Piles (haemorrhoids or hemorrhoids, depending on which side of the Atlantic you’re on) are dilated blood vessels in the last few centimetres (or centimeters, depending on which side of the Atlantic you’re on, again) of the rectum and the anus. If you examine everyone, you’ll find piles in 90%. They have a normal function to perform, i.e. they help in sensing and keeping control of passing wind and liquid motion. So “having piles” is actually normal.

In that case, why do we get worried about piles? Well, firstly, it can cause bleeding. Bleeding is rarely profuse but it occasionally may cause anaemia. Secondly, it can cause pain. Thirdly, it may mask the symptoms of colon and rectal cancer. It is important to remember that rectal bleeding does not always mean piles. Examination is essential for a patient with rectal bleeding. “If you don’t put your finger in (the rectum), you may put your foot in (your mouth)” as the saying goes.

Here’s a patient with piles. Piles don’t usually need surgery but this one did.

To elaborate a bit more on herniae (herniae=plural of hernia), here are some pictures.

Yesterday was Ward 2 sister’s “18th” birthday bash at the pantry. Wah, sooo happy to receive a bouquet of flowers from a “secret admirer”. Why are there proportionately more 18th birthdays than any other birthdays eh?

This I have to say… the nasi kunyit was really good. Haha.

Herniae are a common surgical problem. A hernia is a protrusion of a viscus through its investing structure. What a mouthful… that means: an organ or part of an organ has gone through an opening in the body layers covering it.

There are many possible sites of herniae but the most common type is the inguinal hernia. This is when abdominal contents have protruded out of the abdominal cavity though the abdominal wall at the groin region.

Inguinal herniae are much more common in men than women. They can appear at any age. Smokers are at higher risk of herniae. So are men who have asthma or smoking-related lung disease, difficulty in passing urine (e.g. due to prostate enlargement), long-term constipation and occupations which involve a lot of heavy lifting. This is because the straining causes increased pressure in the abdomen.

Complications of a hernia include obstruction if intestines get stuck in the hernia. If the blood supply to the intestines become tightened off, then it’s called “strangulation”. It can cause the intestines to perforate.

Once upon a time, herniae were the most common cause of small intestine obstruction. Nowadays, they are no longer the no. 1 cause as most herniae would have been repaired early.