What are Piles or Hemorrhoids- Causes, Symptoms, Treatment

What are Hemorrhoids or Piles?

A lot of people don’t even know they have hemorrhoids or piles as the rectum is not an area that one can readily see. Sometimes one is unaware until they find blood in the toilet water after bowel movements and experience pain and discomfort while passing stools. So what exactly are piles and how does one develop them?

Piles or Hemorrhoids are one of the most common problems in the anal region affecting more than half of the population. The main concern is that many patients are embarrassed to seek medical attention and are left untreated.

Hemorrhoids are swollen veins in the wall of the rectum and anus caused by too much pressure in the veins. This disease is usually manifested with a long history of indigestion and constipation resulting in hard stools.

In Ayurveda, the hemorrhoid is correlated, as per its origin and symptoms, with Arsha described by Acharya Sushruta who categorized this disorder in the “Ashta Mahagada” viz Eight grave diseases. Arsha occurs in Guda or anal region, which is undoubtedly a Marma site i.e. area known for its chronicity and difficult management approach.

What are the Causes of Piles?

Piles are a common condition among people of various age groups. In most cases, the main causes of the piles are bad eating habits, poor lifestyle and the other factors that show the negligence of the individual. The disease is painful with lots of discomfort that should be treated as soon as the patient experiences the symptoms. Common causes of piles are:

1. Nutritional factor: Diet low in fiber, eating spicy food leads to the formation of hard stools which results in straining and thus causes piles.
2. Chronic constipation: In the long history of chronic constipation, excess pressure is applied to the rectum making the veins push against the wall of the anus, resulting in feeble and weak anus muscles. This ruptures the hemorrhoids which bleed making stools even tougher to eject and is often accompanied by pain and sensitivity.
3. Recurrent & constant diarrhea
4. Trauma and age factor: In the case of aging, the tissues present across the lining area of the anal region get less supportive and affect the hemorrhoid veins.
5. Increased intra-abdominal pressure due to prolonged straining, an intra-abdominal mass, or pregnancy.
6. Secondary pathologies may lead to hemorrhoids like liver cirrhosis, portal hypertension.
7. Varicose veins or the swollen veins around the anus and lower rectum lead to the formation of piles.
8. Suppression of natural urges like passing flatus leads to the weakening of veins surrounding the anus.
9. Excessive consumption of alcohol, cigarette smoking during bowel movements, a non-vegetarian diet or uncooked or too spicy food adds up to the list.

Risk Factors for Hemorrhoids:

1. Genetic factors: Patients with a family history of piles run at a high risk of getting the disease.
2. Obesity: Being overweight results in increased intra-abdominal pressure. Obese people are in the high-risk zone for having piles.
3. Recurrent and severe constipation: Straining caused while having trouble passing stools with hard consistency is the most common cause and risk factor of piles.
4. Diarrhea: Recurrent and long-lasting complaints of loose or watery stools increase the risk of piles.
5. Sitting in the toilet too long or pushing too hard while passing stool. This habit puts a lot of strain on the veins of the anal area which leads to their swelling and increases the risk of piles.
6. Anal sex
7. Pregnancy: In this period, due to the weight of the baby, the pressure is exerted on the lower abdominal regions and veins in the anal region, especially during the last few weeks when the baby has fully grown in size.
8. Heavy lifting: Holding the weight causes the veins near the anus to swell and penetrate the anus, increasing the risk of piles.

What are the Clinical Symptoms?

Hemorrhoids are the most common cause of rectal and anal complaints with symptoms such as:

1. Anal pain, especially while sitting
2. Pain during bowel movements
3. Lumps on the anus which may become swollen and painful
4. Bright red color bleeding from the anus or rectum, with or without pain, particularly when you pass stool.
5. Mucus or thick fluid in the rectum that results in the urge of passing the stools again.
6. Anal itching, irritation, and discomfort.
7. If the piles are external, pea-sized swelling can be seen and felt at the verge of the anus.
8. Obstruction of flatus.

Classification of Hemorrhoids

In Ayurvedic classics, the type of hemorrhoids is mainly determined by the dominant dosha. Pitta dominants usually experience soft and red inflamed bleeding hemorrhoids with a feeling of fever, diarrhea, and thirst while Vata dominants experience rough, hard texture stools, and constipation. Persons with Kapha have poor digestion and slippery, light and large piles.

As per the treatment approach, the position and origin of the piles matter a lot and are classified as;

Internal hemorrhoid

Internal hemorrhoids within the rectum are not painful due to a lack of sensing nerves. During passing stools, it usually collapses and protrudes outside the anal sphincter, which appears like moist pads of skin that need to be reduced back manually. These prolapsed hemorrhoids are treated with a general diet and lifestyle changes along with conservation Ayurveda medications.

