HAEMORRHOIDS

• Haemorrhoids (Piles) are dilated plexus of superior haemorrhoidal veins, in relation to anal canal
• Patient frequently complaints of bleeding per rectum (bright red coloured) along with defecation, feeling of mass per anus, slimy mucous discharge and feeling of fullness of the bowels with a history of chronic constipation

Classification:

Depending on Location

• Internal - above the dentate line ,is within the canal and internal to anal orifice
• External – below the dentate line, is situated outside the anal orifice and is covered by the skin
• Interno-external haemorrhoids – above and below the dentate line, the two varieties coexist

Depending on etiology

• Primary
• Secondary

• Hereditary
• Anatomical – adaptation of erect posture by mankind - absence of valves in the superior haemorrhoidal veins, occlusion of the veins when it pass through the rectal musculature and congestion during defaecation
• Exciting causes -straining to expel constipated stool, over purgation, diarrhoea of colitis, dysentery, enteritis etc
• Physiological causes – hyperplasia of haemorrhoidal plexus (corpus cavernosum rectum)
• Diet –low roughage diet
• Secondary haemorrhoids – carcinoma of the rectum, pregnancy, chronic constipation, difficulty in micturition due to stricture urethra or enlarged prostate

Internal haemorrhoids:

• Bleeding per rectum – bright red, painless bleeding and occurs along with defaecation (Splash in the pan)
• Pain – when thrombosed or associated with fissure-in-ano
• Mucous discharge
• Pruritis ani
• Anaemia

Prolapse is the later symptom

• First degree – haemorrhoids does not come out of anus
• Second degree – haemorrhoids come out only during defaecation and is reduced spontaneously after defaecation
• Third degree – haemorrhoids come out only during defaecation and is not returned by themselves, but need to be replaced manually and then they stay reduced
• Fourth degree – permanently prolapse occurs. There will be feeling of heaviness in the rectum

Complications - Excessive bleeding, Thrombosis, Strangulation, Gangrene, Fibrosis, Suppuration

External haemorrhoids:

• Thrombosed pile mass appear suddenly and very painful
• Seen lateral to the anal margin as tense and tender swelling
• If untreated, it may resolve or may suppurate or may fibrose giving rise to a cutaneous tag or may burst giving rise to bleeding
• Pruritus

Internal haemorrhoids:

• O/E - internal haemorrhoids without prolapse will not show any abnormal feature. Haemorrhoids can be seen only when the patient strains in the second and third degree. During fourth degree the prolapsed piles can be seen in 3,7 and 11’o clock positions
• Digital examination – cannot feel an uncomplicated internal pile unless it is thrombosed
• Proctoscopy

Internal haemorrhoids:

• Conservative:
  • Bowel regulation- high residue diet, Mild laxatives, Avoid excessive defaecation straining
  • Topical ointments for local applications – for oedema and pruritus
  • Manual dilatation
• Para surgical treatment:
• Sclerosant injection
• Rubber band ligation
• Cryosurgery
• Lord’s procedure for maximal anal dilatation
• Surgical treatment:
• Haemorrhoidectomy – ligature and excision method, closed haemorrhoidectomy, submucous haemorrhoidectomy
• Endostapling technique

External haemorrhoids:

• If thrombosed pile mass – incision under local anaesthesia

Ayurvedic Treatment

Internal medicines

Bleeding piles

• Guduchyadi Kashaya
• Tiktaka Kashaya
• Dusparshakadi Kashaya
• Drakshadi Kashaya
• Abhayarishta
• Kankayana Gutika
• Hinguvachadi Choorna
• Pushyanuga choorna
• Trivrut lehya
• Kalyana Guda

Non bleeding piles

• Chiruvilwadi Kashaya
• Dusparshakadi kashaya
• Kankayana Vati
• Putikarnjasava
• Chavikasava
• Abhayarishta
• Takrapanam
• Hinguvachadi choorna
• Trivrut lehya
• Suranavalehya

Procedure

• Avagaha Sweda -Triphala Kashaya
• Pichu – Murivenna, in Inflammatory stage
• Pichu - Pippalyadi anuvasana taila, in non-inflammatory stage
• Matravasthi - Pippalyadi anuvasana taila
• Apamarga Kshara application
• Ksharasutra