HAEMORROIDS – NON SURGICAL INTERVENTION WITH HOMOEOPATHY

 ABSTRACT 

Piles is another term for haemorrhoids. Haemorrhoids are collections of inflamed tissue in the anal canal. They contain blood vessels, support tissue, muscle, and elastic fibers. Piles are certainly one of the commonest ailments that afflict mankind. This article provides an overview of the aetiology, diagnosis, and appropriate general & homoeopathic management of this disorder.

INTRODUCTION

Haemorrhoids are dilated veins occurring in relation to the anus, and originating in the sub epithelial plexus formed by radicals of the superior, middle, and inferior rectal veins. Haemorrhoids may be external or internal to the anal orifice. The external varieties are covered by skin, while the internal varieties lie beneath the mucous membrane. It is difficult to obtain any accurate idea of their incidence, but clinical experience suggests that very many people of both the sexes suffer from haemorrhoids, and that even more perhaps have piles in the symptom less form. It is frequent experiences to find haemorrhoids at routine rectal examination in patients who never had any complaints referable to them. The incidence of piles apparently increases with age, and it seems likely that at least 50% of people over the age of 50 years having some form of haemorrhoidal formation

 

AETIOLOGY

The veins around anus tend to stretch under pressure and may bulge or swell. Swollen veins (haemorrhoids) can develop from an increase in pressure in the lower rectum.

Factors that might cause increased pressure include:

· Straining during bowel movements  

· Sitting for long periods of time on the toilet.

· Chronic diarrhea or constipation

· Obesity

· Pregnancy

· Anal intercourse

· Diet is also a major factor; people who eat foods low in fiber are prone to constipation and hemorrhoid symptoms. Also, people who eat spicy foods may have exacerbation of their symptoms. Some people who simply do not drink enough fluid may suffer from constipation and haemorrhoid symptoms

· Haemorrhoids are more likely as get older because the tissues that support the veins in rectum and anus can weaken and stretch with aging.

· Other diseases like carcinoma of Rectum, cirrhosis of liver, portal hypertension

 

CLINICAL MANIFESTATIONS

Haemorrhoids are usually not painful, but if a blood clot forms, they can be very painful.

Common symptoms include:

· Painless bright red blood from the rectum

· Anal itching

· Anal ache or pain, especially while sitting

· Pain during bowel movements

· One or more hard tender lumps near the anus

· Prolapse of the haemorrhoids is a later development.  It occurs initially at defecation, the piles appearing at the anal orifice at the height of the expulsive effort, and slipping back immediately afterwards. Later the piles tend to remain in a prolapsed condition after the motion has been passed and the patient finds it necessary to replace them digitally into the anal canal. At this stage they are also liable to come down on any exertion such as sneezing, coughing, lifting, walking or on passing flatus, so that the patient may find himself frequently inconvenienced by the piles prolapsing at the various time during the day. Finally a stage is reached when the piles are more or less permanently prolapsed, with anal mucosa exposed and in contact with the under clothing

 

 

 

Grades of internal haemorrhoids

Internal haemorrhoids are classified by the degree of tissue prolapse into the anal canal.

· Grade I (First degree) - haemorrhoids project into the anal canal with minimal bleeding or may be asymptomatic but do not prolapse.

· Grade II (Second degree) - haemorrhoids protrude beyond the anal verge with straining or defecating and reduce spontaneously when straining ceases.

· Grade III (Third degree) - haemorrhoids protrude spontaneously or with straining and require manual reduction.

· Grade IV (Fourth degree) - haemorrhoids chronically prolapse and, if reducible, fall out again. Others prolapse out of the anus and are irreducible (strangulated), creating a surgical emergency

Complications of Haemorrhoids are rare but include:

· Anemia. Chronic blood loss from Haemorrhoids may cause anemia, in which you don't have enough healthy red blood cells to carry oxygen to your cells. This may result in fatigue and weakness.

· Strangulated hemorrhoid. If blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be "strangulated," which can cause extreme pain and lead to tissue death (gangrene).

 

Test and Examination

Tests and procedures to diagnose internal haemorrhoids may include:

· Examination of anal canal and rectum for abnormalities. During a digital rectal exam, physician inserts a gloved, lubricated finger into rectum. He or she feels for anything unusual, such as growths.

