Ayurvedic Treatment For Hemorrhoids or Piles

Hemorrhoids are enlarged and engorged blood vessels in and around the rectum (anus) to provide extra padding to protect the anal opening. In an abnormal state, they cause decongestion of the anal cushions resulting in decreased anal tone & accompanied by pain, bleeding and itching during evacuation mainly due to lifestyle, age, occupation and dietary factors. The traditional science of Ayurveda, explains hemorrhoids as Guda-arsha. This disease makes the human body a dumping ground of unnecessary, and unlimited toxic and waste substances mainly because of irregular diet, improper digestion, chronic constipation, abnormal body posture, complicated delivery, repeated abortion, psychological imbalances, obesity & stress and can occur in any person whether it is men, women and children of any age group.

The management aspects of treating piles with ayurvedic medicines have shown great results because the herbal remedies have proven the effect on the various causes of the diseases with an individual approach. The ayurvedic medicines act directly on the inflamed blood vessels helping reduce both the pain and bleeding from the rectum in both the internal and external piles.

Ayurvedic texts suggest a fourfold treatment for hemorrhoids based on the stages & severity of symptoms:

1. Conservative medicinal approach
2. Using Caustics or Kshara made of Ayurvedic herbs
3. Agnikarma or Electro-cauterization or Cryosurgery
4. Surgical approach

At initial stage with fewer signs & symptoms, piles will be treated with medicinal management together with a conservative approach with a strict diet and lifestyle changes, Ksharakarma or herbal caustic paste cauterization and if not cured with all above treatment, it may require kshara-sutra ligation or Agni karma approach, depending on the severity and prognosis of the piles.

A: Conservative Medicinal Approach

The conventional preventional approach is the best treatment for hemorrhoids. This approach evaluates the hemorrhoidal aspects in purely biophysical terms as in treating the symptoms exhibited with ayurvedic herbs & formulations along with dietary supplements that aid in improving them. The symptom wise conservational ayurvedic herbs & formulations for hemorrhoids are as follows;

1. Stool softeners: They draw water into the stool content, making it softer and more comfortable to pass relieving constipation like isabgol husk, Triphala churna, Panchsakar churna. 
2. Laxatives: These help in easing bowel movements such as Triphala powder, Haritaki powder, Abhyarista.
3. Deepan-pachan: These drugs improve digestive power & facilitate peristaltic movements like Chitrakadi Vati, Lavan Bhaskar churna, Agnitundi vati.
4. Arshoghan: These are specific formulations to cure piles effectively such as Sooran pak, Arshakuthar rasa, Shigru Guggulu, Pranda gutika.
5. Vedna-hara drugs: These have pain-relieving properties by pacifying vata dosha by acting on the colon like Triphala Guggulu, Madhuyastyadi tail.
6. Vrana-ropak drugs: These have wound healing action on the piles like Jatyadi oil, jatyadi ghrita, kasisadi oil
7. Hot Sitz bath: This is done by warm water bath in a tub of just enough warm water mixed with alum powder or any other anti-inflammatory & analgesic formulation like Tankan bhasma, Triphala kwath, Panchawalkal kwath, cover the hips & anal area to reduce localized swelling.
8. Rakta-stambhak drugs: These are hemostatic medicines helping to reduce the flow of blood in case of bleeding by causing contractions in the involved blood vessels & tissues like Naagkesar, Rasanjan, Bolbaddha rasa, Bol parpati, Kukkutandatvak bhasma Praval pishti. 
9. To reduce burning and itching sensation, lepan or local application of Shata Dhauta ghrita is done.

B: Kshara Or Herbal Alkaline Caustic Application

Piles have an excellent para-surgical procedure in Ayurveda called Kshar sutra chikitsa, a non-invasive, short duration(~30–45 mins) treatment, done under local anesthesia. The treatment procedure entirely depends on the individual body constitution and the nature of the disease.

1: Kshara Karma

Kshar Karma involves the application of a herbal alkaline paste, such as Apamarg Kshar, Snuhi Kshar, into the affected area resulting in the collapse of the vein walls & shrinking of hemorrhoid pedicles as it causes protein coagulation and necrosis of the tissues which sheds the pile mass. 

1. Preparation of Kshara or caustic alkali for soft, deep-seated & projecting pile mass: Kshara is mild & is made by mixing Snuhi latex & Haridra powder, with a little kshara powder of apamarga to apply on the pile pedicles.
2. Method of application of kshara:
   1. The Kshar paste is applied to the dilated pile pedicles with the help of a probe & proctoscope. 
   2. After  Kshara Application the pile pedicle is washed with Dhanyamla which neutralizes the chemical reaction and is followed by the local application of Yashtimadhu Ghrita. 
   3. Kshara application leads to arrest of the bleeding and regression of the pile mass
   4. This method is safe, simple, cheap and ensures a high success rate with fewer complications.

