruded piles are visible as protuberant purple nodules covered by mucosa.

Fig. 4: Indirect inspection of the rectum and sigmoid.[a and b]. Suitable positions for proctoscopic and sigmoidoscopic examination.

[c] With the obturator in position the instrument, directed toward the umbilicus, is passed through the sphincter muscles. The obturator now is removed, the rectum inflated [d] and the insertion of the instrument continued under visual control. [e] Shows the usual lateral deviation of the sigmoidoscope when passed from the rectum into the sigmoid.

TREATMENT OPTION OF HEMORRHOIDS [continued]