Rectal and anal pain-Hemorrhoids

Hemorrhoids known as pilles too,are part of the anal canal and they are pathological when become sawollen or inflamed.
In case of women who have a baby the hemorrhoids are more common,specially those whit a family history of hemorrhoids and varicose veins suffer most.In this case the hemorrhoids develop as part of the pelvic congestion of pregnancy and are probably encouraged by atony of the vesel walls.
The hemorrhoids are painful when they prolapse and become thrombosed as a result of their strangulation by the anal ring-this is particularly likely to occur in women cases during the second half of pregnancy or during and immediatly after labour.
Once the hemorrhoids are thrombosed they remain extruded and become swollen,tense oedematous and tender and after they may ulcerate.The thrombus begins to organize in a few days and swelling then subsides and the pain disappears.But the hemorrhoid remains as small and more fibrous structure.

Prevention:
It is impossible to avoid hemorrhoids but it is often possible to prevent their becoming strangulated and painful.This is done by:
-keeping the bowels regularly and the stool easy to pass without straining.
-gentle replacement of prolapsed hemorrhoids immediately after defecation.
-resting flat in bed for 15-30 minutes after defecation to give the anal sphincter time to recover tone.
-avoiding standing whit the pelvic floor muscles relaxed.

Treatment.
Treatment of strangulated hemorrhoids:
the best treatment for an attack of pilles is rest.Two or three days lying flat in bed will cure more quickly than any other procedure.Lying is essential,sitting up makes the situation worse.The prone position with the hemorrhoids at the hihest level of the body often brings quick relief.
Anaesthetic ointments and anal suppositories satisfy tha patient that something is being done but are of little intrinsic value.
Ice packs and cold compresses are more helpful.hot bath should be avaoided becouse although temporarily soothing,they increase the congestion.
Removal of the thrombus by incision under local anaesthesia is sometimes advised but the results are poor.

Treatment between attacks:
-injecting the internal hemorrhoids with slertosing fluids is indicated when their symptoms is bleeding but this is not reliable in preventing their prolapse.
-other methods of treating internal hemorrhoids without anaesthesia are the application of rubber bands or cryotherapy.
-although the hemorrhoidectomy is a common operation it should only be used when all other methods have failed.
Use a healthy diet based on full grain cereals and fresh fruits and vegetables and fluids!

Rectal and anal pain-Fissue in ano

A fissure in usually posteriorly as a tiny crack in the anal margin.It occurs in an acute form also as a chronic indolent ulcer,but tends to eal more easily in women than in men.Often it is associated whit haemorrhoids.
A fissure is generally caused by the passage of bulky hard stools and commonly develops during the days or weeks after delivery.

Symptoms:
The main complaint is pain during defecation,fallowed by a deep-seated throbbing ache for 2 or 3 hours afterwards.
The aching is caused by rectal spasm and is extremely trying to the sufferer.The fissure often sheds a few drops of blood during defecation but this stops immediately afterwards.

Signs:
The crack or ulcer is visible on careful inspection.The attempt at digital rectal examination causes severe pain and spasm of the sphincters.

Treatment:
Most fissures can be healed by conservative treatment.This consist of:
-keeping the bowels regular and the stool soft by habit,diet and liquid paraffin,and by avoiding straining at stool.
-supporting the anal ring manually during defecation to prevent the crack reopening.
-careful anal hygiene(washing with cotton wool swabs or preferably sitting n warm bath after defecation).
-applying a local anaesthetic ointment before defecation and when this is acting passing an anal dilator which is left in place for a few minutes.This overcome the spasm which is the cause of the pain and the basis for the fissure failing to heal.

If these measures fail more active treatment consists of the fallowing:
-injection of the base of the fissure and of the anal sphincter whit local anaesthetic solution followed by digital dilatation of the anal ring.
-dilatation of the anus under general anesthesia  is probably the most effective of all treatments.
-incision of the internal sphincter.
-excision of the fissure.