Diseases Presenting as Piles

: Digital Rectal Examination

Piles, medically called as hemorrhoid is a very common disease. It occurs more in female than male. It is probably the award to human race for adaption of erect posture, as quadrupeds do not suffer from this disease. Piles, as such occurs due to various local factors, mainly a cushion defect in the vascular bed of rectum and anal canal. But, there are some diseases which present as piles. Common amongst those are:

Cancer Rectum and Colon
Portal Hypertension

Cancer of rectum and colon: Many times the clinicians avoid digital rectal examination and presume that the bleeding from anus is from the simple piles. That is why, it is said that” If the clinician has not put his finger inside, he may put his foot in it”. This shows how much vexing it is, if not carried out. Many great surgeons have missed the diagnosis and operated as simple piles leaving the underlying disease intact. Rectal cancer may present as painless bleeding from anus. As the tumor grows there occurs some obstruction to the venous flow resulting in engorged anal veins, apart from it there may be direct bleeding from the tumor itself. Multiple polyposis is a predisposing cause among many others. Non-vegetarian diet, especially meat consumption is associated with colon cancer. Vegetarian diet, fiber in diet, aspirin, metformin and regular exercise may have some protective effect.
Portal Hypertension: This disease is rather a complication of cirrhosis of liver. Here, there is obstruction to free flow of blood from lower extremities through the liver; and alternative channels open up for the flow of blood to the heart. In that way an alternative channel opens up in the rectum and anal canal, in addition to other sites; the veins become engorged resulting in bleeding from the anus. Cirrhosis of liver may result from chronic hepatitis, commonly hepatitis B and C; amongst other causes alcoholic cirrhosis, biliary cirrhosis and aflatoxin poisoning are some of the common causes.