Hemorrhoids are also known as piles. Hemorrhoids are the swollen blood vessels around the anus. The veins can swell inside the anal canal to form internal hemorrhoids or veins can swell near the opening of the anus to form external hemorrhoids.
Chronic constipation, irregularity of bowel evacuation, and prolonged sojourns on the toilet are thought to be conductive toward piles formation. Pregnancy, because of the pressure of the baby’s head in the pelvis also leads toward hemorrhoid formation.
Hemorrhoids are the most common condition in the anal region and affects 10-15 percent of the populations at one time or another.
Whenever the internal piles pushes out of the anal opening the condition is known as prolapsed hemorrhoids and sometimes blood gets collected in the external hemorrhoids and there they form a clot, these are called as thrombosed external hemorrhoids.
Positions of hemorrhoids – they are usually situated in the 3, 7, 11 o’ clock position, that is left lateral, right posterior and right anterior respectively.
Causes of hemorrhoids
Hemorrhoids symptoms probably result from increased intravenous pressure in the hemorrhoidal plexus (the veins in rectum). Predisposing factors include heart failure, alcoholism, anorectal infections, pregnancy, anal intercourse, and occupations that require prolonged standing or sitting. Other factors include hepatic disease, such as cirrhosis, amoebic abscesses, or hepatitis; loss of muscle tone due to old age, rectal surgery, or episiotomy; and straining due to constipation, diarrhea, coughing, sneezing, or vomiting.
Primary causes mainly include:
- Prolonged Standing position
- Anatomical factors – exerting during act of defecation
- Congenital weakness of vein wall
- Irregular bowel habits
Secondary causes mainly include
- Carcinoma of rectum
- Portal hypertension
Sign and symptoms of hemorrhoids
- Painless bleeding
- Minor trauma causes bleeding
- External piles are painful
- Patient gives history of constipation
- Pruritus is common factor
- Discharge of mucus
- Irritation of perianal skin
Rectal bleeding should be attributed to hemorrhoids only after other more serious conditions have been excluded. Hemorrhoidal bleeding, which typically occurs following defecation and is noted on toilet tissue, rarely leads to anemia; they are painful; only when they are ulcerated or thrombosed.
Diagnosis of hemorrhoids
Hemorrhoids are diagnosed by the client’s history and by examination of the anorectal area. External hemorrhoids can be seen on visual inspection, especially if thrombosed. The client is asked to strain (Valsalva’s maneuver) during the examination to detect prolapse.
Internal piles are usually not palpable or tender on digital examination of the rectum. Anoscopic examination is used to detect and evaluate internal hemorrhoids. For this exam, a speculum or endoscope is introduced into the anus to provide visual inspection of the tissues. Additional diagnostic examination includes testing of stool for occult blood and Sigmoidoscopy, performed to rule out cancer of the colon or rectum, which may aggravate hemorrhoids manifestations or produce similar manifestations. If liver disease with portal hypertension is suspected, liver function studies are ordered.
- Per rectal examination
Treatment for hemorrhoids
- Warm sitz bath
- Increase fluid intake
- Increase dietary fibre
- Stool softness
- Person should not sit for a long duration
- Exercise is helpful in relieving constipation
A high-fiber diet to keep soft is usually all that is needed for treatment of painless bleeding from grade I or II hemorrhoids. Some patients experience local problems with itching or burning, secondary to poor hygiene or edema associated with the hemorrhoids. This often improves with local measures such as diaper wipes, witch hazel pads, and sitz baths. Hydrocortisone cream with or without an anesthetic are popular adjunctive treatment without proven efficacy.
Rubber band ligation is effective for reducible hemorrhoids. The pile is dragged into a hollow chamber and rubber bands deployed off the chamber around the base of the hemorrhoid. Bands are placed are least 5 mm above the dentate line to avoid pain. One hemorrhoids is done at a time, with a 2-to 4 week wait between treatments. About 5-10% of patients experience achy pain and some bleeding, and rarely, pelvic sepsis is seen. Injection sclerotherapy, infrared coagulation, electrocoagulation, and laser treatment have all been used successfully.
Cryotherapy should be avoided because of high complication rate. Rubber band ligation is cheap and has the highest long term efficacy, but it has a higher incidence of postoperative pain than infrared coagulation or injection sclerotherapy. Surgical hemorrhoidectomy is done for patients in which other methods fail. Thrombosed external hemorrhoids present with a visibly swollen, often painful mass that is filled with a firm clot. Patients presenting with acute hemorrhoids symptoms should be treated with prompt evacuation of the clot for pain relief.
