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.