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The symptoms of hemorrhoids The article of Ernest Miles published in Surgery Gynecology Obstetrics 29,496; 1919 described the symptoms of hemorrhoids and is a gold standard which acceped by all rectal surgions. In the primary stage the bleeding is most prominent sign. At the intermidiate stage bleeding is less frequent , while prolapse occuring with every act of defecation but the hemorrhoids are spontaneously reducibly. At thr final stage the bleeding is absent while prolapse is continuous ,unless manually reduced. Pain is usualy absent in the first stage but appear at the second and third stages. Some denied the pain as a symptom of hemorrhoids and relate pain to other rectal pathology such as fissure. The causes(etiology) of hemorrhoids Many different causes ascribed to etilogy of hemorrhoids:constipation, physical efforts , pregnancy, diarrhea, sedentary kind of life (thus unusual frequency of this problem found in clerks, car drivers, tailors and ascribed to sedentary kind of life), man`s upright posture,heredity, low fiber diet, obesity, excessive consumption of alcohol. So many causes for one illness! The only conclusion of average inteligant man may be that the medical world have no idea what is indeed the cause of this medical problem. So it was untill recently!! Now the etiology of hemorrhoids is clarified. The listed causes are only trigers!. While the only real cause of hemorrhoids is unnatural for the human being sitting defecation posture which associated with excessive straining damaging the hemorroidal plexus and causing bleeding and then prolapse.Indeed nations using the squtting toilets almost free from this problem.See the article of 12 family phisicians published on this site. The test/daignosis of hemorrhoids The diagnosis of hemorrhoids can be done by inspection of anal area, digital examination of anus and rectum, proctoscopic examination. the staging of hemorrhoids is not not simple even for experience proctolog and the same pathologic findings can be interpretated differently by different rectal surgeons.However genious criterion was supposed by Miles E. in his article: Observations upon piles in Surgery Gynec.Obstetr., 29,496:1919 Thus at primary stage the only symtom is bleeding, pile is small and covered with healhy mucosa and cannot be detected by digital exploration.The syptomatological equation: bleeding recurrent,often profuse. Prolapse-nil. The intermediate stage: Bleeding less frequent and less copious, while prolapse occurs with every defecation however spontaneously reducible.The pathological equivalent: the presence of hemorrhoids can readily be detected by the examining finger as a thickend longitudinal fold. The final stage: Bleeding- nil , prolapse continuous, unless manually reduced, marked tendency to recurrence during slight exertion.The pathological equation for this stage:it is readily discovered on digital examination as as thikened firm fold which consist from fibrous tissue.The mucosa on proctological observation is thick and tough, in color the hemorrhoid has assumed a puplish hue. Now additional stage, stage four is accepted by most rectal surgeon when hemorrhoid is constantly outside of anal canal and unreducible.
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