By Dr Sajimon George BAMS, AAA, ATMS
Haemorrhoids or piles are dilated or swollen veins (low pressure blood vessels that return blood to the heart) under the rectum around the anal opening.
They occur frequently in the adult general population. Notably, a considerable number of people with hemorrhoids do not complain about symptoms. Many people have hemorrhoids at some point in their lives. Over 50% of the population, in fact, will experience this condition. The prevalence of hemorrhoids is equal between men and women but men are more likely to seek treatment.
Causes of Hemorrhoids or Piles
- Sitting for long periods of time can start the hemorrhoidic process
- Increased straining during bowel movements caused by constipation or diarrhea may lead to hemorrhoids
- Hypertension, particularly portal hypertension, can also cause hemorrhoids
- Obesity can be a factor by increasing rectal vein pressure. Poor muscle tone or poor posture can result in too much pressure on the rectal veins
- Pregnancy may lead to hypertension and increase strain during bowel movements, so hemorrhoids are often associated with pregnancy
- Cigarette smoking during bowel movements, may worsen hemorrhoids and may lead to severe internal bleeding of veins inside rectum area
Symptoms of Haemorrhoids or Piles
- Bleeding per rectum
- Pain in anal region
- Anal irritation
- Secondary anaemia
Main classification of Piles or Hemorrhoids
They can be classified into internal and external hemorrhoids. There is a dentate line in the anal canal, which separates two types of anal skin. While the skin above the dentate line is not sensitive to pain, the skin below this line is quite sensitive to pain.
Internal hemorrhoids occur above the dentate line and are, therefore, usually painless. They can cause bleeding or they may push out of (prolapsed) the anal opening when they become quite large.
External hemorrhoids occur below the dentate line and are generally painful. External hemorrhoids can become very distressing when the blood in the hemorrhoid clots and inflammation irritates the nearby pain-sensitive skin.
Ayurvedic View of Haemorrhoids Treatments Melbourne Clinic and Piles
Hemorrhoids are described in the name of Arsha. This is caused by low digestive fire, vitiation of all doshas, especially that of Apana vatha. “Apaana vatha” is one of the five types of Vatha and is located in the testicles, urinary bladder, phallus, umbilicus, thighs, groin, anus and colon. It control functions such as, voiding of urine, normal delivery and excretion of stool etc.
Its vitiation causes accumulation of waste products and varicosity of veins in the rectum etc.. Constant traveling in a sitting posture on a hard seat, chronic constipation and pregnancy are predisposing factors for this vitiation.
Classification in relation to Dosha involvement (Types according to Ayurveda)
- Vatha Arsha (Hemorrhoids having Vatha dominance) Piles are very hard, rough and blackish in colour. They are very painful usually accompanied by constipation
- Pitha Arsha (Hemorrhoids having Pitha dominance) Piles are very soft, reddish in colour, inflamed and bleeding. Thirst, diarrhoea, fever may also be present
- Kaphaja Arsha (Hemorrhoids having Kapha dominance) Piles are whitish, large , soft and slimy with low digestive fire
- Tridoshaja Arsha (Hemorrhoids having Tridosha dominance) Combination of above mentioned symptoms
- Raktha Arsha (Bleeding Piles)
- Sahaja Arsha (Hereditary Piles)
Line of treatment for Hemorrhoids and Piles
Treatment for hemorrhoids (Arsha) should be carried out in four ways with each having its specific indications.
1. Medical management (Bheshaja chikitsa)
This mode of treatment can cure first degree hemorrhoids. In other degrees of piles it may be used along with other procedures. This treatment is done after assessing dosha predominance.
2. Operative management (Sastra chikitsa) – Application of Kshara-sutra Therapy.
In this process hemorrhoids are tied off at its base (pedicle) by Kshara-sutra or specially processed thread with medicines. By the principle of pressure necrosis, it prevents blood supply to the respective pile mass immediately. Eventually hemorrhoids shrink, shrivel up, die and ultimately fall off within 10 days, leaving some scar tissue which supports the corresponding veins in that area, preventing them to distend or bulge further.
3. Application of Ayurvedic Kshara (Caustics made of Ayurvedic herbs)
It is a non-surgical procedure of Ayurveda indicated for the management of hemorrhoids. A medicine (alkaline in nature) derived from a combination of various herbs is applied to the pile mass with the help of a special slit proctoscope. It is a type of chemical cauterization. The Kshara karma method of treating piles has been described in detail in the Ayurvedic classical text Sushruta Samhitha. The details of preparation of the herbal combination are mentioned in Sushruta Samhitha. Application of kshara is considered superior over other procedures used for the treatment of hemorrhoids or piles.
4. Cauterisation or Agnikarma
Agnikarma in the form of thermal cautery is a suitable procedure in the excision of sentinel piles and anal warts falling in Vatha Kaphaja type of Arsha.
Do’s and Don’ts for Hemorrhoids or Piles
- Drink Plenty of fluids
- Do take adequate fibers in the diet
- Exercise regularly. Walking is the one of the best things
- Train yourself for regular food intake of lunch and dinner
- Lose weight, if you are overweight
- Chew your food properly which enable digestion
- Take buttermilk, onion, leafy vegetables and gree gram etc
- You should not eat any food which is hard to digest
- You should also cut back on spicy and oily foods
- Increase your intake of okra, spinach, carrots, radish and yam in your everyday menu
- Exercise regularly
- Drink plenty of water and other fluids—at least 10 glasses a day.
- Eat foods, which are good sources of fibre, such as whole grain or bran, cereals and breads, fresh vegetables and fruits, and, if necessary, add bran to your foods (about three to four tablespoonfuls per day)
- Keep the anal area clean
- Take warm baths
- The hot poultice of dry radish is very good in non-bleeding piles
- Have enough sleep
- Don’t sit too much on a hard surface because it can restrict blood flow around the anal area
- Don’t sit in the toilet for long periods. This position causes extra pressure on the anal area
- Don’t drink coffee or alcohol
- Hurry, worry and curry is absolutely not advisable for a piles patient
- Don’t lift heavy objects. Even if you lift anything heavy exhale and don’t hold your breath
- Don’t use laxatives regularly as it may become a habit and cause the bowels to lose its ability to function normally
- Don’t consume any medication directly; this can be harmful for your stomach as well as diseases
- To stop bleeding from piles, you can take black sesame seeds, powdered and mixed with fresh ghee or butter
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