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CHAPTER 23
Haemorrhoids

THE incidence of haemorrhoids in 2 NZEF during the war was not high and did not give rise to any marked man wastage. This was due probably to the age group involved.

The only difficulty that arose was due to the presence of mild protrusion and inflammation of the mucous membrane associated with dysentery, a condition which cleared up satisfactorily with simple treatment.

The frequency of dysentery and diarrhoea rendered surgical treatment often undesirable.

External piles, so called, were of no importance, except when needing evacuation of blood clot following thrombosis. Large internal piles, and piles associated with repeated bleeding, were referred to hospital for operation or injection.

A review of cases was made by the consultant surgeon in March 1943. Up to that time there had been the following treatments in the operating theatres of the General Hospitals:

piles—
Operations	393
Injections	259
	——
Total	652

other cases—
Fissure	112
Fistula	42
Anal abscess	60

There had been four cases invalided to New Zealand, the ages being 41, 42, 45, and 37.

Details of these cases were:

1.	Anal stricture following pile operation. Also very depressed, with history of pre-war nervous breakdown.
2.	Only one of three disabilities; had intermittent bleeding; had injections in New Zealand. Had hammer toes and very debilitated.
3.	Healed large ischio-rectal abscess. Two small piles present.
4.	Long history dysentery; ischio-rectal abscess; piles removed and two operations for fistula in ano. Some stricture anal canal and pruritis.

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Two cases were graded and sent to New Zealand on non-medical grounds. The ages of the patients were 27 and 40. Details were:

1.	Chronic ischio-rectal sinus persisting after three operations.
2.	Four operations in twelve months; also chronic headache and very constipated. One large pile still present.

Three years in Egypt had provided only six cases for return to New Zealand, and of these, four were over forty years of age.

During the Italian campaign even less trouble was experienced. Anal conditions, therefore, though often calling for treatment, did not cause any marked wastage of manpower, and remarkably few cases were evacuated from the force overseas—only five cases of haemorrhoids, eight of fistula in ano, and ten of other anal conditions.