Clinical presentation of Hemorrhoids and its
Management by Ksharsutra
Hemorrhoids popularly known as “piles” is the most
common surgical condition of the ano-rectal region. This condition arises when
the veins in the rectum and anal canal swells due to increased pressure because
of the factors like straining, during defecation, pregnancy, any growth, obesity
etc. which plays a major role as the causative factors for piles.
If network of the swollen veins were inside the
rectum, it is called as internal
hemorrhoids. These swollen veins comes out per anus during defecation as
prolapsed masses which either get reduced spontaneously after the act of
defecation or has to be reduced digitally and then it remains inside. In later
cases these swollen veins always remain outside the anal canal as prolapsed
pile masses. Based on this prolapsed, piles are categorized under four degrees
like 1st, 2nd, 3rd, and 4th.
Internal hemorrhoid can also lead to painless bleeding. Prolapsed piles are
particularly itchy type. Those afflicted with this type usually worsen the
condition when they wipe it often due to its itchiness.
If the swollen veins develop under the skin around
the anus, it is called as external hemorrhoids.
And one can feel and even see them. People with Piles usually complaint the
following symptoms :
Ø Swelling
in the anal area. One can also palpate the swollen veins in case of external
piles and 4th degree prolapsed internal piles
Ø Painless
bleeding during defecation which usually comes in the form of splash of blood
Ø Something
coming out per anus during defecation which either gets reduced or has to be
reduced
Ø Itching
in the anal region
Ø Constipation
The ideal thing to do if any person is having the
above mentioned complaint is to consult a medical professional and have a
thorough check up.
Most
common factors that worsen the symptoms are:
Ø Constant
diarrhea or constipation
Ø Extended
period of time for the act of defecation
Ø Difficulty
in giving birth to a child
Ø Obesity
Ø Lifting
of heavy weight
75% of the population have piles at one point of
their lives. But only a small percentage of these patients consult medical
professional and even much smaller percentage has surgical intervention among
them. The rest resorts to conservative management which include lifestyle
modifications and symptom management.
In
lifestyle management, there are three areas to consider:
Ø Diet
Ø Exercise
Ø Habits
Dietary Modifications
Constipation
is a major problem in these patients. It is oftentimes is the result of lack of
fiber and fluids in the diet. Living a sedentary lifestyle and having other
medical conditions can also cause constipation.
One is constipated when
he/she has two or less bowel movements in a week, one strains during
defecation, has hard stool to pass or incomplete evacuation of feces. These in
turn causes the hemorrhoids to develop or if already afflicted, become worse. The things that you can do to remedy your
constipation are:
Ø Eat
a well balanced diet. Add plenty of fiber rich food like fruits, vegetables,
whole grain cereals and legumes.
Ø Drink
more than 8 glasses of water per day
Ø Avoid
caffeinated and alcoholic beverages, as these are diuretics and can cause
effects of dehydration
Ø Observe
healthy bowel habits for which you should do the following things-
¨ Have
your meals at the same time as much as possible to train your bowel
¨ Avoid
straining
¨ Do
not stay in the bathroom longer than necessary
¨ Be
careful on using laxatives to relieve you of constipation
¨ Avoid
hot and spicy foods. Remember the saying“ what burns coming in, would burn
bring out”.
¨ Refrain
from eating processed foods
Ø Be
active in your daily life. Lack of activity leads to increased weight, weaker
muscles, and immune system.
Triphala-
combination of three herbs equal is one of the excellent regulator of the bowel
to manage the constipation. A teaspoon of aloevera
after meal is said to be effective in relieving
hemorrhoids. Hemorrhoids can be prevented or cured when you have the right diet
to prevent constipation.
Lifestyle
modifications would also be the answer to the
elimination of hemorrhoids in your life.
Ø Cease Smoking
: As nicotine affects bowel function
Ø Limit alcohol consumption
For
the symptoms associated with hemorrhoids, some of the things a patient can do
to get relief.
Ø Warm
sitz bath for 15 min., 3- 4 times a day also preferably after a bowel movement
Ø Never
scratch the hemorrhoid
Ø Keep
the anal area clean and dry all the time
Ø Frequently
applying aloevera on the areas promotes comfort
However, in the event that the hemorrhoids become
extremely painful and bothersome like in case of thrombosis, strangulation, a
patient to have surgical intervention like banding, sclerotherapy,
cauterization, hemorrhoidectomy etc.
Hemorrhoids are dealt rationally under the concept
of arsha. And mandagni is said to be the
main reason in its pathogenesis. In modern busy day to day life , people
neglects proper diet and lifestyle habits. It ends in reducing digestive fire
(agni) and making it manda. Mandagni means patient is not able to digest food
material at properly. It results in accumulation of half digested food material
(Aam) in the form of toxins inside or throwing it out before time in watery or
semisolid form which disturbs doshas in ano-rectal region. Acharya Sushruta has
mentioned it in the Ashta Mahagada, showing the gravity of the disease.
In Sushruta samhita, its whole treatment is covered
under four categories i.e. Bheshaja, Kshara Karma, Agni karma, Shastra Karma.
Under Kshar karma, kshar sutra treatment is done as parasurgical procedure for
the hemorrhoids which needs surgical intervention. It is a medicated thread
which is prepared according to set protocol according to the standard
guidelines. In the operative procedure this medicated thread is ligated at the
root of the pile masses under full aseptic conditions.
Effects of kshar sutra ligation on clinical features
of arsha is very significant. Kshara sutra has surgical actions like incision,
excision, debridement, scrapping and medical actions like haemostatic,
antiseptic, healing etc., which acts simultaneously to cure the arsha (piles).
The kshara used in the medicated thread cauterize the tissue of the ligated
masses indirectly by its kshara guna (corrosive properties). The action of
turmeric powder provides the effect of
bactericidal action with healing properties.
The mode of action of kshara sutra starts immediately after contact
with the tissue. Kshara invades into the cells of the lesion till the
destruction of the engorged tissue of the mass occurs or up to the removal of
the pile masses. During the cutting effect, there may be oozing of blood, which
is ceased by the sclerosing effect of the kshara. Hence, there is minimal
chance of bleeding. The chance of infection is also less because of turmeric
and kshara. The pressure exerted by ksharasutra ligation creates mechanical
strangulation of blood vessels and tissue, which causes the local necrosis of
pile masses, forces falling out of the pile mass during defecation.
The beauty of kshara sutra ligation lies in the fact
that it can be conducted at OPD level. It is an ambulatory procedure; patient
can perform his/ her daily routine work from the next day of surgery. It
requires less duration for the completion of treatment. There is minimal need
of anti-biotic and anti- inflammatory drugs. After separation of the mass,
wound heals quickly. Hospitalization period is less. There is least possibility
of recurrences. It is much cheaper than the surgical modalities available in
modern system of medicine. There are minimal adverse affects during the post operative period like
anal-stenosis, incontinence, bowel irregularities . Many studies and experience
of kshar sutra practitioners revealed that kshara sutra ligation is a standard
surgical treatment in the 2nd, 3rd and 4th
degree of arsha (piles) and also an affordable treatment for all the classes of
people in society.
