PILES To Smiles (Haemorrhoids, fleshy masses, Varicose veins inflammation in anorectal region, बवासीर, , अर्श, मस्से, )

        Piles To Smiles

                                  (Hemorrhoids, Varicosity of rectal vein ) बवासीर, अर्श, मस्से)

Be Healthy Be Happy

    

Piles or hemorrhoids are very common disease More than 10 million cases per year in India reported. Treatable by a medical professional. Usually self- diagnosable. Lab tests or imaging not required. Chronic cases can last for years or be lifelong

Hemorrhoids- Haem means blood, and Rhoes means to flow. "Hemorrhoids" are like Cushions, composed of artero - venous channels & Connective tissues, in the anal canal, which helps in regulation or control of stools. Due to excessive stress sometimes they become pathological or "Piles” (Arshas) with symptoms of Swelling & inflammation, the condition is also known as "Varicose veins inflammation" in ano - rectal region.

Piles word originates from Latin word ‘pila' which means a ball or a pillar. Piles are fleshy growths with swollen blood vessels in or around the anus or rectum. The food habits and sedentary lifestyles increase the rate of incidence of hemorrhoids. In most cases, the symptoms of piles are not serious. They normally resolve on their own after a few days.

Piles can affect anyone, it's incidence increases with advancing age usually more common in elderly people and during pregnancy. It is certainly one of the commonest ailments that affect mankind.

Piles can be due to chronic constipation causing extra strain on circular veins at the anal orifice. Make sure that the stool is soft all the time. Take lots of fruits and leafy vegetables to improve the bowel movement. Reduce weight if overweight.

"The food habits and sedentary lifestyle increase the rate of incidence."

Introduction

What are Piles ?

Hemorrhoids are dilated and inflamed veins in the anorectal region. It aggravates due to constipation and straining. Most commonly seen in the people  who intake spicy food, drink alcohol and sometimes it gas a genetic  disposition. It is characterized by  bleeding and mass per anum which may be reducible or irreducible.

Piles are an accumulation of swollen  tissues on the walls of the rectum and anus.. Hemorrhoids comprise muscles, support tissue, blood vessels and elastic fibers. 

Hemorrhoids  veins are located in the lowest part of the rectum and the anus. They are cushioned by smooth muscles and connective tissue. They are drained by tributaries of the superior hemorrhoidal  veins which drain into the inferior mes enteric (hence portal) vein.

"This may sound surprising to some scientifically, each one of us  born with piles or hemorrhoids. However they remain at the thresh hold and hence we are unbothered.. However when they become inflamed and enlarged, it results in uneasiness."

These hemorrhoids are classified by where they are located in relationship to the ‘pectinate line’, the dividing point between the upper 2/3 and lower 1/3 of the anus. This is an important anatomic distinction because of the type of cells that line hemorrhoid, and the nerves that provide sensation.  

Now here comes a second shocker, it has been found that  nearly three out of four adults have suffered from hemorrhoids at some times or the others. For some people it could be a one time occurrence and they may subside naturally for example without seeking a medical assistance. Whereas, for some, it requires medical / surgical consultation. To treat a disease , it is paramount to identify  the root cause.

Hemorrhoids are a normal part of the anatomy. They become an issue only when they begin to swell, causing itching, pain or bleeding. Piles are not painful unless they are thrombosed when they protrude and are gripped by the anal sphincter, blocking venous return.

Parthenogenesis- There is a vicious cycle: these piles or vascular cushions protrude through a tight anus, become further congested, so hypertrophying to protrude again more readily. These protruding piles may then strangulate.

Swelling of rectal vein

Types of Piles

●     External hemorrhoids /sentinel piles arise below the pectinate line and are covered with cells that resemble skin.

●     Internal hemorrhoids are located above the pectinate line and are covered with cells that are the same as those that line the rest of the intestines. With the patient in lithotomy position (patient lying down with both the legs raised), piles take up three characteristic positions at 3, 7 and 11 o'clock.

●   Prolapsed hemorrhoids

Classification

Ø  First-degree piles remain in the rectum.

Ø Second degree piles prolapse through the anus on defecation but can be reduced. (i.e reinserted).

Ø  Third-degree piles remain persistently prolapsed.

                     "Hemorrhoids is a benign condition".

Hemorrhoids (Piles)  in Babies

It is a rare condition in babies. In this disorder,  swollen an irritated lumps can be observed around  the anal opening of the the baby. This is generally associated with  dry and hard fecal matter with streaks of blood.

