Haemorrhoids (Piles) and its management:
Haemorrhoids, Piles, Pile mass, Arsha
Arsha- अरिवत प्राणान् श्रुणान् हिनस्ति इति
Haemorrhoids- which consist of two words: Haema= Blood, Rhoos=Flow
Piles- comes from Latin word ‘Pila’ which means a ball or a pillar.
Piles are defined as varicosity of anal veins.
It can be mainly divided into two categories:
- Idiopathic causes
- Secondary causes
It is very difficult to pin point the evident causes resulting into venous obstruction (varicosity) for the production of piles. However, a good number of factors can be considered/ enumerated which are of importance as contributing agents in the causation of haemorrhoids.
1) Hereditary: Some defect in the venous structure has been held responsible. e.g. congenital weakness of the walls of vein.
2) Constipation: Straining in constipated persons results in the engorgement of internal haemorrhoidal veins, giving rise to the disease piles.
3) Diarrhoea & Dysentery: when associated with much tenesmus, may have similar effects.
4) Faulty habits of defecation: are equally responsible in the formation of piles.
5) Dietary habits: elimination of cereal fibres from the diet results considerably in the high incidence of chronic constipation and ultimately haemorrhoids.
6) Anatomical factors: radicals of the superior rectal veins remain unsupported in the rectum. Theses veins are liable to constriction by the muscular tissue results constriction during defecation, hence may result into haemorrhoids. It is also important to note that these veins have no valves.
Factors encountered under this heading have a definite organic obstruction in the portal circulation interfering with the venous return from the superior haemorrhoidal veins.
1) Portal obstruction
3) Abdominal tumours
1) Classification in relation to the site of origin of haemorrhoids:
- Internal piles
- External piles
- Extro- internal piles
2) Classification in relation to pathological anatomy:
- Primary haemorrhoids: These are three in number seen at 3, 7 & 11 o’clock positions.
- Secondary haemorrhoids: Presence of additional haemorrhoids in between the primary piles is known as the secondary piles.
3) Classification in relation to degree of haemorrhoids:
- First degree haemorrhoids: In the earliest stage of the disease, the pile masses are not clearly visualised, rather at this stage the veins become congested during defecation, and the chief complaint of the patient is the ‘splash in the pan’ (bleeding).
- Second degree haemorrhoids: When the pile mass tend to form larger swellings, then it produces into the lumen as well as descend towards the anal orifice ultimately can be felt in the form of protruding mass during the act of defecation by the patient, but disappears spontaneously after the straining effort for defecation and passing out of stools.
- Third degree haemorrhoids: The protrusion of pile mass apart from the act of defecation and remain prolapsed until reduced by manipulations also exertion of any kind forces the piles to protrude again, which need another attempt for reposition.
- Fourth degree haemorrhoids: In long standing cases and elderly patients, the pile masses attain sufficiently a larger size along the involvement of the skin component due to which the proper replacement is not possible and thus remains permanently protruded.
4) Classification in relation to Dosha involvement (Types according to Ayurveda):
- Vāta Arsha(Haemorrhoids having Vāta dominance)
- Pitta Arsha(Haemorrhoids having Pitta dominance)
- Kafaj Arsha(Haemorrhoids having Kafa dominance)
- Tridoshaj Arsha(Haemorrhoids having Tridosha dominance)
- Rakta Arsha(Bleeding Piles)
- Sahaj Arsha (Hereditary Piles)
Symptoms of Haemorrhoids:
- Bleeding per rectum (Splash in the pan)
- Pain in anal region
- Prolepses of pile mass
- Anal irritation
- Secondary anaemia
Doctor has to be differentiated piles with the other possibilities occur in the same region and with the same symptoms by careful examination of the patient.
External piles has to be differentiated with anal epithelioma, condyloma lata, condyloma accumulate and with sentinel tag. In the same way, internal piles have to be differentiated with hypertrophied anal papilla, pedunculated polys and with prolapsed of rectum (either partial or complete prolapse).
Ayurvedic Treatment for Hemorrhoids (Piles):
Constipation should be treated by laxatives and suitable diet. Treat the patient for anaemia by haematinics in case of bleeding piles. Blood transfusion may be necessary in severe cases.
It should be ascertained, whether the piles are primary or secondary. Idiopathic or primary piles require treatment. Of course, the secondary piles should be treated, if there is excessive bleeding.
In first & early second degree piles, palliative treatment by laxatives, sits bath in luke warm water and local application of Ayurvedic medicated oil or astringent ointment made of Ayurvedic herbs is first tried. In case the bleeding persists or recurs, injection treatment is useful or even operative treatment may be required.
The operative procedures may includes injection treatment, elastic bandaging, cryosurgery, lord’s dilatation, haemorrhoidectomy, Ayurvedic Kshara (Caustics made of Ayurvedic herbs) application or trans-ligation by Ayurvedic kshara sutra (Kshara-sutra Therapy). Each of the methods is to be conducted with specific indications.
Specific Ayurvedic line of treatment:
Particularly, Ayurvedic classical texts advised that the line of treatment for piles (Arsha) should be carried out in four ways with each has its specific indications.
- औषधं-(Medical management)
- शस्त्रं-(Operative management)- Including of successful Ayurvedic Surgical Kshara-sutra Therapy
- क्षारं-(Application of Ayurvedic Kshara (Caustics made of Ayurvedic herbs))
Along with patient has to follow the ‘Ayurvedic life style’ (given on the home page of this site).
He has to be treated with Ayurvedic herbal drugs which are having ‘Vatanuloman’ & ‘Agnidipan’ effects as per given by the Ayurvedic classical texts such as,
- Haritaki Powder (Latin name:Terminalia Chebula) with Jaggery (2-3 times a day)- orally
- Haritaki Powder (Latin name:Terminalia Chebula) with Dry zinger power, in equal portions followed with luke warm water (2-3 times a day)- orally
- Abhayarishta -orally
- Takrarishta- orally
- Chitrakadi vati- orally
- Agatsya Haritaki avleha- orally
- Application of Jatyadi oil- Local application
- Ancare ointment- Local application
- Sits bath- in luke warm water for around 10 mins. twice a day
- Matra basti- Ayurvedic medicated enema made of Ayurvedic herbal oils.