Introduction
Piles is the common term for the ano rectal disease called haemorrhoids. It dates back to early history of humans when we started walking on erect posture. Piles in simple terms denotes the swollen veins in the anus and rectum. It can affect anyone but people with continuous sitting habit & chronic constipation are more prone to developing it. In most of the cases, it is a long-term disease with flare up periods and normal conditions in between. Piles causes pain, bleeding, itching and many other discomforts along with constipation or diarrhoea. Most of the people with piles also suffer from digestive disturbances and compromised immunity. There are many medications and treatments available for piles now. But regular follow up and a healthy lifestyle are compulsory to avoid recurrence and complications.
Signs & symptoms
Frequent constipation altering with loose stools
Dry or oily stools
Pain during and after defaecation and feeling of incomplete voiding of stools
Bleeding through anus; fresh blood just after passing faeces.
Itching around the anus
Lumps or masses in and around anus
Bloating heartburn and indigestion
Gas trouble and distension of abdomen
Causes
- Straining during bowel movements.
- Sitting for long periods of time on the toilet.
- Having chronic diarrhoea or constipation.
- Being obese.
- Being pregnant.
- Having anal intercourse.
- Eating a low-fibre diet.
- Regular heavy lifting.
- Sedentary lifestyle
- Continuous sitting job or bike riding
Pathophysiology
Constipation and prolonged straining are widely believed to cause haemorrhoids because hard stool and increased intra-abdominal pressure could cause obstruction of venous return, resulting in engorgement of the hemorrhoidal plexus. Defecation of hard faecal material increases shearing force on the anal cushions.
Diagnosis
External haemorrhoids can be seen during a physical examination.
Diagnosing internal haemorrhoids might include examination of anal canal and rectum.
- Digital examination of anus and rectum with fingers
- Visual inspection with proctoscope or other instruments
Treatments
In haemorrhoids with mild or negligible discomfort, creams, ointments, suppositories or pads are recommended. These products contain ingredients such as witch hazel, or hydrocortisone and lidocaine, which can temporarily relieve pain and itching.
External haemorrhoid thrombectomy
If a painful blood clot (thrombosis) has formed within an external haemorrhoid, the haemorrhoid should be removed surgically, which can provide prompt relief. This procedure is done under local anaesthesia.
Minimally invasive procedures
For persistent bleeding or painful haemorrhoids, other minimally invasive procedures are available that don’t usually require anaesthesia.
Rubber band ligation – one or two tiny rubber bands are placed around the base of an internal haemorrhoid to cut off its circulation. The haemorrhoid withers and falls off within a week.
Haemorrhoid banding can be uncomfortable and cause bleeding, which might begin two to four days after the procedure but is rarely severe. Occasionally, more-serious complications can occur.
Injection (sclerotherapy) – A chemical solution is injected into the haemorrhoid tissue to shrink it. While the injection causes little or no pain, it might be less effective than rubber band ligation.
Coagulation (infrared, laser or bipolar). Coagulation techniques use laser or infrared light or heat. They cause small, bleeding internal haemorrhoids to harden and shrivel. Coagulation has few side effects and usually causes little discomfort.
Surgical procedures
If other procedures haven’t been successful or in large hemorrhoids, any one of the following surgical procedures are recommended:
Haemorrhoid removal (haemorrhoidectomy)
Hemorrhoid stapling (stapled hemorrhoidopexy)
Prognosis
Piles tend to have a long-term course if not treated on time. But most of piles resolve spontaneously or with conservative medical therapy.
Complications
Thrombosis
Secondary infection
Abscess formation
Ulceration
Incontinence
Anaemia in bleeding piles
Disease & Ayurveda
Arsas
Nidana
Indigestion and faeces collected in the rectum without expulsion are the root cause of Arsas. Following factors along with these can lead to the samprapti:
- Excess sexual intercourse
- Continuous and shaking type of travelling
- Seat which is not levelled up & comfortable
- Squatting
- Friction with cloth, soil, stone/rock, vastiyantra etc.
- Touch with excessively cold water
- Continuous habit of straining
- Holding or forcefully expelling out natural urges like flatulence, urine, faeces etc.
- Diseases like jwara, gulma, atisaaram, grahani, paandu, sopham etc.
- Emaciation
- Uncomfortable postures and movements of body
- Pregnancy
Purvaaroopa
Indigestion
Weakness of legs
Cramps of calf muscles
Giddiness
Fatigue
Oedema around the eyes
Diarrhoea/constipation
Distension of abdomen
Irregular movement of Vaayu below naabhi, and expulsion of air with pain & difficulty
Abnormal sounds in the abdomen
Excess belching & lethargy
Excessive urine output
Less quantity of stools
Lack of concentration
Heartburn
Pain in head, back and chest
Laziness
Discolouration of skin
Weak sense organs
Anger
Grief in everything
Doubt of getting diagnosed as grahani, paandu, gulmam, udaram etc.
Samprapti
Due to the causative factors, the vitiated doshas cause the vitiation of dhaatus like twak, mamsa and medas in excess and develops arsas of many sizes and shapes in anus & rectum.
Lakshana
Due to apaanavayurodha which in turn affects all the Vaayus and other doshas in the whole body, lakshanas of arsas develop in all sites & systems of the body. Main signs and symptoms include:
Indigestion
Emaciation
Lack of enthusiasm
Cough
Thirst
Bad taste in mouth
Breathing problems
Running nose
Fatigue
Bodyache
Vomiting
Sneezing
Swelling
Fever
Loss of libido & sexual drive
Deafness
Blindness
Urinary calculi
Weakness of voice
Overthinking
Excess salivation & spitting
Lack of taste sensation
Pain in all joints, bones, chest, navel, anus and inguinal areas
Mucous secretion from anus
Discoloured, dry/loose stools with undigested food particles
Divisions
- Sahaja
- Jaataja
- Vaatika
- Paittika
- Kaphaja
- Samsargaja
- Sannipaataja
- Raktaja
- Aardram
- Sushkam
Prognosis
Kricchrasaadhya
Chikithsa
Treatment of Arsas needs utmost care and patience. Main therapy for arsas is explained as surgical removal or cautersiation with alkali/heat. Many medicines and procedures are recommended in arsas treatment.
Samana
Aamapachanam
Agnideepanam
Mriduvirechanam
Avagaham
Lepanam
Bandhanam(goshphanabandham)
Sodhana
Most of the sodhana panchakarma therapies are contraindicated for arsas patient due to agnimaandya (less digestive fire).
Therapy advised for young & strong patient is Chedana(cutting), Agnikarma/kshaarakarma and then treatment of wound should be done
Commonly used medicines
Chiruvilwadi kashayam
Abhayarishtam
Baahusaalagudam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
There is no permanent home cure for piles but the pain, swelling and inflammation of haemorrhoids can be relieved with home treatments.
- Eat high-fibre foods
- Use topical treatments such as a cream or suppository
- Soak regularly in a warm bath or sitz bath
- Take oral pain relievers if necessary
Diet
- To be avoided
Hot, spicy and pungent food items
Red meat, especially fried non veg items
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, fresh fruits and vegetables
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Buttermilk processed with curry leaves, turmeric, ginger etc.
Behaviour:
Protect yourself from extreme climate changes.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active
Avoid continuous sitting and squatting
Use stool softeners in case of constipation. Avoid straining
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342598
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
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