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Haemorrhoids (often known as Piles) are enlarged
and engorged blood vessels (varicosities) in or around the anus. These may be associated
with pain, bleeding, itching and feeling as if a lump or bump is
hanging down.
Hemorrhoids
are abnormally swollen veins in the rectum and anus. They are much
like varicose veins we see on a person's legs. When bulging hemorrhoid
veins are irritated, they cause surrounding membranes to swell,
burn, itch, become very painful, and bleed. Hemorrhoids are caused
by too much pressure in the rectum, forcing blood to stretch and
bulge the walls of the veins, sometimes rupturing them.
Symptoms
of Hemorrhoids
The most common symptom of internal
hemorrhoids is painless bright red blood covering
the stool, on toilet paper, or in the toilet bowl. However, an internal
hemorrhoid may protrude through the anus outside the body, becoming
irritated and painful. This is known as a protruding hemorrhoid.
Symptoms of external hemorrhoids
may include painful swelling or a hard lump around the anus that
results when a blood clot forms. This condition is known as a thrombosed
external hemorrhoid.
In addition, excessive straining,
rubbing, or cleaning around the anus may cause irritation with bleeding
and/or itching, which may produce a vicious cycle of symptoms. Draining
mucus may also cause itching.
Many anorectal problems, including
fissures, fistulae, abscesses, or irritation and itching (pruritus
ani), have similar symptoms and are incorrectly referred to as hemorrhoids.
But all these can also result from or complicate hemorrhoids.
Hemorrhoids usually are not dangerous
or life threatening. In most cases, hemorrhoidal symptoms will go
away within a few days. Chronic cases can persist for years.
Causes
of Hemorrhoids:
It is a known fact that constipation
and prolonged straining at stool are main causes of piles but
there are some other important aspects too.
Low fibre diet causing
small caliber stool and straining during defecation.
Sitting
for prolonged period at closet.
Hypertension mainly in portal vein.
Anal sex without proper use of lubricants stresses anus.
Obesity.
Sedentary life style.
Constipation as well as chronic diarrhea.
Pregnancy causes hypertension and increases strain during bowel
movements.
Increased use of alcohol and caffeine.
Lack of erect posture.
Familial tendency.
Higher socio-economic status.
Colon malignancy.
Hepatic disease.
Spinal cord injury.
Loss of rectal muscle tone.
Rectal surgery.
Episiotomy.
Ageing – weakened support
structures.
Types
of hemorrhoids:
1) External hemorrhoids
-
occur outside of anal verge (distal end of anal canal)
sometimes painful.
Swelling and irritation present.
Itching present.
Prone to thrombosis, if the veins rupture a
blood clot is formed
-- these are called Thrombosed hemorrhoids.
2) Internal hemorrhoids -
occur inside the rectum.
Not painful.
May bleed when irritated.
Two severe forms if
not treated properly—
3) Prolapsed
hemorrhoids –
Internal hemorrhoids
that are much distended and pushed outside anus.
4) Strangulated
hemorrhoids –
If anal sphincter muscle
goes into spasm and traps a prolapsed hemorrhoid outside the anal
opening and supply of blood is cut.
Sigmoidoscopic
view of hemorrhoidal veins (Dilated and tortuous)
A sketch showing positions of internal and external hemorrhoids
Endoscopic view of internal hemorrhoids
Examination –
Visual examination of anus is the first step in examining piles.
Anus and surrounding area is examined for external or prolapsed
hemorrhoids. Then digital examination and probing
are conducted and the Doctor has to look for indications of tumor,
polyp, enlarged prostate or abscess.
To confirm visually anoscopy
is done which is done with an anoscope (a hollow tube like device)
For more detailed confirmation examinations like sigmoidoscopy
and colonoscopy can be performed. In sigmoidoscopy,
last 60 cm of colon and rectum are examined while in colonoscopy
entire bowel is looked in.
Lab studies -
A complete CBC may be useful
to rule out infection. Anemia due to hemorrhoidal bleeding is rare (0.5 cases
per 100,000 patients), and its presence should raise suspicion of
an alternate diagnosis.
Imaging
A proctogram may be useful in
cases of rectal prolapse.
Gradation of Hemorrhoids-
Grade I
- Hemorrhoids project into the anal canal and often bleed but do
not prolapse.
