PROCTITIS AND PILES.
Piles (hemorrhoids) are not the result of either the normal or abnormal
growth of the tissues of the anal and rectal mucous membrane. They are
developed by the combination of pathological and physiological
conditions: (1) chronic inflammation or proctitis; (2) stricture of the
anal canal and lower portion of the rectum, which may be spasmodic, or
more or less permanent, which stricture pinches or constricts the
canal, thereby inhibiting the circulation of the blood; (3) the
pressure or straining effort during the act of defecation, occasioned
by the constricted canal, which effort brings on greater local
congestion and constriction of the tissues.
Pile formations are a symptom of chronic proctitis of fifteen, twenty
or more years duration. Proctitis (inflammation of the anus or rectum)
and periproctitis (inflammation of the connective tissue about the
rectum) are by no means uncommon inflammatory processes. The mucous
membrane like the skin is liable to injury or poisons and especially so
at the orifices of the body. Let inflammation set in: if it be not
cured at once, it will invade the canal, especially a canal like the
rectum; in which case it will establish itself throughout from six to
ten inches of its length, sometimes taking in the sigmoid flexure and
even the colon. Just how long chronic inflammation confines itself to
the mucous membrane before invading the areolar or lace-like connective
tissue and the muscular tissue of the organ, I am unable to state.
The first symptom or indication that all the tissues are involved in
the inflammatory process will most naturally be constipation. You have
observed that inflammation of a portion of the skin on the arm, trunk
or leg does not disturb the muscular movements of the region involved,
except when the muscles underneath the skin are affected also, as in
the case of deep burns where the movements are very much disturbed by
the irritability, soreness and contraction of the diseased muscles.
There is also an adhesive product excreted from the inflamed tissue
that binds the muscular fibres of an organ together, and you have
contraction of the organ and its usefulness impaired. Now, as this is
precisely the pathological or diseased condition which chronic cases of
proctitis and periproctitis present, you will readily understand how
spasmodic and partial stricture or contraction occurs in the sore
muscles (circular and longitudinal) of the anus and rectum. The length
and the bore of the canal are diminished, and thus the circulation of
the blood arrested by the pressure or gripping of the contracted
muscles. This congestion of the blood brings about an anatomical change
in the structure of the mucous membrane, which we call piles: a mere
symptom of inflammation.
Medical authors have defined inflammation as follows: "(1) A series of
changes constituting the local reaction to injury; (2) a series of
changes that constitute the local attempt at repair of actual or
referred injury of a part; (3) a series of local phenomena that are
developed in consequence of primary lesion of the tissues and that tend
to heal these lesions; (4) the method by which an organism attempts to
render inert the noxious elements introduced from without or arising
within it; (5) a disturbance of the mechanism of nutrition of an organ
or tissue, affecting the structures concerned in its function."
These effects or changes give rise to the five cardinal symptoms of
inflammation: pain, heat, redness, swelling and impaired function
(dolor, calor, rubor, tumor, functio læsa).
Proctitis may exist many years before the pain and heat become
noticeable or are complained of by the victim of this insidious
disease, the bodily symptoms of which are well expressed before the
local trouble demands attention and treatment. The sufferer from
proctitis is unable to detect the change from a normal color of the
mucous membrane (a light, muddy gray) to an extremely abnormal one (a
fiery redness). The swelling or puffiness of the mucous membrane
becomes more marked as repeated attacks of subacute and acute
inflammation occur, from year to year, over a period of twenty or more
years. During all this time impairment of the function and structure of
the anal and rectal canals is incessantly going on. The nervous and
muscular spasmodic contraction of the diseased anus and rectum, which
in time become more or less permanently constricted, steadily increases
the stagnation and engorgement of blood in the dilated arteries, veins,
arterioles, venous rootlets and capillaries. All of the circulatory
vessels, especially the smaller ones, become enlarged, varicose; and an
aggregation of varicosed vessels forms a tumor called a pile or
hemorrhoid. Inflammation interferes with nutrition of the anal and
rectal tissues, rendering them friable or weak and easily broken;
whence the bleeding and painful fissure or the anal ulcer, which so
often are the outcome of proctitis and an accompaniment of piles.
As already stated, piles are one of the symptoms of proctitis, and all
cases of piles involve more or less irritability and contraction of the
anal canal and the terminal portion of the rectum through which the
fecal matter is forced. All the muscular ability of the rectum,
assisted by straining effort of the abdominal muscles, is concentrated
upon the feces to force it through the constricted portion of the lower
bowel. The force exerted not only develops pile tumors, but carries out
with the feces those tumors that had reached considerable proportions;
thus the frail diseased mucous membrane is torn, and another symptom
added to a chronic disease. Observation for over twenty years has
convinced me that chronic proctitis usually exists fifteen, twenty or
more years before piles are developed (if developed at all), from daily
pressure on the inflamed, congested, dilated, varicose, friable
blood-vessels and surrounding tissue.
Piles are easily and quickly cured without any annoyance to the
sufferer. Chronic proctitis may be cured, but not quickly, as time is
required to undo damage to tissues so long invaded by inflammatory
process. Any one that allows a continuance of "a touch of the piles,"
as the expression is, and omits to take proper treatment as soon as
this "touch" is felt, simply invites or takes chances of some form of
cancer of the lower bowel later in life.
All other forms of disease of the lower bowel will yield to treatment
satisfactory to physician and patient, but I am sorry to say cancer
cases are numerous, and up to the present time we have no cure for this
dreadful disease. If you value health, if you desire to avoid future
suffering and disease, be sure that the lower bowel is free from
inflammation, for with such freedom you will escape the many symptoms
of proctitis described in my treatise on diseases of the anus and
rectum.