Others

Bleeding Piles / or Non-bleeding piles.

Piles often cause bleeding, but the blood tends to be on the edge of the stool. It tends to be bright red followed by passage of mucus. The bleeding of piles is always linked to pains, itching or sourness just inside the bottom or the soreness around the skin around it.

Ayurveda:

In Ayurveda, hemorrhoids are called ARSHA. An ailment that torments the patient's essential force (Prana )as an enemy is called Arsha. 

In modern day to day life of urgency and stress, people neglect proper diet and lifestyle habits. It ends in reduced digestive fire (Agni) called mandagni. It means baiting oneself to unhealthy diet and lifestyle, which simmers the digestive fire (Agni ) or makes it inconsistency. This results in the  inability to digest food material adequately and timely, therefore, accumulating half digested food (Ama) inside in the form of stool. This leads to expelling the half digested before time in a watery or semisolid form or can lead to constipation.This malfunctioning disrupts the Doshas in the ano-rectal region.

Varicosity may be in the external area of the sprinter of the anus or in the internal area of anus i.e. inside the anal sphincter covered with a mucus membrane. According to Ayurveda Arshas / Piles is one among the difficult to treat conditions.

               "Impairment of agni which is hampered due to improper Ahara and Vihar."

“Consult a Proctologist”

According to Ayurveda, hemorrhoids are called ‘Arsha Shoola', which literally means ‘pricking needle type of pain'. It is caused due to vitiation of any of the three doshas. It is classified as ‘digestive disorder'; (Aama) or waste material in the rectal area can give rise to piles.

According to Ayurveda types of Arshas:

Vataja: Dry Hard, painful, different shapes, centrally irregular surface, different colored  fleshy masses associated with constipation, pain radiating to the perineal region during defecation. It may be compared with the sentinel piles or external piles.

Pittaja: Small bluish, moist, fleshy mass of different shapes enlarges during straining with the passage of blood mixed stools and burning sensation during defecation, causing faintness, thirst shock etc. It may be compared with thrombosed hemorrhoids.

Kaphaja: Broad-based, smooth, Fixed oval, fleshy masses and does not suppurate, severe pruritis and passing of mucus containing stool. It may be compared with fibrosed piles or external piles.

Rakthaja: Fleshy masses which bleeds excessively during defecation, usually, associated with blood loss symptoms. The true bleeding hemorrhoids belong to mostly Raktharshas.

Sahaj: Genetically determined, ugly appearance, fleshy masses, with immuno-compromised symptoms.

Tridosha: Mixed features of all the above doshas.

 Ayurveda aim to re balancing of  the doshas and cure the disease.

Ayurveda is a treatment based on natural elements. It utilizes herbs that can treat the root issue and uproot the unwanted weed. Hence you do not have to worry about hemorrhoids backtracking in future.

Cause

●     Stressful Busy & hectic life. long hours of work and irregular eating habits.

● Above 50, more prone to this disease, because of laxity of anal cushions i.e. supporting connective tissue.

●  Pregnancy is associated with hemorrhoids due to the increased pressure of the enlarged uterus on the rectum and anus. In addition, hormonal changes with pregnancy may weaken the muscles that support the rectum and anus.

●     Unhealthy lifestyle and change in food habit (lifestyle disorders) 

●  Chronic constipation or hard stool

●   Regular consumption of junk food, fast food,spicy food.

●    Irregular food timing.

●   Less water intake

●  Low fiber diet and smaller caliber stool cause a person to strain when having a bowel movement, increasing the pressure on the blood vessels.

●  Prolonged sitting for the toilet may increase pressure within the haemorrhoidal blood vessels

●    Obesity 

●  Sedentary lifestyle.   

●   Congestion from a pelvic tumor, Colon cancer, Previous rectal surgery, any growth or cancer in the bowel or pelvis

●     C.C.F (congestive heart failure) or portal hypertension.

●     Habits- Suppression of natural urges (Vega varodha) leading to constipation

●     According to Ayurveda Mandagni (reduced digestive power) as a prime factor.

●     Local irritation factor that is prolonged sitting on a hard seat.

●   Chronic Diarrhea.

●   Systemic Disease like : Liver Disorders.

●   Lifting heavy weights regularly.

●   Anal Intercourse.

●   Hereditary

●  Digestive disorder : According to Ayurveda It is classified as ‘digestive disorder'; (Aama) or waste material in the rectal area can give rise to piles.