Grade II - Hemorrhoids may protrude
beyond the anal verge with straining or defecating but reduce spontaneously
when straining ceases.
Grade III - Hemorrhoids protrude
spontaneously or with straining and require manual reduction.
Grade IV - Hemorrhoids chronically
prolapsed and cannot be reduced. They usually contain both internal
and external components and may present malignancy.
Prevention of Hemorrhoids/Piles–
Drinking more fluids in routine.
Eating more
dietary fibers.
Practicing
better posture.
Reducing bowel movement strain
and time.
Avoid wearing tight under
clothes.
Washing the anus with cool
water and soap may reduce swelling and increase blood supply for
quick healing.
Exercises.
Using squat toilets may help.
Self-Care at Home
Hot
sitz bath.
Stool
softeners – but overuse of laxatives should be avoided.
Cold
compresses or topical analgesics may be a bit helpful for temporary
relief.
Improving
posture and muscle tone.
Taking
herbs and dietary supplements to strengthen vein walls.
Topical
application of astringents and soothing agents (like honey and
aloe Vera)
Drinking
chamomile tea several times a day.
Eating
fiber rich bulking agents like plantain to help create soft stool
and to lessen irritation of existing hemorrhoids.
Butcher’s
broom - extract or Ruscus aculeatus contains
ruscogenins that have anti inflammatory and vaso-constrictor effects.
It helps to tighten and strengthen veins. It has also been used
traditionally to treat venous problems.
Horse
chestnut – extract or Aesculus hippocastanum
contains a saponin known as aescin that has anti inflammatory,
anti edema and venotonic actions. It improves tone in vein walls.
Medical Treatment for Hemorrhoids
–
It
is often used in cases of chronic and severe cases of hemorrhoids.
Rubber
band ligation – Elastic bands are applied to the internal
hemorrhoid to cut off its blood supply and as a result in some days
it withers on its own and is sloughed off thereby inducing normal
blood supply.
Rubber
band ligation of hemorrhoids
Sclerotherapy
– (injection therapy)
In
this a hardening agent or a sclerosant is injected into the hemorrhoids
and thus the vein walls are collapsed and shriveling of hemorrhoid
occurs.
Cryosurgery
–
A frozen
tip of a cryoprobe is used to destroy hemorrhoidal tissues.
LASER,
Infrared or Bicap coagulation –
These are used to
cauterize affected tissues. Lasers are now less popular. One or
two seconds beam of infra red beams generally cuts off the circulation
in case of small, bleeding and internal hemorrhoids.
Galvanic
electrotherapy –
It
causes desiccation of the hemorrhoids by using electric current.
Hemorrhoidectomy
– (surgical treatment)
A true surgical procedure
to excise and remove hemorrhoids. Have possible relations with incontinence
issues in later life so now used only in Grade IV cases. This surgery
is performed either under local anesthetic combined with sedation,
spinal anesthetic or a general anesthetic.
Stapled
hemorrhidectomy –
A useful
procedure for prolapsed hemorrhoids. The tissues proximal to dentate
line is resected as it disrupts the flow of blood to the hemorrhoids.
It is less painful then removal of complete removal of hemorrhoids
and the recovery is also faster.
Enema -
This is done to clean the rectum only. Water
is injected into the rectum and thus easy flushing is done.
Doppler
guided artery ligation –
This is an advanced
surgery for all grades of hemorrhoids. It does not involve any ligation
or cutting of tissues but only the arterial supply to the hemorrhoids
is cut down. In cases of bleeding hemorrhoids it is very useful
as the bleeding stops immediately.
Medicinal
treatment –
In
case of mild problems, creams, ointments and pads containing witch
hazel or topical anti-inflammatory agent containing Hydrocortisone
is used. Warm baths are helpful too.
Homeopathic Treatment for Hemorrhoids
Homeopathy treats the person as a whole. It means that homeopathic
treatment focuses on the patient as a person, as well as his pathological
condition. The homeopathic medicines are selected after a full individualizing
examination and case-analysis, which includes the medical history
of the patient, physical and mental constitution etc. A miasmatic
tendency (predisposition/suceptability) is also often taken into
account for the treatment of chronic conditions. The medicines given
below indicate the therapeutic affinity but this is not a complete
and definite guide to the treatment of this condition. None
of these medicines should be taken without professional advice.
