Hemorrhoids are the tissue cushions present in the anal canal. They contain the blood vessels and the surrounding and supporting tissues, muscles, and fibers. While they are present in everybody, the condition in which the hemorrhoidal veins and capillaries get inflamed is considered to be a health concern. It is commonly known as Piles or Arsha in Ayurveda. It is one of the most common ailments of the rectum, affecting nearly 50% of the population at one point or the other by the time they reach 50. Piles are more common in elderly, and in pregnant women amongst the younger population. However, with sedentary lifestyles and due to increased intake of processed foods, it is becoming common in healthy youngsters as well. In Ayurveda, it is included in the eight great diseases due to the discomfort it produces and due to the difficulty in its management.
Hemorrhoids is an inflammatory disorder
Some people don’t have any symptoms but others have problems like itching, discomfort, and bleeding. In some cases, there will be a clot known as thrombosed hemorrhoid and it needs to be operated or drained. Usually, early symptoms of piles can be treated with dietary and lifestyle changes.
Causes vary from genetic to lifestyle-related
Piles result from chronic and increasing pressure on the veins of the rectum and the anus. There can be several factors for this increased pressure ranging from lifestyle (constant sitting or fiber deficient diets), job requirements (heavy weight lifting), to life stages such as pregnancy and old age. Here are some causes that lead to swollen veins:
- Chronic constipation and constant straining of the muscles to evacuate the bowels
- Constant straining or stretching of the muscles due to irregular bowel habits
- Staying in one position such as long hours of sitting or standing can also trigger piles
- Pregnancy – the pressure from the fetus and hormonal changes cause the hemorrhoidal vessels to enlarge. Also, straining during delivery may also cause the same, however, it can be reversed after some time as the body comes back to normal
- Obesity – which triggers an overall inflammatory response in the body
- Fiber deficient diets such as heavily processed foods and excessive intake of meat products
- Repeated diarrhea & dysentery
- Lifting heavy weights for long periods
- Old Age – as the tissues that support the veins in the rectum and anus get weakened and stretched.
- Psychological factors such as depression that affect the digestive system, assimilation of nutrients, and in the long-term development of piles
Types of Piles or Hemorrhoids
Piles occur when the tissues enlarge, they get weakened and are free of their supporting structure. They are classified per the position of the inflamed area or by the degree of symptoms.
These occur inside the rectum. The person usually can’t see or feel these hemorrhoids, and they hardly cause any discomfort. But these may cause straining or irritation when passing of stool damages hemorrhoids surface and then bleeding starts. Sometimes, due to straining, internal hemorrhoids come out through the anal opening. This is called as a protruding or prolapsed hemorrhoid and you may have pain and irritation. By the degree of management of symptoms, internal hemorrhoids is considered to be:
Degree 1: No mass is visualized, veins become congested during defecation and bleeding occurs.
Degree 2: As the veins enlarge, they are extruded from the canal on defecation, but return at the end of the act.
Degree 3: With further elongation, the veins prolapse on defection and require manual reduction.
Degree 4: In long-standing cases piles mass remain incarcerated.
These are under the skin around the anus. Most of the time getting irritated, external hemorrhoids itch or bleed.
Symptoms of Piles
Usually, the symptoms of piles are not severe. After a few days, they normally get cured with changing some food habits. People having piles may experience the following symptoms:
- A hard, painful swelling may be felt around the anus. It may have coagulated blood. These types of piles are called thrombosed external hemorrhoids.
- Painless bleeding occurs during and after a bowel movement in internal hemorrhoids.
- After passing a stool, the person suffering from piles may experience that the stools are still present.
- The area near the anus is itchy, red, and sore – can happen in both internal and external
- The bowel movement is painful – usually internal
- Presence of mucus in defecation – internal
Complications of Piles
• Too much anal bleeding can cause anemia.
• It can give rise to infection. Piles can cause an anal fistula, in which a new hole is created between the surface of the skin near the anus and the inside of the anus.
• Fecal incontinence occurs in which the bowel movements cannot be controlled.
• Strangulated hemorrhoid occurs, in which the blood supply to the hemorrhoid is stopped, and it gives rise to complications like infection or a blood clot.
Lifestyle Tips for Prevention and Cure of Piles
For Degree 1, 2, and even 3 hemorrhoids, they generally get cured with time once one changes the diet and lifestyle. Also, some treatments can help reduce problems like uneasiness and itching, which many people experience with piles. The best way to check piles is to decrease constipation and keep the stools soft, so that, the bowel movement can be smooth. You can prevent and reduce the symptoms of piles by following these tips:
- Drink enough fluids. Drink around six to eight glasses of water and other liquids such as coconut water and herbal teas.
- Use the toilet in the SQUAT position. If there is no squatting toilet available, use a stool to elevate your feet and bend your knees in the position of squatting. This helps to straighten the lower rectum region while passing the bowel, hence reducing the strain on the veins in the region.
- Stay away from alcohol as it leads to dehydration and aggravation of the symptoms.
- Stay away from excessive meat and STOP processed meat products.
- STOP consumption of excessively spicy food.
- Include light meals that go easy on the digestive system. For this, follow the recipes that are regularly shared on Medhya Herbals Supernutritious Recipes section.