· Visual inspection of anal canal and rectum. Because internal Haemorrhoids are often too soft to be felt during a rectal examination, doctor may also examine the lower portion of colon and rectum with an anoscope, proctoscope or sigmoidoscope. These are scopes that allow seeing into anus and rectum.

· Physician may want to do a more extensive examination of entire colon using colonoscopy. This might be recommended if: signs and symptoms suggest might have another digestive system disease, if have risk factors for colorectal cancer, you’re older than age 50 and haven't had a recent colonoscopy.

 

Prevention of Haemorrohids

The best way to prevent Haemorrhoids is to keep your stools soft, so they pass easily. To prevent Haemorrhoids and reduce symptoms of Haemorrhoids, follow these tips:

1. Eat high-fiber foods. Eat more fruits, vegetables and wholegrains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can cause Haemorrhoids or worsen symptoms from existing Haemorrhoids. Add fiber to your diet slowly to avoid problems with gas.

2. Drink plenty of fluids. Drink six to eight glasses of water and other liquids (not alcohol) each day to help keep stools soft. Consider fiber supplements. Most people don't get enough of the recommended amount of fiber — 25 grams a day for women and 38 grams a day for men — in their diet. Studies have shown that over-the-counter fiber supplements, such as Metamucil and Citrucel, improve overall symptoms and bleeding from Haemorrhoids. These products help keep stools soft and regular. If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause constipation or make constipation worse.

3. Don't strain. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.

4. Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.

5. Exercise. Stay active to help prevent constipation and to reduce pressure on veins, which can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that may be contributing to your Haemorrhoids.

6. Avoid long periods of sitting. Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.

 

GENERAL MANAGEMENT

· Soak regularly in a warm bath or sitz bath. Soak your anal area in plain warm water 10 to 15 minutes two to three times a day. A sitz bath fits over the toilet.

· Keep the anal area clean. Bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Soap isn't necessary and may aggravate the problem. Avoid alcohol based or perfumed wipes. Gently dry the area with a hair dryer after bathing.

· Don't use dry toilet paper. To help keep the anal area clean after a bowel movement, use moist towelettes or wet toilet paper that doesn't contain perfume or alcohol.

· Apply cold. Apply ice packs or cold compresses on your anus to relieve swelling.

 

HOMOEOPATHIC MANAGEMENT

The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. Homoeopathy medicines are effective in treating. It is true that this method takes a longer time, but it is also the best one because not only the haemorroids are cured but also the patient.

Indicated Remedies	Indications
Aesculus hippocastanum	When this remedy is needed, Haemorrhoids are sore and aching, with a swollen feeling. Pain may last for hours after the bowels have moved. People who need this remedy often have the sensation of a lump, or a feeling that a lot of small sharp sticks are inside the rectum, poking them. Sharp and shooting pains may be felt in the rectum and back. A person who needs this remedy may also have low back problems.
Aloe	Haemorrhoids that are swollen and protrude “like a bunch of grapes” and are soothed by cold soaks or compresses may be helped with this remedy. Haemorrhoids may alternate with diarrhea, and the person may have a lot of flatulence.
Arnica montana	Sore, bruised-feeling Haemorrhoids may be relieved with this remedy, especially when straining or over-exertion (for instance, childbirth or heavy lifting) has brought on the Haemorrhoids.
Calcarea fluorica:	This remedy may be indicated for Haemorrhoids with bleeding and itching in the anal region, or internal Haemorrhoids causing soreness in the very low back and sacrum. The person may also have problems with flatulence and constipation.
Graphites:	Burning Haemorrhoids with soreness, cracks, and itching in the anal region suggest a need for this remedy. A person who needs Graphites is often overweight, has difficulty concentrating, and tends toward skin eruptions.
Hamamelis:	A raw, sore feeling in the anus, with bleeding Haemorrhoids, indicates a needfor this remedy. Pulsation may be felt in the rectum, and the lower back often aches.Symptoms may be worse from warmth.
Ignatia:	Haemorrhoids accompanied by spasms and stabbing pain in the rectum suggest a need for this remedy—especially if the person is sensitive and emotional. Stitching pains can be felt in the rectal area when coughing. Bleeding and pain are often worse when the stool is loose, and rectal prolapse sometimes follows bowel movements.
Nux vomica:	Itching, painful Haemorrhoids, a feeling of constriction in the rectum, and chronic constipation with ineffectual urging are indications for this remedy. People who need Nux vomica are usually impatient, tense, and irritable, and often have a tendency toward heavy use of stimulants, strong foods, and alcohol or drugs.
Pulsatilla:	When this remedy is indicated, Haemorrhoids are itchy and uncomfortable, with sticking pains. They are likely to protrude, with improvement after lying down. Warmth often aggravates the symptoms. This is a very helpful remedy for Haemorrhoids that appear during pregnancy or around the menstrual period.
Sulphur:	Itching, burning, oozing Haemorrhoids accompanied by a feeling of fullness and pressure in the abdomen suggest a need for this remedy. The anus is inflamed and red and may protrude significantly. The person may feel worse from warmth and bathing, and have flatulence with a strong, offensive odor.