“Avoid constipation.”

Sign & Symptoms

●     Painful Defecation Intense pain while passing stools. 

●   Dry and hard fecal matter with streaks of blood.

●  Associated with leakage of mucous  in the stool resulting in painful expulsion of contents of the rectum.

●     Anal Pruritis / Itching in the anal region, /  Bikkatul maq'ad : Burning and itching in the anal area known as ‘pruritus ani’. It is common among the children.

●    Constipation :Hard bowel movements, and straining while going to the toilet.

●     The area around the anus is red and sore.

●     Difficulty in sitting on a hard surface.

● Anal Bleeding / Pus Discharge : Bleeding from rectum during defecation or after defecation. It leads to unsatisfying bowel habits.

●   Persistent constipation, mucous discharge i.e.  discharge of sticky substance along with feces.

●   Feeling of dissatisfaction even after defecation i.e. a  person may feel that he still wants to defecate even after he has done so.

●  A mass like protrusion (thrombosed external piles) coming out of the anus while defecation.

●   Lack of appetite, or diminished appetite, indigestion, flatulence, chronic backache or cramps in the calf muscles and body ache.

●     Piles are not painful unless they are thrombosed when they protrude and are gripped by the anal sphincter, blocking venous return.

●     The person becomes pale or anemic due to hemorrhage in the rectum. Giddiness and stupor are also found in some cases. The person becomes lethargic and does not feel energetic to do any work.

●  Piles or Hemorrhoids In Pregnancy : These are resultant of increasing pressure over the engorged veins around the anus and constipation. If constipation lingers over a period and is not treated, it can cause veins around the anus to protrude, from straining that  accompanies constipation, leading to piles or permanently protruding veins around the anus.

If piles occur, keep constipation in check and avoid spicy food.                                             

●  Visible Anal Mass

Diagnosis

●     Usually self-diagnosable.

●     History of constipation or diarrhea.

● Diagnosed through a proper per rectal examination and further investigations.Rectal examination where a finger is used, to feel the lumps or abnormal masses. Interestingly, internal hemorrhoids cannot be usually felt, prolapsing piles are obvious. Internal hemorrhoids are not palpable, (The rectal examination may be deferred if there is an intense pain or swelling).

●     Proctoscopy to  visualize the internal hemorrhoids.

● Blood test for anemia - hemoglobin level, and red blood cell count may be checked. Prothrombin time (PT) is checked if the patient is taking Warfarin a blood-thinning drug.

●     An abdominal examination to rule out other diseases.

Complication

●     Bleeding

●     Fissure

●     Fistula in ano

●     Anemia

Lifestyle

●     Avoid being sedentary.

●   Increase intake of fluids (juices, soups and water)

●     Drinking warm milk with dry dates / Chuara. at bedtime.

●     Follow regular timing for getting good sleep.

●     Chew each morsel of food 30-40 times before swallowing.

●     Never hold the urge to pass stool.

●   Most importantly never strain  during defecation.

●     Lose weight if obese

●     Take a break from your long sitting job. Get up, walk exercise.

●     Do not over straining yourself

●     Do not skip breakfast.

●     Eat easily digestible food.

●   Pass the bowel as soon as you feel the urge. Do not strain yourself to have a bowel movement.

●     Keep the anal canal clean. Take Warm baths.

●     Do not sit on hard surfaces, it can restrict blood flow around the anal area.

●     If you aim to eat a high fiber diet and drink plenty of water (6-10 glasses a day), you should be able to keep the feces soft, which will help you pass them without straining.

●    Drink a glass of warm water with lemon and honey on an empty stomach. This will correct and prevent piles.

●  Bathroom Habits

Exercise

Walking- Walk for at least 30 minutes a day. As it makes an excellent remedy for internal as well as external hemorrhoids. It helps to relieve pressure on the blood vessels in the pelvic region, relaxing muscles at the same time. 

"The pressure in the abdominal area and lack of physical activity are the root causes of hemorrhoids.”

Yoga

Ashwini mudra posture (अश्विनी मुद्रा)

Formation :

Sit in a meditative pose like Padmasana, Sukhasana or Vajrasana. Draw the lower part (anus) upwards while exhaling, and loosen it downwards while inhaling. This is called Ashwini mudra. One can also lie on the back and do this mudra. One should  perform this mudra  when the stomach is empty. One can perform this mudra  for 20 to 25 times and than gradually reach 75 to 100 tomes.