Mixed hemorrhoid

Hemorrhoid starts off as internal and moves on as internal and later as the prognosis worsens and leads to the external type of hemorrhoid.

External hemorrhoid

External hemorrhoids are those that are present outside the anal verge and thus are more uncomfortable. While straining or passing stools, they appear outside due to the movement of stool and become visible. Blood clots occur on them, leading to a painful stage called thrombosis which turns these piles from pink to blue and could even bleed.

Grading of Hemorrhoids

For proper diagnostic approach and treatment planning, the stage and grading of piles is required. The grading of hemorrhoids as per its clinical symptoms and position of mass or tag readily helps in choosing a treatment approach and also aids to compare therapeutic outcomes among them. On the basis of their location and degree of prolapse, the classification of hemorrhoids is as follows;

Grade 1 – hemorrhoids are not bulging out, with painless bleeding.

Grade 2– bulging out, but spontaneously regresses

Grade 3 – Bulges out and needs to be returned digitally or manually reduced by the patient.

Grade 4 – Permanently bulge or prolapsed and can’t be returned digitally.

Treatment and Management

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.

The treatment modality is mainly focused on the grading of piles and the symptoms;

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

1st-degree hemorrhoids: Medicinal management along with a conservative approach

2nd-degree and 3rd-degree hemorrhoids: A Conservative medicinal approach along with strict diet and lifestyle changes can help to cure 2nd and 3rd-degree piles initially but may require kshara-sutra ligation or Agni karma approach, depending on the severity and prognosis of the piles.

A: Conservative Medicinal Approach

1. Stool softeners like isabgol husk
2. Laxatives if you are constipated such as Triphala powder, Haritaki powder, Abhyarista.
3. Deepan-pachan drugs like Chitrakadi Vati, Lavan Bhaskar churna, Agnitundi vati.
4. Arshighan such as Sooran pak, Arshakuthar rasa, Shigru Guggulu, Pranda gutika.
5. Pain medicines or vedna-hara drugs like Triphala Guggulu.
6. Wound healer or Vrana-ropaka like Jatyadi oil, jatyadi ghrita, kasisadi oil
7. Hot Sitz bath (sitting in a tub of just enough warm water to cover your anus mixed with spatika or alum powder) for localized swelling.
8. Use of rakta-stambhak single herbs like Naagkesar, Kaharwa, Aristak, Rasanjan, Bol, and formulations like Bolbaddha rasa.
9. To reduce burning and itching sensation, lepan or local application of Shata Dhauta ghrita is done.

B: Kshara or Herbal Alkaline Caustic Application

Kshara-sutra ligation

1. If the texture of pile masses is soft to touch, reddish in color and slightly protruded, then kshara sutra ligation is done.
2. Kshara Sutra is a medicated thread that is applied to external pile mass. This cuts off the blood supply to the vein and shrinks the pile mass.
3. It takes about 7-10 days to shed off the ligated hemorrhoids.
4. Daily dressing and guda-pooran with jatyadi oil are done.
5. Sitz baths and NSAIDs are advised for post-operative pain.

Kshara- karma

1. Kshara is the herbal alkaline paste that cauterizes and shrinks the pile mass.
2. Include sclerosing agents like apamarga kshara, arka kshara, which is applied to hemorrhoids.
3. Results in the vein wall collapsing and shrivel up the hemorrhoids.
4. This method is safe, simple, cheap and ensures a high success rate with fewer complications.

C.  Agnikarma Therapy or Electro-Cauterzation or Cryosurgery

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 are often used when other methods fail or have fewer chances of success rate.

D: Surgical Approach

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. The opted surgical intervention is the ligation and excision procedure or conventional open hemorrhoidectomy.
3. In this procedure, a semilunar shaped incision is made with a sharp instrument and after that 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

Favor

1. Stay hydrated and drink plenty of fluids, at least 8-10 glasses per day.
2. Include dietary fiber and supplements in the diet. Eat foods, that are good sources of fiber, such as whole-grain or bran, cereals, and bread, fresh vegetables and fruits.
3. Be active and exercise regularly. It can include walking for 30 minutes, yoga, etc.
4. Manage body weight as per BMI.
5. Include buttermilk, onion, leafy vegetables and green gram, okra, spinach, carrots, radish, etc
6. Avoid food that is hard to digest, cut back on spicy and oily foods.
7. Maintain anal hygiene, keep the anal area clean and dry.

Avoid

1. Don’t sit too much on a hard surface.
2. Don’t sit in the toilet for long periods.
3. Don’t drink coffee or alcohol
4. Avoid Hurry, worry and curry.
5. Don’t lift heavy objects.
6. Don’t use laxatives regularly as it may become a habit and worsens the bowels’ natural functioning.

Hemorrhoids are a painful and debilitating condition that directly links to the quality of life. However, Ayurveda medicines are boon to this condition and could be the solution for the cure along with healthier lifestyle changes.