PILES, or are small tumors situated either within or on the verge of 11w anus. They consist of folds of mucous and sub-mucous membrane in an inflamed, infiltrated, or permanently thickened condition, and usually contain enlarged veins. There are several varieties of these tumors. Somelhnes the pile is mainly composed of little knot of varicose veins in the sub-mucops tissue; in this case it is readily emptied, by pressure, of the fluid blood contained in it, which, however, returns when the pres sure is removed. Sometimes the blood in a dilated vein coagulates, forming a solid tumor surrounded by tissues, thickened in consequence of inflammation; or the tumor may consist of a kind of erectile tissue formed by an abnormal condition of the vessels of the mucous membrane; this variety is especially liable to bleed. • These tumors are divided into /deeding and blind piles, according as they are or are not accompanied with hemorrhage; and into internal and external piles, according as they are within or without the sphincter muscle of the anus.
The following are the general symptoms of this affection. The patient, after hai' ing experienced for a varying time a feeling of beat, fullness, and dull pain about the lower part of the bowel, becomes conscious of a sensation as if there were a foreign body in the anus; and, on examination after an evacuation, discovers a small tumor, usually about the size of a grape,• which either remains outside, or is retracted, accord ing as it originated without or within the sphincter. This; tumor gradually increases, and others form around it, until a mass at length results as large as a pigeon's egg, or larger. In its ordinary indolent state the tumor has little sensibility, and occasions com paratively little annoyance; but when it is inflamed (from strangulation of the sphincter muscle, or from any other cause), it is exquisitely tender to the touch, and is the seat of burning and stinging sensations, rendering the evacuation of the bowels (and sometimes of the bladder also) difficult and painful. In women an inflamed pile may cause pain in the back, irritation of the womb, with mucous discharge, and ninny other anomalous symptoms. In severe cases the patient can neither stand nor sit with comfort, and only finds relief in the horizontal position.
Piles may be caused by any circumstances which cause congestion in the lower bowel, such as luxurious and sedentary habits of life, pregnancy, and such diseases of the liver as tend to check the return of blood from the veins of the rectum. Moreover, anything that causes irritation of the rectum, such as acrid purgatives and especially aloes, dysentery, inflammation of the prostate gland, etc., may cause piles. But of all causes, constipation is probably the most frequent; it operates in producing them partly by the pressure of the accumulated and hardened aces upon the veifis carrying the blood away from the rectum, and partly by the straining and irritation such fxces occa sion during their evacuation.
In the treatment of piles, it is expedient to relieve the congested state of the lower bowel by one or two doses of sulphate of magnesia, and a cooling vegetable diet, after which the continued use of mild laxatives should be resorted to. A teaspoonful of an electuary, consisting of an ounce of confection of senna, half an ounce of cream of tartar, and half an ounce of sulphur, if taken in the middle of the day, usually acts gently about bedtime, which is far the best time for the bowels of patients of this kind to act, as the parts irritated by the passage of the evacuation become quieted during the night. In long-standing cases, in which there is general relaxation of the mucous mem brane, the confection of pepper in doses of a dram may be given thrice daily with advantage, or a scruple of common pitch may be taken at bedtime in the form of pills or in capsules Amongst the milder forms of local treatment must be mentioned (1) the injection of the rectum with cold water both before and after the motion; (2) washing the anus with yellow soap and water sifter each evacuation; (3) the application of gall ointment or of other astringents; and (4) the injection of astringent lotions, as, for instance, of sulphate of iron, in the proportion of a grain to an ounce of water. If these fail, recourse may he had to pressure by means of instruments specially devised for the purpose; to the application of strong nitric acid, which, in the case of internal piles, affords the most speedy and effective means of relief (the operation must, of course. be performed by a surgeon, and if the parts cannot be protruded, the acid must be applied through the speculum); to ligature; or, in the case of external piles, to excision. When the piles are inflamed, leeches to the anus (but not applied directly to the tumors) are sometimes required; but the inflammation generally subsides under the influence of rest in the horizontal position, fomentations, poultices, and low diet.
The treatment of the hemorrhage that frequently accompanies piles requires a few words. If the bleeding is moderate in quantity, and has continued for some time with out inducing weakness or any other bad symptom, it is not expedient to interfere with it. When, however, it obviously requires checking, the effect of cold water injected into the rectum, as already recommended, should be tried, and, in case of its failing, astringent injections should .be had recourse to. At the same time, the patient should remain in the horizontal position, and take the medicines usually prescribed for internal hemorrhage, amongst which may be especially mentioned oil of turpentine, in doses of 20 drops three or four times a day, or ergot of rye in divided doses to the extent of a dram daily. In rare cases it is necessary to tie a vessel, or to touch it with a red-hot wire (through the speculum), or to plug the anus.
See FUNGI.