Homeopathic treatment for hemorrhoids
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat hemorrhoids but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several well-proved medicines play an important role in treatment for hemorrhoids that can be selected on the basis of cause, sensation and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. Some important homeopathic remedies are given below which are helpful in treatment for hemorrhoids:
Aloe, Sulphur, Nux vomica, Hamamelis, Acetic Acid, Nitric Acid, Calcaria Carb, Phosphorus, Kali Carb, Sangunaria, Lachesis, Alumina, Aesculus Hip, Arsenic Alb, Causticum Diascorea, Podophyllum, Rhus Tox, Collinsonia and many other medicines.
Nitric acid – extremely painful to touch and bleed easily during stool. Sticking, pricking pains as from splinters. Pain is so severe that patient may break in sweat and becomes anxious. Blood from piles is profuse, dark and offensive. Hemorrhoids discharging thin acrid, offensive, yellowish green pus.
Piles associated with diarrhoea. Stools are greenish, slimy, watery and offensive. Stool come out with great straining. Rectum feels full but nothing comes out as expulsion is difficult. Pain as from splinters in the rectum remaining for many hours after stool. Aggravation by cold applications.
Ignatia – prolapse of piles with every stool, have to be replaced, sharp stitches shoot up the rectum. Aggravation for hours after stool. Stitches in hemorrhoids during cough. Hemorrhage and pain aggravate when stool is loose. Pressure as of a sharp instrument from within outwards. Sometimes no pain after a constipated stool.
Aloe soc. – piles protrude like a bunch of grapes with great soreness and tenderness. Constant backache, bearing down sensation in the rectum, sensation of fullness in pelvis. Piles are mostly moist due to constant mucus secretion from the anus. Dark blood after stool. Intense itching and burning in the anus preventing sleep.
Ratanhia – stool must be forced with great effort; protrusion of hemorrhoids. Fissures of anus, with great constriction, burning like fire, as do the hemorrhoids; temporarily relieved by cold water. Fetid, thin diarrhea; stool burns; aching, as if full of broken glass. Anus aches and burns for hours after stool. Feels constricted.
Collinsonia – Sensation of sharp stitches in rectum; sense of constriction, most obstinate constipation, with protruding hemorrhoids; constipation during pregnancy; with membranous dysmenorrhea, following labor.
Kali carb – large, difficult stools, with stitching pain an hour before. Piles, large, swollen, painful. Itching, ulcerated pimples around anus. Large discharge of blood with natural stool. Pain in hemorrhoids when coughing; burning in rectum and anus; easy prolapse.
Sulphur – hemorrhoids blind or flowing dark blood, with violent bearing-down pains from small of back towards the anus; lancinating pain from the anus upward, especially after stool; suppressed hemorrhoids, with colic, palpitation, congestion of lungs; back feels stiff, as if bruised; anus swollen, with sore stitching pains; considerable blood passed with soft, easy stool, painless piles; bleeding, burning and frequent protrusion of the hemorrhoidal tumors; weak digestion, Dysuria; shooting in the rectum stops the breath.
Silicea – piles are intensely painful, boring, cramping from anus to rectum and testicles; protrude during stool, become incarcerated and suppurate; piles protrude with the stool and discharge bloody mucus; can only be returned with difficulty; fistula in ano with chest symptoms; aching, beating, throbbing in lumbo sacral region; anus is constantly damp.
Nux vomica – piles, blind or flowing, irregular piles; stitching, burning or itching of the anus; stitches and shocks in the small of the back, with bruised pain, so that the patient is unable to raise himself; frequent constipation, with ineffectual urging to stool, and with sensation as if the anus were closed and constricted; frequent tendency of the blood to head and abdomen, with distension of the epigastrium and hypochondria; hematuria from suppressed hemorrhoidal flow or menses; ischuria, suppression of urine; backache, must sit up to turn in bed; strangulated.
Muriatic acid – hemorrhoids like a bunch of grapes which look purple and burn when touched. Piles in children; protruding, reddish blue.
Aesculus hip. – painful, blind, or protruding piles of purplish color which are very sore with aching, burning and itching and a sensation of sticks or splinters in the rectum, rarely bleeding. Hard , dry stools passed with difficulty and followed by a feeling of prolapse of rectum. Pain in the back and hips; bleeding gives relief.
Hamamalis – painless bleeding followed by protrusion which is out of all proportion to the loss of blood; the blood is of dark color. There is anemia, breathlessness and weakness not withstanding good appetite.