Hemorrhoids

What are the Haemorrhoids ( Piles )?

It is important to note that all people have hemorrhoidal tissue as part of their normal anatomy. Only in a minority of people do hemorrhoids become enlarged or otherwise symptomatic. Hemorrhoidal tissue lies within the anal canal and perianal area and consists of blood vessels, connective tissue, and a small amount of muscle.

There are two main types of hemorrhoids: internal and external. Internal hemorrhoids are covered with a lining called mucosa that is not sensitive to touch, pain, stretch, or temperature, while external hemorrhoids are covered by skin that is very sensitive. When problems develop, these two types of hemorrhoids can have very different symptoms and treatments.

Symptoms

Roughly 5% of people will develop symptoms attributable to their hemorrhoids and only a small fraction of those patients will require surgical treatment. Patients may experience symptoms caused by either internal or external hemorrhoids or both.

Internal haemorrhoids

Painless rectal bleeding or prolapse of anal tissue is often associated with symptomatic internal hemorrhoids.  Prolapse is hemorrhoidal tissue coming from the inside that can often be felt on the outside of the anus when wiping or having a bowel movement. This tissue often goes back inside spontaneously or can be pushed back internally by the patient. The symptoms tend to progress slowly over a long time and are often intermittent.

Internal hemorrhoids are classified by their degree of prolapse, which helps determine management:   

 Grade One:     No prolapse

 Grade Two:     Prolapse that goes back in on its own

 Grade Three:  Prolapse that must be pushed back in by the patient

 Grade Four:    Prolapse that cannot be pushed back in by the patient (often very painful)

Bleeding attributed to internal hemorrhoids is usually bright red and can be quite brisk.  It may be found on the wipe, dripping into the toilet bowl, or streaked on the stool itself.  Not all patients with symptomatic internal hemorrhoids will have significant bleeding.  Instead, prolapse may be the main or only symptom. Prolapsing tissue may result in significant irritation and itching around the anus.  Patients may also complain of mucus discharge, difficulty with cleaning themselves after passing stools, or a sense that their stool is “stuck” at the anus with Bowel moment.  Patients without significant symptoms from internal hemorrhoids do not require treatment based on their appearance alone.

External hemorrhoids

Symptomatic external hemorrhoids often present as a bluish-colored painful lump just outside the anus and they tend to occur spontaneously and may have been preceded by an unusual amount of straining. The skin overlying the outside of the anus is usually firmly attached to the underlying tissues. If a blood clot or thrombosis develops in this tightly held area, the pressure goes up rapidly in these tissues often causing pain. The pain is usually constant and can be severe. Occasionally the elevated pressure in the thrombosed external hemorrhoid results in breakdown of the overlying skin and the clotted blood begins leaking out. Patients may also complain of intermittent swelling, pressure and discomfort, related to external hemorrhoids which are not thrombosed.

Anal skin tags

Patients often complain of painless, soft tissue felt on the outside of the anus. These can be the residual effect of a previous problem with an external hemorrhoid. The blood clot stretches out the overlying skin and remains stretched out after the blood clot is absorbed by the body, thereby leaving a skin tag. Other times, patients will have skin tags without an obvious preceding event. Skin tags will occasionally bother patients by interfering with their ability to clean the anus following a BM, while others just don’t like the way they look. Usually, nothing is done to treat them beyond reassurance. However, surgical removal is occasionally considered.

What causes symptomatic hemorrhoids?

The majority of factors thought to produce symptomatic hemorrhoids are associated with an increased pressure within the abdomen that gets transmitted to the anal region. Some of these factors include: straining when having a bowel movement, constipation, diarrhea, pregnancy, and irregular bowel patterns. It seems that, over time, these factors may contribute to the prolapse of internal hemorrhoidal tissue or thrombosis of external hemorrhoidal tissue.

Examination

Dr saraja’s ayurveda hospital is having VDO PROCTOSCOPE , which gives proper image of interior of the anal canal and lower part of the rectum. Patient can see the images of haemorrhoids while examining.

Office-based therapies for internal hemorrhoids

The most commonly used office procedures are rubber band ligation, infrared coagulation, doppelr guided haemorrhoidal artery ligation and sclerotherapy. These treatment options are for internal hemorrhoids only and do not apply to external hemorrhoids.

Office treatment of external hemorrhoids

This involves the injection of a local anesthetic (numbing medicine) and excising the hemorrhoidal tissue. The pain associated with a symptomatic, thrombosed external hemorrhoid (see description above) often peaks about 48-72 hours after its onset and is largely resolving after roughly four-five daysExternal hemorrhoids, which are not thrombosed, are generally managed symptomatically, with dietary management and topical agents. Only occasionally are they removed surgically.

Operative procedures

Haemorrhoidectomy( closed and opened).

Stapler haemorrhoidopexy( MIPH).

Laser haemorrhoidopexy.

The above procedures are having mild to moderate complications with recurrence.

According to ayurveda broadly we can compare haemorrhoids with arshas.

susrutha explained four types of procedures to treat haemorrhoids.

Bhesaja chikista( oral medications).

Kshara chikista( herbal caustic medicine application over the internal haemorrhoids).

Agnichikista( excision of haemorrhoids by using thermal energy).

Sastra chikista( surgical procedures).

We at Dr. saraja’s treat the haemorrhoids by using bove methods according to the patient’s condition as a office procedure under local anaesthesia.

Kshara karma is a wonderful technique, in our hospital we have conducted this technique for many patients as a day care procedure. Initially, first 2 days patient complains mild discomfort while passing stools. Patient can do his regular activities from next day onwards. if we examine a patient after 21st day of ksharakarma, we cant find any pile mass inside the anus, no chance of recurrence in a life time.

Laser haemorrhoidoplasty

In our hospital this produre we are doing as a office based procedure.

Under local anaesthesia( peri anal block) by using LASOTRONIX 1470/15W machine ablate the pile masses from its base , hardly it takes 20 min for complete procedure. After 1 hour pt can go home and they can do their regular activities. They can resume their office works after 2 days.

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