2: Kshara Sutra Ligation

Ayurvedic Kshar-sutra is a medicated thread used as a non-surgical treatment for hemorrhoids with a high success rate and negligible reoccurrence. 

Preparation of kshara-sutra

The Standard Kshara Sutra is prepared by overall 21 coatings described as follows;

1. 11 coatings of Snuhi ksheer or latex
2. 7 coatings with a combination of Snuhi latex and Apamarga Kshara
3. 3 coatings with a combination of Snuhi latex and Haridra Churna.

The procedure of kshar-sutra ligation

1. This method opts if the pile masses are soft to the touch, reddish in colour and slightly protruding outwards.
2. The application of Kshar-sutra is done under local anesthesia.
3. The external pile mass is ligated with the medicated thread which eventually cuts off the blood supply and shrinks the pile mass.
4. It takes about 7-10 days to shed off the ligated clump with the stools.
5. Daily dressing and guda-pooran with jatyadi oil are done.
6. Sitz baths and NSAIDs are advised for postoperative pain.
7. Usually, no hospitalization is required and patients can go home after the treatment.

C:  Agnikarma Therapy Or Electro-Cauterization 

Agni karma or thermal heat burn is a much more natural method of treatment for bleeding piles without failure, with minimal chances of recurrence. In this technique, the unwanted sprouted lumps or dry pile mass are destroyed using maintained red hot thermo-cautery that leads to slow solidifying of the pile mass & removing it from the root.

1. If the pile masses are rough, stable, and profuse then they are subjected to treatment with Agni karma therapy to avoid any chances of recurrence.
2. Cauterization techniques are very effective for hemorrhoids but often used when other methods fail or have fewer chances of success rate.
3. Agnikarma is marked to be a fast procedure done after shredding off the pile mass by vaso-constriction due to heat applied also keeps the bleeding in check.

D:  Surgical Approach

Chedana karma in Ayurveda is the opted surgical approach with ligation & excision of pile mass, similar to conventional open hemorrhoidectomy.

1.  If the mass is thinly rooted with a reddish hue protruded but is slimy and has a coating of mucus, then only Shastrakarma is possible in these cases to root out the Arsha.
2.  Each pile pedicle is ligated separately with the help of thread followed by excision of pile mass. 
3. After that thermal heat cauterization is done to arrest active bleeding.
4. The procedure of Kavalika placement ( bandaging) followed by the Gophana Bandha (T-shape bandage with an opening in the center for smooth passage of flatus) should be performed. 

E: Preventive Approach

The preventive approach is based on wise words that it is much better than healing because it saves the person from being sick. Instead of waiting for lifestyle ailments to occur, a proactive approach with preventive guidelines decreases the likelihood of the problem. It basically compiles the Do’s & Dont w.r.t food and lifestyle pattern that is required for a healthy bowels and a piles-free lifestyle. They are as follows; 

1. Do’s
   1. Fill up on fiber content: Include dietary fiber and supplements in the diet like fiber bran, and shredded wheat.
   2. Eat healthily: Eat foods, which are good sources of fiber, such as whole-grain or bran, cereals, and bread, fresh vegetables like spinach, okra, carrots, radish, peas, squash, sweet potato and fruits like sour pomegranate, pear, apple, raspberries etc.
   3. Stay hydrated: Drink plenty of fluids, at least 8-10 glasses per day. 
   4. Include dairy products like cow milk, clarified butter, Buttermilk, ghee.
   5. Stay active: Be active and exercise regularly. It can include walking for 30 minutes, yoga, etc. to manage body weight as per BMI.
   6. Avoid food that is hard to digest, and cut back on spicy & oily foods.
   7. Maintain anal hygiene, and keep the anal area clean and dry.
   8. Regular sleep, Exercise, Regular diet, and Non-suppression of natural urges is a must.
2. Don’ts
   1. The patient should not sit too much on a hard surface.
   2. Avoid sitting in the toilet for long periods. 
   3. Exclude carbonated drinks, coffee, and alcohol from the diet as these all predispose to constipation.
   4. Patients are advised to avoid Hurry (too much stress), worry (anxiety) and curry (spicy food) for better prevention.
   5. Strictly avoid lifting heavy objects. 
   6. Patients are suggested not to use laxatives regularly as it may become a habit and worsen the bowels’ natural functioning.
   7. It is advisable to avoid food items like chilies, fried foods, maida products, non-veg and mainly avoid excessive Pressure during defecation.

In this materialistic world, the desire to be aware & health-conscious is a must to remain healthy. Ayurveda has immense potential to manage all stages of hemorrhoids with remarkable efficacy without any complications or side effects as it does not have a one-size-fits-all approach because of different constitutions & dosha involvement in hemorrhoids.