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(piles) pl. n. enlargement of the normal spongy blood-filled cushions in the wall of the anus (internal haemorrhoids), usually a consequence of prolonged constipation or, less often, diarrhoea. They most commonly occur at three main points equidistant around the circumference of the anus. Uncomplicated haemorrhoids are seldom painful; any pain is usually caused by an anal fissure. The main symptom is bleeding, and in first-degree haemorrhoids, which never appear at the anus, bleeding at the end of defaecation is the only symptom. Second-degree haemorrhoids protrude beyond the anus as an uncomfortable swelling but return spontaneously; third-degree haemorrhoids remain outside the anus and need to be returned by manual pressure.

First- and second-degree haemorrhoids may respond to bowel regulation using a high-fibre diet with faecal softening agents. If bleeding persists, elastic bands may be applied or a sclerosing agent may be injected around the swollen cushions to make them shrivel up. Third-degree haemorrhoids often require surgery (see haemorrhoidectomy), especially if they become strangulated (producing severe pain and further enlargement).

External haemorrhoids are either prolapsed internal haemorrhoids or – more often – perianal haematomas or the residual skin tags remaining after a perianal haematoma has healed.

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