Hemorrhoid Surgery- Modern vs. Ayurvedic Perspectives

Hemorrhoid is a condition portrayed by the prolapsed anal-centric muscular pads that may bring about discharges mixed with bleeding and pain while passing stools from the rectum or anal canal. Present-day clinical science has various range of treatment options starting from diet and healthy lifestyle adjustment along with oral medications, sclerotherapy, banding, LASER removal and so on in the beginning phase and different surgeries, for example, Hemorrhoidectomy is a serious stage with a shifted success rate. While Ayurvedic recommends fourfold treatment for Hemorrhoids i.e. medicinal treatment with herbal supplements, kshara or herbal-caustic paste application, thermal cauterization and at last surgical intervention with a high success rate and low recurrence rate.

In ordinary cases, the hemorrhoidal condition can be treated by dietary adjustments alongside some Ayurvedic herbal meds. In a specific extreme types of cases, surgery is important to give good long-term relief including a more noteworthy degree of prolapse, where other operative techniques may be utilized to address the issue. Hemorrhoids being spouted masses of tissues that comprise of muscle with swollen, extended and protruding veins are essentially classified into two groups; 

1. Internal Hemorrhoids
2. External Hemorrhoids

Hence the treatment for Hemorrhoids ranges from dietary and way of lifestyle changes to careful surgical extraction and relies upon the seriousness and severity of signs & symptoms and reaction to the moderate conservative management approach. 

A few strategies with a surgical approach have been developed so far to fibrosis the Hemorrhoidal tissue onto the hidden inward opening and restore the anatomy, depending upon the therapeutic assessment of different treatment choices. The available surgical options are summed up as follows, which mostly opts-in extreme phases of Hemorrhoids going from Grade I to Grade IV. The surgical perspective options available in modern medicine and Ayurveda are listed below;

Modern Perspective of Hemorrhoid Surgery

Surgical management of Hemorrhoids in modern medicine;

1. External Hemorrhoids Management– In the Acute stage with signs & symptoms like severe pain with hematoma, then mostly the treatment of choice is oral medications with analgesics, anti-inflammatory action that are prescribed along with laxatives and antibiotics, meanwhile allowing the wound to heal by granulation tissue. 
2. Internal hemorrhoid Management-Treatment for internal Hemorrhoids depends on the severity of symptoms and response to conservative management.
   • Rubber Band Ligation: The band ligation or Banding is done around the base of the Hemorrhoidal mass inside the rectum that causes the death of the piles mass by cutting off the blood circulation and Hemorrhoidal mass withers within a few days, with subsequent fibrosis of the mucosal layer that aids to fix the affected tissue, preventing sliding of the anal mucosa. This method is effective in 65–75% of first and second-degree internal Hemorrhoids. 
   • Hemorrhoidectomy: Hemorrhoidectomy is indicated for grade three and four types of Hemorrhoids and for individuals with grade first and second types of Hemorrhoids who have failed conservative management. A hemorrhoidectomy is a surgery to remove the internal or external type of Hemorrhoids that are extensive or severe. Surgical hemorrhoidectomy is the most effective treatment for Hemorrhoids, though it is associated with the greatest rate of complications. Surgical Hemorrhoidectomy is practiced in two ways – open and closed Hemorrhoidectomy.
   • Closed hemorrhoidectomy is the surgery that is most usually used to treat an internal type of Hemorrhoid. Normally every one of the three hemorrhoidal sections is treated at one time. Post-operative care incorporates regular sitz bath, mellow analgesics, with avoidance of constipation.
   • Open Hemorrhoidectomy: The hemorrhoidal tissue is excised in the same manner as in a closed procedure, but here the incision is left open. 

3. Stapled hemorrhoidopexy: Stapled hemorrhoidectomy is the most up to date expansion to the surgical approach for internal Hemorrhoid methodology. This is a minimally invasive procedure for Hemorrhoids and is effective in Grade three and fourth types of Hemorrhoids, especially with mucosal prolapse.

4. Lateral internal sphincterotomy: In this method, the opening of the inner anal sphincter muscle is reduced during hemorrhoidectomy in individuals with high resting sphincter pressures. It is hypothesized to reduce postoperative pain. It is not used in most cases. 

Ayurvedic Perspective of Hemorrhoid Surgery

Ayurvedic herbal treatment is mostly advocated with mild & less complicated signs and symptoms of Hemorrhoids usually having an onset of less than a year. The essential moderate Ayurvedic management executes the herbal medications like Triphala churna, arshoghni vati, jatyadi tailam etc pointed toward improving digestion, pacifying bowel movements, blood purification and hemostatic action.

1. Kshar-sutra ligation: Kshar karma or Application of Alkaline paste on the pile pedicle is demonstrated in Grade second or third type of non-bleeding Hemorrhoids where pedicle is delicate, broad, profound & deeply situated or possibly internal and anticipating. This technique cures the piles within 5-7 days with a week of rest and care, having a success rate of more than 97%.

2. Extraction of Pile mass is demonstrated when pile mass is of the limited narrow base, projecting type and prolapsed with the sign of blood mixed mucoid discharge resembling III grade & IV prolapsed Hemorrhoids. Several surgical excision techniques may be used if conservative management and simple procedures fail. All are related to some level of complications including bleeding, infection, anal strictures and urinary retention, because of the closeness 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. Extraction of Pile mass surgically is done when the mass is of the restricted narrow base, projecting and prolapsed with a blended mixture of blood with mucus discharges resembling third and fourth grade prolapsed Hemorrhoids. Various surgical extraction methods might be utilized if the conservative administration of Ayurvedic herbal formulations and basic strategies fizzle. 

Hemorrhoid is a major problem in today‟s society related to lifestyle, age, occupation and dietary factors. It affects the physical as well as mental health of people. Patients suffering from this disease do not take proper diet due to fear of pain with bleeding per rectum during defecation. Moreover, the patient becomes very anxious after observing the pan full of blood. Improper diet further vitiates Doshas and condition becomes worse. Thus, Ayurveda definitely can play a great role in the treatment of Arsha and it‟s complications without any side effects. Moreover by following the principles of Ayurveda one can avoid the occurrence of this disease.

Hemorrhoid is a significant issue in today‟s society identified with way of life, age, occupation and dietary components. It influences the physical just as the emotional well-being of individuals. Individuals experiencing this condition don’t usually have a proper eating regimen because of fear of excoriating pain along with bleeding from the rectum while passing stools. Inappropriate eating regimen further vitiate Doshas and the condition becomes worsened. Consequently, Ayurveda unquestionably can provide an extraordinary role in the treatment of Hemorrhoids and their related complications without any side effects with its herbal medicinal approach. Also by following the standards of Ayurveda, one can dodge the occurrence of Hemorrhoids with a high success rate and a few recurrence rates.