HOMEOPATHIC THERAPEUTICS
Reportorial rubric:
[Kent] Rectum, Hemorrhoids
[Murphy] Rectum, Hemorrhoids
[Murphy] Diseases,
Hemorrhoids
[Boericke] Abdomen, Hemorrhoids (piles)
Homeopathic Remedies
AESC, ALOE, ARS, COLL, HAMM, MUR AC, NIT AC, NUX V,
PAEN, RATH, SUL, Am
carb, bar c, fic, kali carb, podo, phos, carbo veg, mill, thuja.
Materia Medica
Aesculus
hippocastanum – Painful, blind or protruding piles of purplish color which is very sore with aching, burning and itching and a sensation of
sticks or splinters in the rectum,
rarely bleeding. Hard dry stool passed with difficulty and followed
by a feeling of prolapse of rectum. Bleeding gives relief. This
remedy is especially suitable to the form of haemorrhoids arising
from portal congestion, abdominal plethora. They may or may not
bleed, but there is a feeling in the rectum as of splinters or sticks.
This remedy actually produced many liver symptoms and haemorrhoids
in the provers. Other indicating symptoms are aching in the lumbar
region, protruding purple piles with severe pains in the sacrum
and small of the back and fullness in the region of the liver. Dryness,
burning and itching are good indications. Hughes prefers Nux vomica
and Sulphur in haemorrhoids dependent on congestion of the portal
system. Pulsatilla is one of the best remedies in haemorrhoids after
Aesculus. Passive congestion and dyspeptic troubles are the keynotes;
blind haemorrhoids. Haemorrhoids that bleed easily. It acts best
in the higher potencies (Dewey). Haemorrhoids from chronic constipation
may be cured with Aesculus.
Aloe socotrina – When he blood passes like water from hydrant, piles protrude like bunch of grapes. Better
by cold water, flatus with faeces. Violent itching and
burning in anus. Constantly putting finger in anus. Constant bearing
down in anus; bleeding, soreness which gets relieved by cold water.
Sense of insecurity in rectum when passing flatus. Lumpy, watery,
jelly like stool. Hemorrhoids protruding, very sore and tender. This is also a most useful haemorrhoidal
remedy. It is indicated where the piles protrude like a bunch of
grapes, bleeding often and profusely, and are greatly relieved by
the application of cold water. There is a very marked burning in
the anus the bowels feel as if scraped. There is a tendency to diarrhoea,
with the well-known uncertain feeling in the lower bowel. This tendency
to diarrhoea will distinguish from Collinsonia, which has the tendency
to constipation. Ratanhia has burning in the anus, and protrusion
of varices after a hard stool. The characteristics of this remedy
are burning and fissure of the anus, great painfulness and sensitiveness
of rectum (Capsicum).
Arsenic album – Burning pain and restlessness relieved by hot application. Hemorrhoids burn like fire and skin around the anus gets excoriated. Painful spasmodic protrusion of rectum
with severe tenesmus.Great exhaustion from least exertion with burning
pains. Night aggravation of complains with restlessness and fear
and fright.
Collinsonia – Hemorrhoids with backache and obstinate constipation. Prolapse of rectum. Piles bleeding or blind and protruding. There may be obstinate
constipation and diarrhea. But says that no remedy can equal Collinsonia in obstinate cases of hemorrhoids,
which bleed almost incessantly, he recommends the tincture. It is
of special use in females with inertia of the rectum and a congestive tendency to the pelvic organs. It suits pregnant
women who suffer from piles, and pruritus may be a marked symptom.
The indicating symptoms are chiefly a sensation of sticks
in the rectum, with constipation from inertia of the
lower bowel. It is especially applicable to heart pains resulting
from a suppression of a habitual hemorrhoid flow. It is somewhat
similar to Nux, but is a far more useful remedy.
Hammamelis – Painless bleeding followed by prostration which is out of all proportion to the blood lost. The blood is of dark color. There is anemia, breathlessness
and weakness notwithstanding good appetite. Venous congestion and
venous stasis are characteristics. Bruised soreness of affected parts. Passive hemorrhage from any part as piles.