Effect :

Blood circulation to the anal part becomes proper and it attains health. Vitality increases many fold.

Benefits :

• Good for Prolapse rectum, Prolapse uterus and piles.
• Ashwini mudra successfully  avoids and cures diseases associated with piles and constipation.
• It also relieves problems caused by gas.
• Anal part is maintained healthy.
•  The basic action is contraction and relaxation of anal areas. Ashwini Mudra gives instant relief from pain and you can keep practicing this asana to get rid of hemorrhoids/ inflammation, especially the itching and burning sensation. You can do this asana anywhere at the office while talking to someone while watching television or even while standing or walking. Ashwini mudra is the ultimate yoga for piles and hemorrhoids.

“Ashwini Mudra can cure piles by improving blood circulation and tensile strength of anal pads”

   

Vajrasana (Ankle pose)

●     This Asana helps in easing constipation and regulating the Apana Vayu. It can be done after meals.

Pawanmuktasana (Wind-relieving pose)

Halasana

Padahastasana

Blood vessel of lower abdominal cavity gets stretched which in turn is helpful for the hemorrhoids patient.

Ardha Matsyendrasana

Baddha Konasana

Malasana

Mulabandhasana

●     Sit in Padmasana pose or lotus pose.

●     Stretch your hands over the knees and close your eyes.

●     Relax and keep your awareness on breathing first, then focus your mind on pelvic floor region i.e. the abdominal area.

●     Take a deep breath and fill up your lungs with air, now contract the pelvic floor muscles slowly in an upward direction.

●     Hold this position for few seconds without over straining the muscles.

●     Release and come back to normal state. Repeat this 10 times for each yoga seasons.

Tadasana

●    Fish Pose Matsyasana (मत्स्यासन )

The posture is dedicated to Matsya the fish. Incarnation of Vishnu, the source and maintainer of the universe and all things.

Technique :

• Sit in a Padmasana
• Lie flat on the back with the legs on the floor.
• Exhale, arch the back by lifting the neck and the chest, take the head back and rest the crown on the floor. Drag the head further back by holding the crossed legs with hands and increase the back arch
• Now take the hands from the legs, bend the arms, hold the elbows, with the hands and rest the fore arm on the floor behind the head.
• Stay in this position for 30 seconds while breathing deeply.
•  Rest the back of the head  on the floor, lie flat on the back, inhale then come up to Padmasana, release the legs and relax.
• Recross the legs the other way and repeat the pose for the same way. length of time.

Benefit : 

1. It greatly improves posture, flexibility, digestion, thus reducing constipation.
2. This is the best exercise for stomach. It activates the intestine and cures constipation.
3. The pelvis joints become elastic.The asana relieves inflamed and bleeding piles.

Great Seal (Maha Mudra) (महा मुद्रा )

Mahāmudrā literally means maha -  great or noble  and mudra -  means shutting, closing or sealing. In this sitting posture the aperture at the top and the bottom  of the trunk are held fast and sealed.

Technique :

• Sit on the floor with the legs stretched straight in the front
• Bend the left knee and move it to the left, keeping the outer side of the left thigh and the left calf on the floor.
• Place the left heel against  the inner side of the left thigh near the  perineum. The big toe of the left foot  should touch the inner side of right thigh. The angle between the extended right leg and the bent left leg should be a right angle of 90 degrees.
• Stretch the arm forward towards the right foot and hook the big toe with  the thumbs and forefingers.
• Lower the head to the trunk until the chin rest in a hollow between the collar bones just above the breast bone.
• Keep the spine fully stretched and do not allow the right leg to tilt to the right.
• Inhale completely. Tighten the entire abdomen from the anus to  the diaphragm. Pull the abdomen back towards the spine and also up towards the diaphragm.
• Relax the abdominal tension, then exhale,, again inhale and hold the breath, maintaining the abdominal grip. 1-3 minutes
• Relax the abdominal tension, exhale, raise the head, release the  hands and straighten the bent leg.
• Repeat on the other side, keeping the left leg straight and the right one bent for an equal length of time.

Benefits :

• This asana tones the abdominal organs, the kidneys and adrenal glands
• It is also good for piles.

Pranayama

●     Bhastrika

●     Sit comfortably in lotus pose of Padmasana.

●     Take a deep breath and fill your lungs with air

●     Breathe out gently within 2 seconds.

●     Keep doing this for at least 5 to 10 minutes.