- Eat more fiber-rich foods. Fruits, vegetables, and whole grains are rich in fibers. Eating of more such foods can soften the stool and reduce the straining that can cause hemorrhoids.
- Consider fiber supplements. People those who do not take fiber-rich foods can take natural fiber supplements such as Psyllium Husk. These people should drink at least eight glasses of water or other fluids regularly. If not, the supplements can cause constipation or make it worse.
- Do not suppress the urge to defecate. When you feel the need to pass a bowel movement, go immediately. If you ignore this, the stool may become dry and will be harder to pass.
- Don’t strain while sitting on the toilet seat. Straining and exerting more pressure to pass a stool during constipation can create greater pressure in the veins in the lower rectum. So avoid this.
- Exercise! Physical activity induces multiple chemical and biological reactions in our body releasing several hormones that support the digestive activity. It also increases blood circulation, decreasing the capillary pressures in the veins. Additionally, physical activity makes our muscles strong, hence making them robust against all the harmful effects of piles.
- Reduce weight! Excess weight may exert pressure on the hemorrhoids, hence weight loss helps to relieve the strained veins.
- Reduce extended periods of sitting. Constant sitting makes the muscles weak, severely impacting all motions related to the digestive system. Always make sure to move a little during prolonged sitting periods such as office hours, long flights, and anywhere possible.
- Avoid sitting for too long on the toilet as it can add more pressure on the veins in the anus.
Treatment and Management of Hemorrhoids
The treatment of piles via medicinal plants and lifestyle changes is usually more effective, permanent, and cheaper than the allopathic treatment. Majority of the medications and allopathic treatments as available have multiple side effects and work on alleviating the symptoms rather than removing the cause. Additionally, the surgical procedures when applied can lead to recurrence or incontinence in a majority of the cases.
Medications and Allopathic Treatments
Several medicines are available to reduce the symptoms of an individual suffering from piles. There are certain painkillers, ointments, creams, and pads are given to soothe redness and swelling around the anus.
These medicines do not cure piles but can reduce the symptoms and pain. Do not use them continuously for 7 days in a row, because they may cause further complications like thinning of the skin and more irritation.
Always take the medicines according to the instructions of a doctor.
The doctor may prescribe corticosteroids to reduce inflammation and pain. He may also give laxatives if the person has piles and constipation and it will help the person pass stool more easily.
In some cases, a patient may need to be operated. The doctor may put an elastic band around the piles to stop blood supply and after a few days, it would fall down. Sometimes, injection is given to shrink the piles and ultimately it dries up. When there is excess bleeding in the piles’ tissue, then it is removed by surgery.
Natural Remedies and Ayurvedic Treatments for Hemorrhoids
- Sitz bath – Sitting in warm water at least for 15 minutes daily. It will clean the bowel as well as reduce inflammation. These Ayurvedic medications can be added to the bath – Tankan bhasma, Sphatic bhasma, Triphala kwath, Panchawalkal kwath.
- Laxatives – Daily consumption of Ayurvedic formulations as Triphala, or Psyllium Husk, or Haritaki that work as a laxative and provide essential fiber to soften the stool and nourish the gut flora.
- Ksharkarma: It involves application of a sclerosing agent such as apamarg kshar and snuhi kshar into the hemorrhoid. The kshar shrivels the hemorrhoids and collapses the inflamed vein walls. It has been noted that the success rate of this treatment after four years is ~70%.
- Kashar sutra ligation: This treatment is applied when the lifestyle and dietary changes do not work overtime or if the patient is suffering from acute peripheral conditions requiring immediate treatment. In this method, a medicated herbal coated thread is applied onto internal and external piles mass. It has been observed that the piles mass withers down and falls off within 5-7 days. It has a cure rate ~ 97% with the following additional benefits:
- Simple safe and sure treatment
- No complications with no recurrence
- Economical with a very high success rate
- No antibiotics required
- Daycare surgery
- Useful in all age and cardiac patients
- Ayurvedic medications to promote digestive fire (Agni) – Chitrakadi vati , Lavan baskar churna, Agnitundi vati.
- Arshoghna – Ayurvedic formulations to remove piles mass are Sooranpak, Arshakuthar ras, Shigru guggulu, and Triphlaguggulu. These medications are suggested for Degree 1 and Degree 2 piles. Guggulu as mentioned in two of the medications is one of the best known anti-inflammatory herbs of Ayurveda.
- Apart from this, there are some surgical treatments as Chedan Karma and Agni Karma, which are intrusive and applied only when other methodologies fail. They have not been observed to be fully effective on the recurrence rate, however, they are used in extreme cases.
Foods that should be consumed
- Cow milk, Butter, Buttermilk, Ghee
- Wheat, Rice, Millets
- Fruits and Vegetables
- Green vegetables
- Wood Apple or Bael
- Fibrous vegetables such as jackfruit, lotus root, and Okra
- Digestive System support vegetables as Papaya, Banana, Pointed Gourd, Bottle Gourd etc.
Foods that should not be consumed
Chilies, Fried Foods, Maida (Refined Wheat Flour) products, Non-Veg, Paneer or Cottage Cheese, Constipating foods such as heavily processed foods.
LIFESTYLE CAUSES OF ARSHA (PILES): AN AYURVEDIC REVIEW