HAEMORRHOIDS or HEMORRHOIDS, commonly called piles, swellings formed by the dilatation of veins of the low est part of the bowel, or of those just outside the margin of its aperture. The former, internal piles, are covered by mucous mem brane; the latter, external piles, are just beneath the skin. As the veins of the lining of the bowel become dilated they form definite bulgings within the bowel, and, at last increasing in size, escape through the anus when a motion is being passed. Growing still larger, they may come down spontaneously when the indi vidual is standing or walking, and they are apt to be a grave source of pain or annoyance. Eventually they may remain con stantly protruded—nevertheless, they are still internal piles be cause they arise from the interior of the bowel. Though a pile is sometimes solitary, there are usually several of them. They are apt to become inflamed, and the inflammation is associated with heat, pain, discharge and general uneasiness; ulceration and bleeding are also common symptoms, hence the term "bleeding piles." The external pile is covered by the thin, dark-coloured skin of the anal margin. Severe pressure upon the large abdominal veins may retard the upward flow of blood to the heart and so give rise to piles; this is apt to happen in the case of disease of the liver, malignant and other tumours within the pelvis or abdo men, and pregnancy. Probably the anatomical arrangement of veins at the lower end of the rectum and habitual constipation are predisposing causes of piles. It is often said the exciting cause may be vigorous straining at stool or exposure to damp, as from sitting on the wet ground, but there is little solid evidence for the statements. Piles are often only a symptom, and in their treatment this fact should be kept in view; if the cause is removed the piles may disappear. Moreover, if they indicate the existence of cancer of the rectum the whole aspect of the case is altered. The appearance of piles or of haemorrhage assumed to be from piles for the first time in a person of middle age or over is highly suggestive of the major disease. Sometimes when a pile has been protruded, as during defaecation, it is tightly grasped by spas modic contraction of the circular muscular fibres which guard the outlet of the bowel, and it then becomes swollen, engorged and extremely painful ; the strangulation may be so severe that the blood of the vessels coagulates and the pile mortifies. This, indeed, is nature's attempt at curing a pile, but it is distressing, and, as a rule, it is not entirely successful.
The palliative treatment of piles consists in obtaining a daily and easy action of the bowels, in rest, cold bathing, astringent in jections, lotions and ointments. The radical treatment consists in their removal by operation, but this should not be contemplated until palliative treatment has failed. If, for one reason or an other, no operation is to be undertaken, and the piles are trouble some, relief may be afforded by warm sponging and by sitz-baths, the pile being gently dried afterwards by a piece of soft linen, smeared with vaseline, and carefully returned into the bowel. Under surgical advice, cocaine or morphia may be brought in con tact with the tender parts, either in the form of lotion, suppository or ointment. If, as often happens, blood coagulates in the vein of an external pile, the small, hard, tender swelling may be treated with anodyne fomentations, or it may be rendered insensitive by the ether spray and opened by a small incision, the clot being turned out. Diathermic treatment is often useful. The usual operation consists in strangling the pile by ligatures.