Acupressure

Give deep pressure with fingers or thumb for two minutes.

Bandha

Mula Bandha :

Chakra (Energy centers)

●     Concentrate on Muladhara chakra. (First Chakra)

“FIG - A natural antidote for piles”

Mudra

Apana Mudra

It is good for Piles

Sahaj Shankh Mudra

●  Formation: Join both the hands together interlocking the fingers and press the palms together. Apply a gentle pressure with both the thumbs by laying them parallel to each other on the index finger. This forms the Sahaj shankh Mudra.

●     Effect: According to Yoga physiology, all 10 main nerves get activated and the body becomes very strong with this Mudra. Ten main nerves are Sushumna, Ida, Pingala, Gandhari, Hasti, Jiva, Poosha Yashaswini, Alamboosha, Kuhoo and Shankhini.

●     Benefits: The nerve Shankhini would activate Mooladhara Chakra. This Mudra cures piles and problem related to anus

Prana Mudra

●     Formation: The tips of little fingers and ring fingers are joined with the tips of the thumbs.

●   Effect: The element of earth, water and fire are joined, so this helps remove the obstacles present in blood vessels resulting in improved blood circulation.

Marma (vital points)

Marma point is located at the site of the anus. Injury (by hard stool) to marma will cause trauma to blood vessels resulting in hemorrhage.

Diet

●   Eat well cooked home made food.

Patient is counselled to change the diet, which was primary reason for the spawning of the disease. One may have to sacrifice their favorite cuisine. and switch to natural foods. But the price is worth the wholesome health.

Here are some remedies from your kitchen to get relief from hemorrhoids, however these should not be treated as an alternate for treatment.

●   Eat fiber

●   Fresh Vegetables : Include lot of fresh vegetables like cucumber,onions, cauliflower, broccoli, cabbage, spinach, Punarva (spreading hog weed), Surana / Jimikand  (tuber of elephant,s foot), Patol (Parwal or pointed gourd) etc. in your daily diet.

● Whole Grain : Whole grains are fiber enriched and are effectual in offering relief from hemorrhoidal symptoms. These foods include brown rice, oats, beans, lentils, barley etc.

●  Soaked Raisins : Dried grapes It is soaked overnight to be consumed in the morning are very beneficial in reducing constipation.

Soaked Raisins

●  Drink Water :  Staying well hydrated  is very important, so drinking plenty of hot water every day can keep one hydrated and also improve metabolism. Water inflates the volume of stool and makes it soft. Besides water is a pronounced way to beat dehydration. Ensure that you drink 6-8  glasses of water daily to ease the passage of stools. At the same time, drinking excess water an disrupt digestion and deteriorate pile problems.

Water

●   Sweet Lime / Mausambi

Sweet Lime

●   Orange

Orange

●   Ghee / Clarified Butter : Making a habit of taking a spoon of pure ghee on empty stomach or with food can also improve the overall digestion and metabolism.

●   Fig or Anjeer eases bowel movement. A natural antidote for piles. Fig is rich in soft fiber, as they are able to create the bulk that is important for the peristaltic movement.

Fig / Anjeer

●     Eat bananas with cardamom.

●   Flax Seed : While soluble fiber absorbs water in your intestines and slows down digestion, which may help regulate blood sugar levels and lower cholesterol, insoluble fiber adds bulk to the stool, which may prevent constipation  and promote regular bowel movements

Flax Seed

●    Aloe Vera Juice Regular use of aloe vera will help to reduce piles to a great extent. It works as a laxative and decreases the formation of piles over a period of time.

Aloe Vera juice

●    Drink Buttermilk to cure bleeding piles. Buttermilk 1 liter per day, in divided doses. If this helps no medicines are required.

●     Eat lots of raw radish for bleeding piles. Radish reduces inflammation due to piles.

Radish

●     Cooked carrots eaten with whey checks bleeding piles.

●     Eat raw tomatoes with rock salt.

●     Bitter gourd juice with khand (unrefined sugar) prevents piles.

                                                     

●     Olive oil Consume one teaspoonful of olive oil daily to get relief from inflammation.

●     In vegetables  Elephant Yam / Jimikand or Suran Amarphophalus painofillus is an excellent choice  for non-bleeding piles. It should be cooked with ghee and consumed.

Elephant Yam / Jimikand

●     Eat lots of salads along with sprouts

●     Chaulai Ka saag or Amaranth is good.

