Author: Dr. Ranjeet Singh, Dr M. Shadid MO (Ayurveda)
Revised & assisted by; Dr. Manoj kureel MS (surgeon Ay.)

Overview:

Hemorrhoids is a Greek word made from haina= blood, rhoos= following, that is a disease associated with flowing blood.Bleeding is often the chief complaint of a patient with piles. Piles are one of the most common problem of the anal region affect a much as half of the population. Suffering from piles is not only painful but embarrassing as well. Hemorrhoids also called piles are painful, swollen veins in the lower portion of the rectum or anus.
Haemorrhoids are enlarged, bulging blood vein in an about the anus and lower rectum. Piles are often associated with long history of indigestion and constipation resulting in hard stools. They can be dry or may bleed. Hemorrhoids are mainly found in three main sites –left lateral portion, right anterior portion and right posterior portion. In Ayurveda hemorrhoid is called as Arsha.

Classification of Piles?

External piles
External pipe are located below the dented line and are covered with anoderm.

Internal Piles-
These are located above the dentate line and covered by pain sensitive anorectal mucosa that is why they are usually painless.

Grading of internal Piles?

1st Grade – Painless bleeding.
No prolapse.
2nd Grade- Prolapse through the anus standing but go back in anal Canal spontaneously.
3rd grade- Prolapse through the anal canal.
Require manual reduction by the patient.
4th grade- Permanently prolapsed.
Can be manually reduced.

What are the causes of piles?

  • Straining during bowel movements
  • Chronic constipation
  • Sitting for long period of time
  • After delivery
  • During pregnancy
  • In some diseases like liver cirrhosis
  • Accumulation of waste product in the body and vericos vein in the rectum

Other contributing factors-

  • Suppression of natural urges
  • Excessive consumption of alcohol
  • Non vegetarian food
  • Uncooked or spicy food

What are the symptoms of piles?

  • Anal pain, sespecially while sitting
  • Pain during bowel movement
  • Bright red blood on toilet tissue, stool or in salad bowl
  • Anal itching, irritation on discomfort
  • One or more tender mass near the anus
  • If the piles are external pea sized swelling can be seen and felt at the anus
  • Bleeding will more after occur if the Pitta Dosha is aggravated
  • Excessive Eructation
  • Constipation, obstruction of flatus, loss of appetite
  • Anaemia, dysponea
  • Weakness

What are the possible signs of piles?

  • Skin tag
  • Prolapsed hemorrhoids
  • Proctoscopy demonstrates hemorrhoids and is investigation of choice
  • Anaemia, due to persistent profuse bleeding from hemorrhoids

What are the complications due to piles?

  • Gangrene
  • Thrombosis and pain
  • Ulceration
  • Strangulation
  • Fibrosis
  • Hemorrhage
  • Infection

Treatment modalities of Piles-

Modern Aspects-

In modern science the treatment of Piles or hemorrhoids is categorised into three categories such as medical treatment, parasurgical treatment, surgical treatments. Actually, no specific treatment is available in modern science, rather symptomatic treatment is adopted which contains wide range of antibiotics, ASAIDS, heastatics agents, antihistaminic drugs, steroidal treatment, local anaesthetic applications and local antiseptic lotions and ointments.

Ayurvedic treatment of piles-

1. Conservative

  • Use of laxative drug as a no longer constipation such as Triphala powder, Haritaki powder and Abhyarishtha
  • Deepan-pachan drug such as chitrakadi Vati, Lavan Bhaskar powder, agnitundi Vati
  • Arshoghna- such as sooran Pak, Arshakuthar Ras, shigru guggulu, pranda gutika.
  • Hot sitz bath for localised swelling
  • Use of Rakta stambhak such as bolbaddha Ras
  • Vran ropak (wound healer) such as jatyadi tail and jatyadi ghrit
  • Vedna Har drug (Analsegisics) such as Triphala guggulu

2. procedure-

  • Kshar Sutra ligation
    It is a procedure in which medicated thread are applied on to enternal and external piles mass within 5-7 days piles mass are falled.
  • Chedana Karma
    Number of surgical excision techniques may be used if conservative management and simple procedure fails
  • Agnikarma-
    A number of cauterization methods have been shown to be effective for hemorrhoids, but are usually only used when other methods fail this method can be done using electrocautery or cryosurgery.
  • Kshar Karma-
    It involves the applying of a sclerosing agent such as apamarga kshar, snuhi kshar and arka kshar into hemorrhoid This causes the vein walls to collapse and the hemorrhoids to shrivel up.