CONCLUSION

Homoeopathy treats the person as a whole. It means that homoeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homoeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. It is true that this method takes a longer time, but it is also the best one because not only the haemorroids are cured but also the patient.

Deep-acting medicines are required to treat the constitution and bring about lasting relief.

MULTI-DIMENSIONAL APPROACH FOR CHILDREN’S URINARY TRACT INFECTION (UTI)

 ABSTRACT

Urinary tract infection (UTI) is one of the most common pediatric infections. It distresses the child, concerns the parents, and may cause permanent kidney damage. The condition can occur occasionally or recur frequently. This article provides an overview of the aetiology, diagnosis, and appropriate general & homoeopathic management of this disorder.

INTRODUCTION

A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. Acute pyelonephritis in children may lead to renal scarring with the risk of later hypertension, preeclampsia during pregnancy, proteinuria, and renal insufficiency. Recurrence of UTI is the most troublesome part. It tends to recur quite frequently in some childrens; so much so that people may have multiple attacks (up to 6-7 ) in one year.

AETIOLOGY

UTIs are generally ascending in origin and caused by perineal contaminants, usually bowel flora. However, in neonates, infection is assumed to be hematogenous in origin rather than ascending. This feature may explain the nonspecific symptoms associated with UTI in these patients. After the neonatal period, bacteremia is generally not the source of infection; rather, UTI or pyelonephritis is the cause of the bacteremia.

Bacteria cause the large majority of urinary tract infections in children. Viral infection of the bladder is less common, while fungal infections of the urinary tract are rare and occur most commonly in immunocompromised individuals

 Bacterial sources include the following:

· Escherichia coli - This is by far the most common organism, causing more than 90% of all cases of acute pyelonephritis

· Extended-spectrum beta-lactamase–producing E coli is becoming more frequent

· Klebsiella oxytoca and species

· Proteus species

· Enterococcus faecalis and species

· Gram-positive organisms, including staphylococcal species and group BStreptococcus- These are rare causes of acute pyelonephritis

 

RISK FACTOR

Until now, High grade Vesicoureteral reflux (VUR) has been considered the most important risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. Reflux nephropathy is not always acquired; rather, it reflects reflux-associated congenital dysplastic kidneys. 

Congenital or acquired anomalies, including dysplasia, hypoplasia, and obstruction, increase the risk for UTI, VUR, and pyelonephritis.

PATHOGENESIS

The exact pathogenesis of renal scarring following acute pyelonephritis is not well understood. the acute inflammatory response that is meant to eradicate the invading bacteria is also responsible for early renal parenchymal damage and subsequent scarring. This process is an inflammatory response that features chemotaxis, phagocytosis, the release of lysosomal enzymes and superoxides, the production of peroxide and hydroxyl radicals, tubular ischemia, and reperfusion injury. The fibrosis that follows is initiated mainly by macrophages.

The pathogenesis of proteinuria in reflux nephropathy is also not well understood, and it is variably attributed to immunological injury, macromolecular trapping and mesangial dysfunction, vascular alterations and hypertension, and glomerular hyperfiltration.

Hypertension occurs in 10 to 30% of children and young adults with renal scarring, and it may take up to 8 years to develop. The exact cause of hypertension due to renal scarring is not known, but it is believed to be due to segmental ischemia with increased renin secretion, and it is not dependent on scarring severity. However, the belief that infection and VUR are the cause of upper tract parenchymal damage is undergoing critical review. Increasing knowledge shows that reflux nephropathy is not always acquired but that it rather reflects reflux-associated damage related to congenital dysplastic kidneys.

