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Diseases of Bladder

haemorrhoids, rectum, swellings, anus, blood, especially, hemorrhoids, frequent and constipation

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HIEMORRHOIDS.—Nodular swellings of the blood-vessels (veins) at the lowest point of the rectum, inside or outside the anus. The disease, which is of very frequent occurrence in both sexes, generally sets in after the thirtieth year of life, although it may occur earlier. The significance of haemorrhoids is usually greatly overrated among the laity. The obsolete and erroneous opinion that haemorrhoids affect internal organs is widely disseminated ; and the belief that these swellings were due to a disease has occasionally been the cause of serious consequences. It cannot be too strongly emphasised that haemorrhoids are absolutely nothing but a local affection of the rectum, caused by the sluggish flow of the blood from this part of the body because of its distance from the heart. The blood over fills the veins, and swellings take place as a consequence.

The swellings, which at first may be the size of a small shot or a cherry stone, may gradually attain the size of a plum, and are superabundantly filled with blood. Sometimes these swollen vessels surround the anus in the form of a ring, being arranged like a string of beads. In some cases only a single node is visible ; in other cases several swellings are closely associated. The haemorrhoids are of a bluish-red colour. In some cases they are located so deeply within the anus that they are not visible externally, and can merely be felt with a finger in the interior of the rectum. Such internal piles of haemorrhoids are sometimes present in addition to others which may be seen and felt externally. The distended blood-vessels do not always form nodular swellings, but frequently permeate the entire mucous membrane of the rectum as thick cords, their upper ends being visible only by aid of the rectoscope.

Haemorrhoids are very obstinate to treat. They develop very slowly and gradually, and may cause no disturbances until months or years have passed. It often happens that the first manifestation of the affection con sists in hemorrhage from a ruptured node. The bleeding may consist of a few drops only ; or as much as several teaspoonfuls, or even tablespoonfuls, may be passed. The hemorrhage generally recurs after days, weeks, of months. Some hemorrhoids bleed almost uninterruptedly for years, thereby often causing severe anemia and pallor of the entire body. Another danger of such frequent hemorrhages lie in the fact that they weaken the resistance of the body, especially of the heart. The haemorrhages generally occur during defzecation, owing to the strong downward and outward pressure of the rectum. Unfortunately, patients suffering with hemorrhoids are usually constipated, and are therefore compelled to strain very much at stools.

In addition to bleedings, haemorrhoids cause various other disturbances, such as frequent desires to evacuate the bowels, painful defxcation, itching, and the passage of mucus and pus in consequence of frequently occurring inflammations of the mucous membrane of the rectum. It happens at

times that luemorrhoidal swellings become caught by the ring-muscle (sphincter) of the anus, so that they can be replaced in the rectum only wth difficulty. Hiemorrhoidal nodes which are situated outside the anal opening are always exposed to the danger of bacterial infection. They become inflamed, swell, suppurate, and may even become gangrenous. In that case they arc a torture to the patient ; and they interfere with walking, standing, sitting and lying still more than external haemorrhoids are prone to do under ordinary conditions. The irritation caused by the discharges from the rectum occasionally give rise to considerable soreness of the skin surrounding the anus.

II[cmorrhoids sometimes result from general disturbances of circulation (principally from heart-defects and diseases of the liver) which cause con gestions of the blood-vessels, especially of the abdominal vessels. More frequently, however, they are due to purely local congestions, arising, for instance, in consequence of a sedentary occupation or of constipation. For this reason constant constipation is looked upon as one of the most frequent causes of hemorrhoids. The pernicious habit, met with especially in girls and women, of suppressing the stools on account of modesty, etc., often leads to severe constipation. The pressure of fecal masses upon the blood vessels causes distention and It is easier to prevent haemorrhoids than to heal them. The principal condition is strict cleanliness of the antis, especially after evacuations of the bowels. Regular movements must be carefully attended to. If there is a tendency to constipation it is necessary to stimulate evacuation by observ ing care with regard to the diet, by physical exercise, or by taking laxatives or enemas. Regular and loose evacuations of the bowels are of the greatest importance for patients suffering from hemorrhoids. The anus should be carefully cleansed after evacuations by washing it with a sponge and drying it with a soft piece of gauze (paper should not be used), whereupon it should he greased with lanolin or vaseline. Prolapsed nodes should be pushed back with the fingers, care being taken that the nails are not long enough to injure the parts. In cases of constricted haemorrhoids cooling compresses made of aluminium acetate or of weak lead-water may be applied ; warm sitz-baths of from 15 to 20 minutes' duration are also advisable. W'hen several nodes are present, particularly if they are large, their removal can be accomplished only by surgical interference.

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