HEMORRHOIDS AND ITS AYURVEDIC TREATMENT

HEMORRHOIDS AND ITS AYURVEDIC TREATMENT

INTRODUCTION

The word arsas is derived from the root “Ru-gatau” after adding the suffinx  ‘Asuna’ which means to take life.It is an entity in which it trouble patient like a “mansa keela”, common people call them piles. Hemorrhoids often described as "varicose veins of the anus and rectum", hemorrhoids are enlarged, bulging blood vessels in and about the anus and lower rectum. Hemorrhoids are usually found in three main locations: left lateral, right anterior and right posterior portions. They lie beneath the epithelial lining of the anal canal and consist of direct arteriovenous communications, mainly between the terminal branches of the superior rectal and superior hemorrhoidal arteries, and, to a lesser extent, between branches originating from the inferior and middle hemorrhoidal arteries and the surrounding connective tissue

CAUSES

The exact causes of symptomatic hemorrhoids are unknown. A number of factors are believed to play important role including

1. Irregular bowel habits ( constipation or diarrhea)

2. Lack of exercise

3. Nutritional factor ( a low-fiber diet)

4. Increased intra-abdominal pressure (prolonged straining, an intra-abdominal mass, or pregnancy

5. Genetics, absence of valves within the hemorrhoidal veins,

 6. Aging.

 7. Other factors that are believed to increase the risk include 

·         Obesity 

·         Prolonged sitting 

·         Chronic cough 

·         Pelvic floor dysfunction.

CLASSIFICATION

A) On the basis of position-

1. Internal

2. External

3. Interno-external

 B) On the basis of symptoms-

 1. Grade I: No Prolapse. Just prominent blood vessels.

 2. Grade II: Prolapse upon bearing down but spontaneously reduces.

3. Grade III: Prolapse upon bearing down and require manual reduction.

4. Grade IV: Prolapse and cannot be manually reduced.

SIGN & SYMPTOMS:

The symptoms of pathological hemorrhoids depend on the type present. Internal hemorrhoids usually present with painless rectal bleeding while external hemorrhoids may produce few symptoms or if thrombosed significant pain and swelling in the area of the anus.

External

If not thrombosed external hemorrhoids may cause little problem. However when thrombosed they may be very painful with this pain typically resolves over 2 to 3 days. The swelling may take a few weeks to disappear, and after healing a skin tag may remain. If they are large and causing issues with hygiene, they may produce irritation of the surrounding skin and thus causes itching around the anus.

Internal

 Internal hemorrhoids usually present with painless, bright red, rectal bleeding during or following a bowel movement. The blood typically covers the stool, a condition known as hematochezia, is on the toilet paper, or drips into the toilet bowl. The stool itself is usually of a normal colour. Other symptoms may include mucous discharge, a perianal mass if they prolapse through the anus, itching, and fecal incontinence. Internal hemorrhoids are usually only painful if they become thrombosed or necrotic.

COMPLICATIONS 

·         Anemia

·         Thrombosed

·         Strangulated piles

MANAGEMENT

Conservative:

1. Prevention of constipation- Laxative- Triphala churna, Panchasakar churna, Haritaki churna, Abhayaarista.

2. Deepan pachan- Chitrakadi vati , Lavan baskar churna, Agnitundi vati.

3. Arshoghna-Sooranpak,Arshakuthar ras, Shigru guggulu.

4. Hot sitz bath- Nimba pathra kwath,Triphala kwath ,Panchawalkal kwath.

5.Rakta stambhak-Bol baddha rasa, Bol parpati,Kukutandatwak bhasma Praval pisthi.

6. Vran ropak-Jatyadi tail, Devadarvyadi velichenna,durvadi tailam

7. Vednahar-Madhuyastyadi tail, Triphala guggulu,Narayana Tailam

PROCEDURES:-

 1. KASHAR SUTRA LIGATION: It is a procedure in which medicated herbal coated thread are applied onto internal and external piles mass within 5-7 days withered piles mass falls off. Cure rate-97%

 2. CHEDAN KARMA: A number of surgical excision techniques may be used if conservative management and simple procedures fails.All are associated with some degree of complications including bleeding, infection, anal strictures and urinary retention, due to the close proximity to the rectum to the nerves that supply the bladder. There may also be a small risk of fecal incontinence, particularly of liquid, with rates reported between 0-28 percent.

 3. AGNI KARMA: A number of cauterization methods have been shown to be effective for hemorrhoids, but are usually only used when other methods fail. This procedure can be done using electrocautery, infrared radiation, laser surgery, or cryosurgery. Infrared cauterization may be an option for grade 1 or 2 disease. In those with grade 3 or 4 disease re-occurrence rates are high

 4. KSHARKARMA: Involves the applying of a sclerosing agent, such as apamarg kshar snuhi kshar, into the hemorrhoid. This causes the vein walls to collapse and the hemorrhoids to shrivel up. The success rate four years after treatment is ~70%

Benefits of kshar sutra therapy

·         Simple safe and sure treatment 

·         No complications 

·         No recurrence

·         Very economic 

·         Very high success rate 

·         Day care surgery

·         Useful in all age and cardiac patients

APATHYA

 Chilies, Fried Foods, Maida product, Non-Veg, Paneer, Constipating foods, Constant sitting, Excessive Pressure in defeacation.etc.

PATHYA

Cow milk, Butter, Buttermilk, Wheat, Ghee, Rice, Green vegetable, Regular sleep, Exercise, Regular diet, Non suppression of natural urges etc

CONCLUSION

According to Ayurveda, Arsha is a Maharoga (major disorder) described as Dirghanubandhi (chronic) and Dushchikitsya (difficult to treat) in nature along with Tridoshik (vat-pitta-kapha) and Marmashri (vital weak spots) (Guda and Bhaga) conditions. Out of which Guda is a Sadyapranahar marmas. Ayurveda has immense potential to solve many challenging and unresolved problems of the medical world. Kshara sutra ligation takes less time and, if the patient has any associated systemic disorder, then the procedure can still be performed with proper prophylactic measures. Kshara sutra ligation and ksara karma treatment is much more beneficial in comparison with hemorrhoidectomy at maximum point.