●  Prunes or dried plums (सूखा आलूबुखारा)are rich in fiber improve one's digestion and soften stools, preventing constipation and reducing the risk of straining.

●     The ripe fruit of papaya is very beneficial.

●    Banana

Help Manage Piles

The components of bananas (and aloe vera juice) work like a laxative and decrease the formation of piles over a period of time.

●   Soak 8-10 raisins in hot water. Allow for cooling and then crushing well and strain. Taking this as routine helps to regulate bowel movement.

●     High fiber food is the remedy for piles. Like whole grain, oats, cereals, fruits, (apple), vegetables, (beets, cabbage, carrot, green leafy vegetables, beans, peas), nuts, seeds and bran.  If necessary, add bran to your foods (about 3-4 tablespoonful per day) This will make the passing of stool easy.

●  Kokum (Garcinia) useful in bleeding piles. Can be taken in form of sherbet or in dal or vegetable.

●     Cucumber, beetroot, carrots, onion either cooked or raw to be increased in the daily diet.

●     Eat 250 gm of Guava daily

“Water is the best, most natural stool softener”

Avoid

●    Reducing intake of spicy, gravy, chili, oil non vegetarian food can go a long way in helping improve digestion.

●   Avoid prolonged sitting posture, horse riding and sitting on hard seats.

●     Junk food, processed foods and frozen foods

●     Low intake of water

●     Suppression of natural urges.

●     Overeating and untimely food habits.

●     Stress/ anxiety/ mental worries.

●     Avoid chilies, spices and deep-fried items.

●     Avoid straining on the toilet, try not to strain (push too hard) when you go to the toilet; it is better to try to pass stool only when your body is ready to do so.

●     Avoid fats and animal products, red meat and high protein diet are especially hard on the lower digestive tract.

●     Bajra should not be eaten by piles patient.

Herbs

●    Triphala Powder : Constipation is said to be one of the major triggers of hemorrhoids. Regular consumption of Triphala powder can help in dealing with constipation and hence keep piles at bay.

Triphala Powder

●     Isabgol (Psyllium seeds) (Plantago ovata) 

Adding some Psyllium seeds to your daily menu will do wonders. Add one teaspoon of seeds in a glass of water or milk  and serve them in the morning, before breakfast. These seeds are very rich in fiber they soften stools and make them easier to pass. This means you'll no longer have to strain during bowel movements so blood pressure in the rectal area will remain quite constant, preventing piles from forming.

●  Lemon Juice : The nutritious ingredients in lemon juice bolster the blood vessels and capillaries and can be of great help in treating hemorrhoids.A mixture of lemon juice, ginger, honey,mint juice can be consumed once every day.

                                      

Lemon Juice

●   Haritaki Terminalia chebula (fruit rind) Chew the fruit rind pieces of ‘haritaki' with Jaggery 5 minutes before food. Continue the treatment for 7 days.

●    Pippali Piper longum Boil 1 tsp of powder in a glass of water to make a decoction. Take this decoction half an hour before meals as digestives. Alternatively, take 40-60 ml of milk decoction of ‘pippali' 3 times a day for 3-5 days.

●    Giloy Take 5 ml juice of Guduchi (Tinospora cordifolia) with honey and buttermilk thrice daily.

●     Ginger Take a piece of fresh ‘ginger’ and remove its skin. Chew this piece with a pinch of salt 5 minutes before food. Continue this treatment for 4 days.

●   Dry ginger and coriander seeds Boil together half tsp each of coarsely powdered dry ginger and coriander seeds in 1 glass water. Drink this decoction 15 minutes before food.

●    Ginger and lemon Extract juice from fresh ‘lemon' and ‘ginger' separately. Mix together 1 tsp each of lemon juice and ginger juice with a pinch of salt. Take this mixture after food, twice daily for seven days.

●     Parijat or Harsingar Eating seeds of parijat daily.

Home remedies

●     Flax seeds ease bowel movement.

●     An oral mixture containing 10 g of the pulp of ripe bael fruit, 3 g of sugar, powder of seven black peppers and few cardamoms is very efficacious in checking bleeding from piles.

  ●     To stop bleeding from piles take black sesame seeds, powdered and mixed with fresh ghee or butter.

●   Radish Juice : The compounds present in Radish juice are known as effective recovery agents. It can be consumed twice a day for treating piles.

Radish Juice

  

●     Tamarind leaves juice is good for bleeding piles.

  ●     Take the juice of neem fruit with jaggery.