Muriatic acid – Piles like bunch
of grapes which look purple and burn when touched. Piles in children; protruding; reddish blue. Tendency to involuntary
evacuation while urinating .Hemorrhoids most sensitive to all touches, even sheet of toilet paper is painful. Anal itching and prolapsus ani while urinating. Hemorrhoids during
pregnancy, bluish, hot, with violent stitches.
Nitric acid – Hemorrhoids that
have ceased to bleed, but very painful and hanging down loosely
with sharp pricking pains in rectum. Great straining while passing
stool and hemorrhoids that bleed easily. Haemorrhages from bowels
and violent cutting pains after stools lasting for an hour after
stool. Severe burning and stinging. Rectum feels torn and severe
fissures in rectum. Severe exhaustion and irritability after stools.
Nux-vomica – One of the main remedy for bleeding or non- bleeding piles
to be given when there is burning pain and constipation with ineffectual
desire. If the hemorrhoids be large
and blind, with a burning, stinging and constricted feeling
in the rectum and a bruised pain in the small of the back, and especially
if excited by sedentary habits or abuse of stimulants, then Nux
may be prescribed with confidence. Itching hemorrhoids keeping the
sufferer awake at night, relieved by cold water, or bleeding piles
with constant urging to stool, and a feeling as if the bowel would
not empty itself are further indications. Great sensitiveness of
the anus cannot make use of the softest toilet paper; the piles
are so sore and sensitive that the slightest touch is unbreakable.
Paenoia – Hemorrhoids with ulceration,
the anus and surrounding parts are purple and covered
with crusts, ulcers within the anus are very painful.
The whole mucus membrane studded with ulcers and cracks. Biting,
itching in anus that provokes scratching. Anal orifice swollen and
burning in anus after stool then internal chilliness. Fistula ani
with painful ulcers. Purple hemorrhoids covered
with crusts and severe atrocious pains with and after each
stool.
Ratanhia - The rectal symptoms are most
important. Aching in rectum as if full of broken glass.Anus burns for
hours after stool and feels constricted. Dry heat at anus with sudden
knife like stitches. Stools must be forced with great effort and
thus hemorrhoids too protrude out. Fissures of anus with great constriction
and burning like fire. Hemorrhoids too burn and get relieved by
cold water.
Sulphur –This remedy corresponds to ailments
producing hemorrhoids and to the troubles resulting from piles which
have stopped bleeding, and as a result fullness in the head and
uneasiness in the liver; constipation is present; a desire for stool
and itching of the anus.Itching and burning of anus and piles dependent
upon abdominal plethora. Frequent unsuccessful desire to go to closet.
Stool hard, knotty and insufficient. Redness around anus with hemorrhoids oozing and belching.
Ammonium carb – Protrusion of piles after stools with
long lasting pains cannot walk. Piles also protrude
independent of stool. Burning and itching in anus which
prevents sleep. Piles worse at the
times of menses.
Kali carbonicum – Piles painful, burning
like fire and bleed copiously. Great distension and swelling inside.
Fistula of the anus. Burning temporarily relieved by sitting in
cold water or by cold application.
Carbo veg. - Protruding piles, blue, even
suppurating, offensive, swelling, burning in the rectum, oozing
of fluid from rectum, flatulence; Itching, gnawing and burning in
rectum.Soreness, moisture around anus at night. Discharge of blood
with stool. White hemorrhoids with excoriation of anus.Bluish burning
piles and paining after stool.
Millifolium
– Hemorrhage from bowels. Bleeding hemorrhoids and stool
as well as urine is bloody. Blood is bright red in color.
Ficus
religiosa – Hemorrhage and hemorrhoids. Bloody hemorrhoids
with bright red blood and pain, soreness, burning, itching and aching
in rectum.
Phosphorus – Known for bleeding
hemorrhoids and great weakness after stool. White, hard stool with
discharge of blood from rectum each time with and after stool. Painless
copious debilitating stools with very fetid stool as well as flatus.
Green mucus with long, narrow, hard stool like a dog's. Seems as
if anus is open at all times. Blood from hemorrhoids is bright red
in color and great debility co-exists.
Thuja – Piles swollen and painful while sitting with burning pains in anus. Anus
is fissured and painful to touch with many painful warts. Constipation
with violent rectal pains causing stool to recede. Distended, indurations
in abdomen and chronic diarrhea.
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