The present time is the era of changing food habits, sedentary lifestyle & mental stress that aids up in disturbing the digestive system resulting in many lifestyle-related diseases. Haemorrhoids is one such common anorectal condition characterized by the dilatation of the venous network & connecting tissue due to altered venous drainage of the anus and sliding down of the anal canal lining creating an outgrowth of anal mucosa from the rectal wall associated with symptoms like anal itching, soiling, rectal bleeding & discomfort.
The inference in contributory factors of piles includes hereditary, excessive straining and obstruction of the blood flow in the rectal veins due to an increase in intra-abdominal pressure. The proper comprehensive history of the patient with the clinical aspects of physical examination is required for proper prognosis and tailor-made management protocol as many people often pin up any anorectal symptom to piles when there may be another reason too.
The common symptoms of hemorrhoids like rectal bleeding, pain, pruritus, or prolapse are extremely comprehensive & are seen in various anorectal conditions. For the best treatment protocol, proper diagnosis with a thorough history & adequate physical examination of the affected part help in precise differential diagnosis to confirm the diagnosis
In Ayurveda classics, both disorder and patient examination are considered a discrete entities to acknowledge the exact progression of the disease condition in order to get rid of the disease from the root. In this regard, clinical diagnosis is considered as the bench-mark with the art of debriefing the patient to extract the information regarding a present or previous health condition.
The foremost requirement for a correct diagnosis is based on listening to the complaints of the patient with extreme patience and cross-questioning accordingly. A carefully detailed history of the present and past medical health condition is a mainstay of clinical diagnosis making.
Assembling & analyzing the important details from the patient’s medical history including details of the eating habits, toilet habits, usage of any laxative medication or enema, suppositories, is required for implied clinical decision making while empathy with patience is apt for patient satisfaction. This basically includes;
The eight-fold examination protocol or ashtavidha rogi pareeksha is practised basically by the Ayurveda physician, aimed at spotting the vitiated dosha that causes the disease. This includes eight features, viz;
Physical examination of the patient includes an abdominal examination, visual inspection of the perineum, digital palpation of the rectum, assessment of the neuromuscular functioning of the perineum and proctoscopy if needed.
The inspection of the abdominal quadrants, anal opening and perianal area is to be performed after the interrogation of the patient signs involved. The inspection & palpation of the perianal and anal area involves below-mentioned findings suggest anorectal conditions like piles;
The patient’s anus and lower part of the rectum are examined in detail to exclude internal hemorrhoids occurrence. This is done after proper counseling and verbal consent of the patient. A sterile gloved finger lubricated with local anesthetic jelly is inserted into the anal canal and after completion the finger is withdrawn.
The use of a proctoscope i.e. surgical instrument which is inserted into the rectum to check inside of the anal canal, assess the inner walls of the rectum for any abnormality that is not revealed by digital rectal examination. On prcotoscopic examination, the following findings suggest the hemorrhoid type;
Clinical diagnostic investigations may be required to exclude any serious pathology assessed during the rectal examination and proctoscopic findings.
The diagnosis aspect is done by careful implementation of all of these guidelines to analyze the haemorrhoidal disease severity based upon the observations for deciding treatment modality in terms of diet & lifestyle regime as well as dosha predominance aids in the assessment of the progression of the disease in its early form even before the production of the symptoms. If a disease is correctly diagnosed, then treatment is very easy and flawless and, the morbidity and mortality would be minimized.
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