  ●     Sabja seeds added to lemonade, lassi or bel sharbat.

●   Ice Application : It is easily available and very easy and most preferable home remedy. Its application compresses blood vessels, reduces soreness and gives respite from pain.

●    Grated bitter gourd stirred into buttermilk is another home based treatment for hemorrhoids. You can also add pepper, ginger or rock salt to the buttermilk,which acts are a great hemorrhoid pain reliever.

"Piles if not controlled in time creates a problem"

"Prevention is better than cure" this saying holds very good for the management of hemorrhoids.

Treatment

●     Allopathy  

For first and 2nd degree Hemorrhoids, oral medications and external therapies help in good recovery.In case of 3rd and 4th degree though medications and therapies help, sometimes surgical intervention may be required.

 Medical therapy 

IF the primary focus of piles management mainly on the disease symptoms including surgery , (excision,) without correcting the cause., than the chances are  more likely that  the disease may surface again.

●     Laxatives: Liquid Cremaffin 2 tbsp at bedtime or tab Dulcolax.

●     Glycerin suppository if difficulty in voiding, straining at stool.

●   Venusmin tab 500 mg three times a day. Or Daflon capsules 500 mg three times a day. Or Venex 500 mg tab for 3-4 days

●   Warm water sitz baths / Arabzan  (or Tub Bath) salted with Epsom salts: Epsom salts baths are very popular due to their relaxing properties, cope with hemorrhoids better. These are even more efficient than regular sitz baths as the salts not only help you keep the affected area clean but they also speed up healing and the recovery of damaged blood vessels walls. To use this remedy correctly, add 2-3 inches of water in your sitz bath and a measure of salt, soaking in for 20-30 minutes so that the active ingredients in these products exert their action on the haemorrhoidal veins.

Sitz Bath /  Tub Bath

Avagaha Sweda Sitting in a wide tub half filled with luke worm water for 5-10 mins once a day eases anal discomfort, itching caused due to piles.

●   Or add potassium permanganate crystals in hot water. Sitting in this water for 10 minutes twice a day will help reduce the itching and spasm of anal muscles.

●     Treatment of thrombosed piles with analgesics, and bed rest. The pain usually resolves in 2-3 weeks.

●     Direct treatment:

●     1st and small 2nd degree piles -

●   Local application of ointment: Anovate or proctosedyl or Shield ointment. To be applied before and after defecation.

●     Proctosedyl rectal capsules.

●     Soft paraffin soothes.

●  The patient is treated for anemia in case of bleeding piles. Blood transfusion may be necessary in severe cases.
* SURGERY Excision & Cauterization

●     If no relief: Inj. Sclerotherapy.

●     Large 2nd-degree piles: Elastic band ligation.

●     The operative procedures may include injection treatment, elastic bandaging, cryosurgery,

●     Lord’s dilation: Correction of anal spasm (if present) by manual dilatation under general anesthesia.

●   Injection Sclerosant Therapy :It is done in 1st and 2nd degree piles (internal) as outpatient procedures. Using proctoscope and Gabriel syringe 3-5 ml of 5% phenol in almond oil is injected  into the submucosal plane just above the ano-rectal ring to the pedicle. All the three piles can be injected seperatly. 3-5 ml to each site in single sitting. Technique can be repeated after 6 weeks. This technique is not done in presence of sepsis or prolapse. In advert deep injection can precipitate pelvic abscess, prostitis, impotence and retro vaginal fistula.

 

●    Barron's Banding : It is done for second degree piles. It causes ischemic  necrosis and piles falls off. At one time  only two piles can be banded.Repeat banding can  be done after 3 weeks.. Band should be placed 2 cm above the dentate line.Complications of Barron's banding include discomfort, pain and bleeding. Rubber band ligation - which produces an ulcer to anchor the mucosa.

●     Photo-coagulation is also used.

●  Lords Dilatation : In case of inflamed, permanently  prolapsed oedematous piles. Initially manual stretching of anal canal sphincter is tied. This prevents the congestion of anal cushions and relaxes the anal sphincter, as a result of which  the prolapse piles get reduced. Once edema subsides in 1-2 weeks, formal procedure is done.

●     3rd-degree piles:

● Surgery: Haemorrhoidectomy excision of the pile with ligation of vascular pedicle which requires admission.

●  Stapled Hemorrhoidopexy : It is circumferential excision of the mucosa and sub-mucosa 4 cm above the dentate line  using circular haemorrhoidal stapler passed per anally.