CLINICAL MANIFESTATIONS

Signs and symptoms of urinary tract infection (UTI) and pyelonephritis vary with the age of the patient. Neonates often present with nonspecific symptoms of jaundice, hypothermia or fever, poor feeding, vomiting, and failure to thrive. Neonates, especially male newborns, may develop hyponatremia and hyperkalemia as a result of secondary pseudohypoaldosteronism.

Infants and young children aged 2 months to 2 years often present with nonspecific symptoms of fever lasting longer than 48 hours, as well as with poor feeding, vomiting, and diarrhea. Their urine may be malodorous; hematuria may be noted.

Preschoolers and school-age children present with fever for greater than 48 hours. They may complain of abdominal pain or flank pain. Vomiting, diarrhea, and anorexia may be present. Their urine is typically malodorous, and hematuria may be noted. Voiding-related symptoms including enuresis, dysuria, urgency, and frequency, may occur but need not be present.

DIAGNOSIS

Physical examination findings in pediatric patients with UTI can be summarized as follows: Costovertebral angle tenderness, Abdominal tenderness to palpation, Suprapubic tenderness to palpation, Palpable bladder, Dribbling, poor stream, or straining to void

The American Academy of Pediatrics (AAP) criteria for the diagnosis of UTI in children 2-24 months are the presence of pyuria and/or bacteriuria on urinalysis and of at least 50,000 colony-forming units (CFU) per mL of a uropathogen from the quantitative culture of a properly collected urine specimen.

Laboratory studies includes   Complete blood count (CBC) and basic metabolic panel (for children with a presumptive diagnosis of pyelonephritis), Blood cultures (in patients with suspected bacteremia or urosepsis), Renal function studies (ie, serum creatinine and blood urea nitrogen [BUN] levels), Electrolyte levels.

Voiding cystourethrography (VCUG) may be indicated after a first febrile UTI if renal and bladder ultrasonography reveal hydronephrosis, scarring, obstructive uropathy, or masses or if complex medical conditions are associated with the UTI. 

Management

Natural Treatment

· Cranberry Juice produces hippuric acid in the urine. This acidifies urine and inhibits bacterial growth. Try to drink 1 liter of UNSWEETENED cranberry juice daily.

· Take one teaspoon of colloidal silver morning and night. This is a natural antibiotic that destroys bacteria, viruses, and fungal growth.

· Vitamin C acidifies urine and thereby inhibits bacterial growth.

· Celery, parsley, watermelon are natural diuretics – drink juice made with these fruits and vegetables.

· The most important thing is to drink – lots! Pure water is good – try to drink a glass every hour.

· Stay away from coffee, alcohol, all sweetened drinks, sugar, and processed foods.

HOMOEOPATHIC MANAGEMENT

Homeopathic remedies for urinary tract infection has a great role to play in curing the infection and also in stopping their recurrence. Moreover homeopathic medicines are very safe . They use body’s own defenses to fight the infection. Once treated with homeopathic medicines recurrence of Urinary Tract Infection greatly reduces and eventually stops.

A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition.