Why kshar karma?

  • Simple, safe and ensures treatment
  • It causes very less complications
  • Very less history of recurrence
  • Success rate is very high
  • Day care surgery

Simple home remedies for Piles?

  1. Apply sesame oil on external dry piles followed by a warm fomentation( warm moist compresses or sitting in warm water). The easiest method is to sit in a tub with the buttocks submerged in warm water.
  2. Make a appointments by mixing an equal amount of powdered long pepper and turmeric with milk apply this on the external piles.
  3. After meals drink a glass of butter milk mixed with two teaspoons of water melon juice. Do this everyday for 1 month.
  4. Mix a tablespoon each of lime juice, Ginger juice, and fresh mint juice. Ddd some Honey and drink.
  5. Mix half teaspoon of flax seed powder, 2-3 teaspoon of psyllium husk, and one fourth teaspoon of rock salt together.Take with luke warm water at bed time.
  6. Drink one-half cupful of aloe vera juice three times a day until hemorrhoids disappear.

What are the useful medicinal plants and formulations for piles (Hemorroids)?

  • AMROID tablet and ointment, AANARSHA capsule, ARSHKEY tablet ( ARSHKEY a’ 7 days kit’ is design for integrated management of hemorrhoids. For relief in symptoms associated with external and internal hemorrhoids.
  • Akrarishtha, Abhyarishtha, Arshakuthar Ras ( For non-bleeding piles)
  • Kutja ghan vati, suranadi vati, bal parpati ( for bleeding Piles)
  • Manjishta ( Rubia cordifolia)
  • Haridra (Curcuma longa)
  • Chitrak (Plumbago zeylanica)
  • Apamarga (Achyranthus aspera)
  • Kutja (Holarrhena antidysenterica)
  • Suran (Amorphophallus campanulatus)

Mild and moderate laxatives-

  • Capsule Laxamed
  • Capsule Herbolax
  • Capsule Anuloma DS

Strong laxatives-

  • Tablet Regulax forte
  • Tablet Myrolax forte

Do not start self-medication. Consult your doctor first before taking these drugs.

Recommended food and regimen in Piles?

Regimen-

  • Purgation
  • Blood letting
  • Alkalies
  • Angnikarma
  • Burning with caustics or fire

Food-

  • 60 days old rice
  • Barley
  • Horse gram

Vegetables

Patola, Dhatura, garlic, agnimantha, punrnava, dadima coconut, lotus root, forest kharjuna, leaves of neem, sugar candy, cold water and flowing water.

Does and don’t?

Do’s

  • Avoid hot, heavy, spicy and salty food.
  • Include high fiber food.
  • Maintaining regular bowel habits
  • Regular exercise such as walking, running, swimming.
  • Daily consumption of Green leafy vegetables, buttermilk, grapes, fig, guava, pomegranate and easily digestible dietary articles.
  • Keep the ano-rectal area clean.

Don’ts

  • Straining while passing stools.
  • Incompatible dietary articles, highly processed food.
  • Avoid chilly, spicy, non vegetarian diet.
  • Avoid constipation.
  • Sitting for long duration.
  • Suppression or natural urges.

References:

2018,hemorrhoids- a comprehensive review on its types and Management.
2. Concise textbook of surgery by; Arif Naseem, 2nd edition, pub- pulse Publications, chap- 38 ,the anus and anal Canal, pg- 565-570.
3. A guide to Ayurvedic clinical practice b;y Vaidya Vasant Patil, pub- chaukhamba Publication, Chap-0 6, diseases of digestive system page number 71- 76.
4. Ayurvedic home remedies by;, Dr Pratap Chauhan, pub- Jiva Ayurveda haemorrhoids, pg-82 -84.
5. Ayurvedline, Ayurvedic drug index, part- 1 chap- Gastro- intestine system pg no- 488, 489.
6. Good health through food and regimen by;DR. TL Devaraj, pub-chaukhamba orientalia, edition 2018 chapter- 25, pg no- 72 -73.
7. The science of self Healing by; Dr. Basant lad, pub- Motilal banarsidas publisher,-s 6th edition 2017, appendix – ,,B first aid treatment pg no- 159.

8. CCRAS, Ministry of AYUSH

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