●  Cryosurgery : Using nitrous oxide (-980) or liquid nitrogen(-1960). Extreme cold temperature is used to coagulate and cause necrosis of piles which get separated and falls off.  Subsequently It is relatively painless and can be done on OPD basis.

●    Laser piles treatment : It is a day care procedure performed under anesthesia in 30 minutes post which the patient can be discharged. Laser energy is delivered by radial fiber directly in the sub mucosal hemorrhoidal nodes to shrink the nodes from inside. Moreover, laser energy is used to reduce the blood supply nourishing the abnormal growth. Laser surgery  prevents the occurrence or recurrence of a prolapse.

“Why is Surgery not the answer?  Surgery may lead to loss of elasticity and tensile strength of the anal sphincter. It causes anal leakage and inability to contain bowel movement”

Ayurveda

4 Modes of treatment : Medicine, Surgery, Para surgery with alkali and Cautery based on the nature of piles.

Ayurveda aim to re balancing of  the doshas and cure the disease. This can be done by some natural herbs such as Triphala churna, Chitraka, Aaritaki, Amalki, Avipattikara churna, turmeric, Guggulu,, Bibbitaki, castor oil etc. The best part is that  herbs are not habit forming and have no side effects.

Contrarily Ayurveda zeros in on the root cause so that the chances of recurrence or negated or negligible.

Patient is counselled to change the diet, lifestyle and constipation which was primary reason for the spawning of the disease. One may have to sacrifice their favorite cuisine. and switch to natural foods. But the price is worth the wholesome health.

Ayurvedic offers a holistic remedy based on natural ingredients. And what are those "Five great element". According to the principles of Ayurveda. The elements, Prithvi, Jala, Agni, Vayu , Akash should be in synchronization. Besides Ayurveda emphasis the equilibrium between the  three doshas (Vata, Pitta and kapha.), which are the key to overall wellness.

Agni Deepana Karma this helps to maintain normal metabolic activity and healthy body.

                             "When one's body is off balance, disease are the upshot."

Acharya Sushruta  has included Arsha  as one of the Mahagada. Mahagada are the ailments which are difficult to treat / cure.

●    Kaaseessaadi tail - when applied externally, shrinks the piles and cures itching in the anal region.

●     Application of Jatyadi oil - Local application on pile masses.

●     Abhayarishta - Can be taken in the dose of 30 ml with equal quantity of Lukewarm water before going to bed for constipation and piles.

●     Bowel regulator like Triphala 1 tsf with warm water at night. Or Cassia fistula ( Amaltas fruit pulp) to be used.

●     Munnaka (Vitis vinifera) boiled with milk.

●     Boiled milk with 1 tsp of ghee at bedtime.

●     Tab Pilex

●     Mayra Basti - Ayurvedic medicated enema made of Ayurvedic herbal oils.

●     Restoring the digestive fire. Appetizers -  cut the ginger and add lemon juice over it along with salt and eat it with food.

●  Shastra karma However in the 4th degree, pile mass will remain protruded outside, becomes difficult to clean the anal area after defecation. It is better to go for surgical Removal of the pile mass.

●  Para surgical measures These are minimally invasive procedures. These procedures are minimally effective, ambulatory and minimal or no complications, nonhazardous and acceptability by the patients

●     Caustic cautery: Kshara karma

● Thermal cautery : Agni karma Which can be equated to cauterization in the modern surgical science.

●  Kshara Sutra: (Para surgery with alkali) This is a para surgical measure capable to perform excision slowly by virtue of its mechanical pressure and chemical action. Mechanism of action -  Kshar Sutra by its action i.e. chemical cauterization and mechanical strangulation of the blood vessel causes local gangrene of the pile mass  tissue and ultimately resulting in falling out of the mass within 5-7 days. The healing of the resulting wound takes 10-15 days.

“Kshara sutra gives the best curative results”

Homeopathy

Homeopathy helps in relieving the pain, discomfort, bleeding and constipation and it also helps in reducing the pile mass. No surgery should be tried without trying homeopathy first.

“High fiber diet,

plenty of fluids,

regular exercise

and
        say   Al Vida to piles.

Wish you a happy, healthy, and fulfilled life !

Link: https://madhuchhandacdmo.blogspot.com/2018/02/piles-haemorrhoids-fleshy-masses.html

* Medicine as suggested above should only be taken under the consultation and supervision of registered medical practitioner.