Haemorrhoid is a more common disease now a days. It may seem as a simple disease, but complications may turn it into an medical emergency. The most important of the complications is the development of severe anaemia as in the case of worse bleeding piles. It is not associated with any pain in most cases.
Profuse haemorrhage is not rare. Most often, it occurs in the early stages of the
second degree. The bleeding occurs mainly externally, but it may continue internally after
the bleeding haemorrhoid has retracted or has been returned. In these circumstances, the
rectum is found to contain blood.
The other most important complications include,
One or more of the internal haemorrhoids prolapse and become gripped by the
external sphincter. Further congestion follows because the venous return is impeded.
Second-degree haemorrhoids are most often complicated in this way.
Strangulation is accompanied by considerable pain. Unless the internal
haemorrhoids can be reduced with in 1 or 2 hours strangulation is followed by
The affected haemorrhoid or haemorrhoids become dark purple or black and feel
solid. Considerable oedema of the anal margin accompanies thrombosis. Once the
thrombosis has occurred, the pain of strangulation largely passes off, but tenderness
persists. Superficial ulceration of the exposed mucous membrane often accompanies
strangulation with thrombosis.
Gangrene is due to the loss of blood supply to a particular area. Gangrene occurs when strangulation is sufficiently tight to constrict the arterial supply of the haemorrhoid.Very occasionally; massive gangrene extends to the mucous membrane with in the anal canal and rectum. it can undergo further putrifaction.
After thrombosis, internal haemorrhoids sometimes become converted into
fibrous tissue. The fibrosed haemorrhoids is at first sessile, but by repeated traction
during prolapse at defaecation, it becomes pedunculated and constitutes a fibrous polyp
that is readily distinguished by its white colour from an adenoma, which is bright red.
It is uncommon. It occurs as a result of infection of a thrombosed haemorrhoid.
Throbbing pain is followed by perianal swelling, and a perianal or sub mucous abscess are the
6. Pyle phlebitis (portal pyaemia)
Theoretically, infected haemorrhoids should be a potent cause of portal pyaemia
and liver abscess. but it is very rare in practice.