rs in the abdomen, pregnancy, or an
enlarged or misplaced uterus, is not infrequently a cause of the
disease, by keeping the hemorrhoidal veins over-distended. Those
diseases which provoke much straining, as stricture, inflammation or
enlargement of the prostate gland, and stone in the bladder are also
active causative agents. The most common cause of all, however, is
constipation; and persons of indolent, sedentary and luxurious habits of
life are the ones most frequently affected with this derangement. The
following are also prolific causes of piles, viz.: pelvic tumors,
violent horseback exercise, indigestion, pregnancy, habitual use of
drastic cathartics, diarrhea, dysentery, sitting on heated cushions,
long-continued standing posture, diseases of the liver, worms, the
wearing of tight corsets, eating highly seasoned or indigestible food,
and the use of alcoholic stimulants. No age is exempt from piles, nor is
the disease peculiar to either sex. Aside from the serious inconvenience
and pain which are experienced with most forms of piles, there is a
tendency to fistula, and to cancer in the rectal region. It is
important, therefore, that the disease should not be allowed to run on
unchecked.

[Illustration: Fig. 2.
Piles: internal and protruding. ]

SYMPTOMS. The most common symptoms at first are slight uneasiness, such
as a little soreness or itching at the verge of the anus, and at times
lancinating pains. These sensations are more severe as a rule if the
bowels are constipated. If the piles are external they frequently become
inflamed, swollen and painful, and in some instances they suppurate,
which usually results in relief. When internal piles have increased to
any considerable extent, or have become inflamed, they produce not only
itching at the extremity of the bowel, pain in the back, etc., but also
a sensation of fullness in the rectum, as though some foreign body were
present, and, on action of the bowels, there is a sensation as though a
portion of the faeces had not been expelled. When the internal piles
become large, they frequently come down with faecal matter from the
bowel, as illustrated in Fig. 2, and this prolapsus becomes more and
more marked with the progress of the disease, until, in many cases, the
tumors are forced down at each action of the bowels, causing
excruciating pain until they are properly replaced. Usually, in the
early stages, they recede spontaneously; however, after a time it
b