The following are the diseases which resemble luemorrhoids most: 1. Polypi. 2. Villous tumors. 3. Malignant growths. 4. Prolapsus. 5. Pruritus ani. 6. hemorrhages.
Polypi can be differentiated from tamorrhoids by their soft, smooth, elas tic feel, pyriform shape, and long, slender pcdiele.
Villous tumors by their broad base, slow growth, spongy feel, dark-red color, and frequent haemorrhages.
Malignant growths in the early stage present a number of hard nodules on the side of the rectal wall; at a later date they become larger and break down, after which the diagnosis is made without dif ficulty.
Prolapsus involves the entire circum ference of the bowel. The tumor is cone shaped, with a slit in the centre, and has a velvet-like appearance, while piles are distinct tumors.
Pruritus ani is frequently called itch ing piles. This is not warranted, 'since there is an absence of both tumors and hmnorrhage, while the itching is caused, in a large percentage of cases, from some irritating discharge from the rectum, thread-worms, neuroses, or eczema of the skin. Hemorrhages of all kinds from the rectum are usually attributed to piles, but may be due to ulceration, injury, fissure, and malignant growths.
Etiology.—Neither sex nor station in life is a bar against the production of heemorrhoids. The erect position man occupies is, from gravity alone, conducive to them. The rectum is abundantly sup plied with veins, which enter into the formation of the hTmorrhoidal plexus. A portion of this blood is returned through the internal iliac to the inferior cava, the remainder by way of the in ferior mesenteric to the liver; and these veins, like others of the portal system, have no valves. The branches of the superior htemorrhoidal veins in their journey upward pass through little slits in the muscular wall, and therein, Ver neuil claims, is to be found the principal cause of this disease. IIe believes that the dilatation is due to the obstruction of the calibre of the veins from the mus cle contracting on them as they pass through it. While this anatomical fact undoubtedly tends to dilatation under certain conditions, it does not seem to be sufficient of itself to account for the enlargement of the veins in all cases. It
is well known that the rectal and anal plexuses have no valves, and, further, that, when a patient afflicted with pro lapsed piles is requested to strain down, they at once become engorged with ve nous blood as a direct result of the press ure of the abdominal muscles. It is not at all unreasonable, then, to suppose that the pressure from the above muscles on the blood-column or the pressure from a pregnant uterus of some growth might be productive of haemorrhoids by inter fering with venous circulation. Some of the common causes of this disease are morbid growths of liver, spleen, uterus, ovaries, and prostate by causing venous obstruction.
Haemorrhoids and painful fissure are often associated with uterine disease, either inflammatory in nature or due to the pressure of tumors. Murray (Ar chives of Gynacc., June, '91).
Local causes are always responsible for the development of haemorrhoids. Among local causes those which prevent the return-circulation through the portal system and vena cava are most impor tant. Rectal and perirectal tumors, the pregnant uterus, tumors of the large in testine, disease of the adnexa, stones in the bladder, intestinal ulcerations, steno sis, catarrh, etc., may give rise to hannor rhoids. The most. important and benign causes are those which are due to the pressure of hard and stagnated ficees upon the rectal ampullre or sigmoid flex ure. When haemorrhoids develop with normal defecation, there is present a cer tain hypoplasia of the venous plexus, perhaps also an atrophy of the rectal mucous membrane itself. In eases with diarrhoea there exists, as a rule, a more deeply situated catarrh of the large in testine or rectum under whose influence an increased congestion of the hmmor rhoidal plexus might occur. J. Boas (Deutsche medizinal-Zeit., Oct. 30, '99).
Constipation, stone in the bladder, urethral obstruction, and purgatives are also conducive to piles from the intense straining which they induce. Congestion of the liver, obstructive diseases of the heart, improper diet, alcoholism, and irregular habits, as well as inherited pre disposition, may all be said to be etiolog ical factors.