HAEMORROIDS (PILES) – A HOLISTIC NON-SURGICAL HOMOEOPATHIC APPROACH

     Haemorrhoids (also known as Piles) are certainly one of the commonest ailments that afflict mankind. 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

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. 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.