Indicated Remedies	Indications
Cantharis:	Strong urging to urinate—with cutting pains that are felt before the urine passes, as well as during and after—may indicate a need for this remedy. Only several drops pass at a time, with a scalding sensation. The person may feel as if the bladder has not been emptied, still feeling a constant urge to urinate.
Clematis:	This remedy may be indicated if a person has to urinate frequently with only a small amount being passed. A feeling of constriction is felt in the urinary passage, and the flow may be interrupted, or there may be dribbling afterward. A tingling sensation may occur, lasting long after urination is finished.
Equisetum:	If cystitis is accompanied by dull but distressing pain and a feeling of fullness in the bladder, even after urinating, this remedy may be helpful. Urging and discomfort are more intense when the bladder has recently been emptied, improving over time as the bladder become more full.
Aconitum napellus:	This remedy is often useful when a person feels anxious both before and during urination, with hot, scanty urine, and a burning or spasmodic feeling in the outlet of the bladder. It can also be helpful if retention of urine occurs after a person has been very cold and chilled, or after a shaking experience.
Apis mellifica:	This remedy is indicated when the person frequently needs to urinate, but only small quantities are passed. Stinging and burning sensations are felt (especially with the last few drops) and the person may also experience soreness in the abdomen. Heat and touch make the symptoms worse, and cold applications, cool bathing, and open air bring relief. A lack of thirst is another indication that Apis may be needed.
Belladonna:	This remedy may be beneficial if urging to urinate is frequent and intense, and the bladder feels very sensitive. A cramping or writhing sensation may be felt in the bladder area. Small amounts of highly-colored urine pass. (This remedy is sometimes helpful if a person passes small amounts of blood and no serious cause can be found on medical examination.)
Berberis vulgaris:	Cystitis with twinges of cutting pain, or a burning feeling that extends to the urethra and its opening, may indicate a need for this remedy. The passage may also burn at times when no attempt at urination is being made. After emptying the bladder, the person feels as if some urine still remains inside. Urging and discomfort are often worse from walking.
Borax:	This remedy can be helpful for cystitis with smarting pain in the urinary opening and aching in the bladder, with a feeling that the urine is retained. Children may cry or shriek, afraid to urinate because they know the pain is coming. Borax is often indicated for people who are sensitive to noise and inclined toward motion sickness
Chimaphila umbellata:	If a person has a troublesome urge to urinate but has to strain (or even stand up and lean forward) to make it pass, this remedy may be useful. A scalding sensation may be felt while the urine flows, with a feeling of straining afterward.
Causticum:	In paralytic conditions about the bladder Causticum deserves first place. It is one of our great remedies in enuresis, and its characteristics are involuntary micturition at night in sleep, when coughing, sneezing or blowing the nose, showing a weakness of the sphincter.
Mercurius corrosives	Has tenesmus of the bladder with intense burning. The burning Is less, but the tenesmus is greater, than in Cantharis. The passing of the urine drop by drop reminds of Aconite, which has the same symptoms.
Lycopodium:	This remedy may be helpful if a person has to urinate frequently during the night and passes large amounts of urine. Or the person may feel a painful urge, but has to strain to make the urine flow. Pain may be felt in the back before the urine passes. (If fever is present, the urine has a reddish color, or discomfort is felt in the kidney region, the person should see a doctor.)
Nux vomica:	Irritable bladder with a constant need to urinate, passing only small amounts, suggests a need for this remedy. Burning or cramping pain may be felt in the bladder area, with an itching sensation in the urethra while the urine passes. The person may feel very irritable, impatient, and chilly. Symptoms may be relieved by hot baths or other forms of warmth.
Terebinth:	The urine of Terebinth is one of its most characteristic features. It is smoky, turbid, depositing a sediment like coffee grounds, which indicates the presence of disintegrated blood cells. Haematuria from venous congestion of the kidneys calls often for Terebinth. It has burning during micturition and most painful strangury; the urine, too, may contain albumen and has the odor of violets.
Staphysagria:	This remedy is often useful in cystitis and often helps when symptoms are unclear, or if other remedies have not been effective. Frequent urging is felt, with burning pain at the end of urination. Urine passes when the person is standing up, but only dribbling occurs while sitting. Flakes or sediment are sometimes seen in the urine. (Sarsaparilla is sometimes helpful when stones are forming or the kidneys are involved; however, these conditions need a doctor’s care.)
Sepia:	This remedy may be helpful if a person has to urinate frequently, with sudden urging, a sense that urine will leak if urination is delayed, and small amounts of involuntary urine loss. The person may experience a bearing-down feeling in the bladder region, or pressure above the pubic bone. A person who needs this remedy often feels worn-out and irritable, with cold extremities, and a lax or sagging feeling in the pelvic area.
Sarsaparilla:	This remedy is often indicated for cystitis that develops in a woman after sexual intercourse, especially if sexual activity is new to her, or if cystitis occurs after every occasion of having sex. Pressure may be felt in the bladder after urinating, as if it is still not empty. A sensation that a drop of urine is rolling through the urethra, or a constant burning feeling, are other indications. Staphysagria is also useful for cystitis that develops after illnesses with extended bed rest, or after the use of catheters.
Coli Bacillinum	near specific medicine for treating e-coli infection. It helps in treating the recurrence of E coli Infection.

 

CONCLUSION

In a significant number of children, homoeopathic treatment can help to prevent recurrence of frequent urinary tract infection, thus helping children avoid  renal scarring, hypertension & renal insufficiency, the treatment with homoeopathy has two stages in cases of long standing. acute inflammation needs to be treated with a different set of medicines and its recurrence to be treated once the acute stage is over. deep-acting medicines are required to treat the constitution and bring about lasting relief. it is true that this method takes a longer time, but it is also the best one because not only the urinary tract infection are cured but also the patient.