Hemorrhoids or piles are dealt with rationally under the concept of Arsha in Ayurveda, & called mamsa-ankura meaning ‘pricking like needle’, formed by the abnormal enlargement of the anal cushions due to inflammation & forming fleshy projections that cause distortion of the blood supply channel, resulting in weakening of the supporting connective tissue. The most cardinal manifestation of hemorrhoidal disease is painless bright red coloured rectal bleeding associated with bowel movement.
Ayurveda classifies hemorrhoids as a digestive disorder due to tridosha imbalance & also included it in ashta-mahagada or eight dreadful disease list. Varicosity at anal opening might resemble shapes such as mustard-like, pea-like, barley like plum, fig, and like so many ankuras or buds that the doshas involvement in their manifestation.
The classification system of hemorrhoids is important to decide the approach to treatments and also to evaluate the healing effectiveness among the treatment given. The stages of the hemorrhoids are generally classified based on their location in the guda–valli (anal canal) as said in the ayurvedic context and symptoms exhibited due to the prolapse of the clumps i.e how far it reaches the anal canal.
For feasible applied aspects, internal hemorrhoids are graded based on their appearance and degree of prolapse below the pectinate line into the anal canal known as Goligher’s classification. The grading of internal hemorrhoids are;
GRADE I / First-degree hemorrhoids:
Remains inside the rectum only.
Internal hemorrhoid bulges into the canal & remains inside the canal triggering the anal cushions to bleed due to pressure over the walls during straining.
GRADE II / Second-degree hemorrhoids:
Prolapse through the anus while defecating & reduce spontaneously
The anal cushions slide through the anus on straining but reduce spontaneously while pressure is applied on the rectal or anal wall area causing mild discomfort and automatically returning to their usual size after the anal cushions get relaxed.
GRADE III / Third-degree Hemorrhoids:
Prolapse through the anus on defecation but need manual reduction
The anal cushions droop down the anus on exertion and require manual replacement into the anal canal causing painful bleeding & soiling of clothes. They need conservative treatment to prevent them from becoming too painful or infected.
GRADE IV / Fourth-degree Hemorrhoids:
Remains persistently prolapsed
The protruded part of the lump stays out at all times and is irreducible manually also, exhibiting symptoms like pain, bleeding, clotting, hematomas, and possible strangulation if not treated.
Hemorrhoids are the most common anorectal condition which in normal anatomy acts to assist the anal opening in maintaining bowel continence. The hemorrhoidal disease is clinically diagnosed using a simple internal examination of the anal passage. There are various treatment options for more severe hemorrhoids, but they are treatable with dietary and lifestyle modifications such as high-fibre diet, hydration, laxatives or stool softeners, and avoiding the straining, and certain topical and oral ayurvedic formulations effectively. Most patients can be treated with office-based primary care with dietary advice and avoidance of the risk factors involved and certain herbal formulations.
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