Author:
Dr Varsha Vijay Agrawal
M.D.(Hom.), P.G.Diploma Psychological Counselling.
Associate Professor, Hod Surgery Dept.
Takhatmal Shrivallabh Homoeopathic Medical College and Hospital Amravati(M.S)
Haemorrhoids is one of the most ancient disease condition from which the human race is suffering.
It is a chronic and most neglected disease. Animals do not suffer from haemorrhoids, it is said that humans are paying for their erect posture. Globally incidence ranges from 50-80%. In India, it affects around 75% of the population. The most affected age group is middle age and affects both genders.
Haemorrhoids and Piles are synonyms. Haemorrhoids are the Varicose condition of the Veins of anorectum. Varicose means the Veins are congested, dilated, elongated, and tortuous. Haemorrhoids are classified into-Internal haemorrhoids which are above the line dentate line and covered with mucous membrane. External haemorrhoids are below the dentate line and covered with skin whereas Interno-external haemorrhoids are covered with a mucous membrane above and below by skin. Haemorrhoids which are located at 3,7,11 o’clock position is called Primary haemorrhoids whereas haemorrhoids which are located in between primary ones are called secondary haemorrhoids.
as shown in fig. 1
Fig. 1: Primary and Secondary Haemorrhoids
Aetiology: Factors which lead to the development of haemorrhoids are :
- Hereditary: It contributes to the development of piles, as the condition is seen in members of the same family due to the congenital weakness of the vein wall.
- Anatomical: It contributes to the development of piles in humans as superior haemorrhoidal veins lie unsupported in loose submucous connective tissue, these veins have no valves, they have to drain against gravity and these veins are liable to be constricted by contraction of muscles during defecation.
- Constipation: It is a leading factor in the development of piles, a hard stool that requires straining is considered to be a potent cause of haemorrhoids.
- pregnancy: In females piles develop during pregnancy.
The symptoms of haemorrhoids are as follows:
- Bright red painless bleeding per rectum is the principal and earliest symptom and occurs as a ‘splash in the pan’ and it may continue for months. first-degree haemorrhoids in which piles are internal and they do not prolapse outside the anal canal but only bleed.
- Prolapse is a late symptom. It can be second-degree haemorrhoids that prolapse on defecation but return or need to be replaced manually and then they stay reduced.
but later on, haemorrhoids are permanently prolapsed outside the anal canal and are called third-degree haemorrhoids. (as shown in Fig. 2)
- Mucous discharge from the engorged mucus membrane which causes pruritis.
- Anemia is caused by bleeding.
Fig. 2 :Third degree haemorrhoids
Diagnosis of Haemorrhoids is based on a detailed history and a careful clinical examination which includes digital examination which helps to exclude other disease conditions like anorectal mass and secondly proctoscopy should be done in sim’s left lateral position to visualize haemorrhoids.
MIASMATIC Understanding
- Piles are Generally Syco-psoric.
- piles are Classed under psoric miasm when they are associated with discomfort and itching.
- Rectal haemorrhoids with extreme sensitiveness and pain are classed under sycosis.
- Haemorrhoids with putrid and fetid discharge are classed under syphilis.
- Bleeding haemorrhoids with changing symptomatology are tubercular.
Treatment of Haemorrhoids
In the treatment of haemorrhoids, constitutional homeopathic medicines along with dietary and lifestyle modifications play a vital role. Hard stool causes damage to anal cushions and so increase intake of fibers or adding bulk in the diet helps in avoiding straining during defecation. Diet must include green leafy veggies, plenty of fruits and fruit juices, and at least 2-3 liters of water per day. Lifestyle modification which includes regular exercise, avoid sedentary habits, improving anal hygiene, avoid long sitting in toilets and reading newspapers in the toilet, and regular bowel habits.
Homoeopathic medicines that are commonly used in cases of haemorrhoids are discussed below, which are selected on basis of symptom similarity.
Nux Vomica
- Bleeding piles with great itching of rectum keeping patient awake at night, compel him to sit in a tub of cold water for relief.
- Ineffectual urging to stool, unsatisfactory stool
- The reason for the development of haemorrhoids is the use of strong medicines, spices, wine .leading a sedentary life, and constipation.
- nux vomica patient does a great deal of mental work leading a sedentary life which causes haemorrhoids. The patient is very sensitive to all impressions. The patient is very irritable, fastidious, zealous, and quarrelsome.
- piles are aggravated by spices, overeating, wine, and stimulants and relieved by sitting in cold water.
- nux vomica is the best medicine to start treatment of cases that have been drugged by quacks medicines if symptoms correspond.
- Analogue of NV in haemorrhoids is Aesculus hippo
Aesculus hippocastanum
- This remedy has marked action on lower bowel causing engorgement of haemorrhoidal veins with characteristic backache and absence of actual constipation.
- It is a remedy for both bleeding and non-bleeding piles.
- Abdominal plethora -causing deep throbbing pain
- Dryness of rectum as if sticks or splinters were pricking the folds of the mucous membrane
- Weak feeling at sacroiliac symphysis as if the back was about to give out at this point, because of backache patient is Unfit for business.
- Stool – large hard, dry so anus is raw and sore.
Sulphur
- sulphur are people having a dirty filthy look of skin with is prone to skin problems.they are having aversion to bathing. they are depressed irritable aversion to business. delusions think rags as beautiful things. The main action of this remedy is on venous circulation producing a plethora
- Sudden cessation of bleeding from haemorrhoids and patient complaints of the fullness of head and liver
- Burning and itching at anus
- Burn like fire relieved by heat with great prostration
- Stitching pain when walking or sitting but not at stool, preventing sitting or sleeping
- Redness around the anus is marked feature
- A frequent unsuccessful desire for stool
- Stools –hard and knotty, pt is afraid of defecation because of pain
- Morning diarrhoea with bleeding per rectum, painless drives pt out of bed at times with rectal prolapse
- Patient has desire for sweets.
Aloe Socotrina
- Suited to old persons leading a sedentary life aversion Aversion to physical and mental work, old beer drinkers. people who are dissatisfied and angry about themselves.
- Acts entirely on rectum producing catarrh of its mucous membrane
- piles are due to bad effects of sedentary life and drinking alcohol which causes portal congestion
- Piles like Bunch of grapes, bluish in color,bleeding profusely relieved by cold water
- Piles are tender, sore, and hot to touch.
- The patient passes stools without efforts almost unnoticed. They are watery jelly-like with mucous accompanied with the expulsion of copious flatus this is because of loss of power of sphincter ani
Collinsonia
- Pelvic and portal congestion, resulting in haemorrhoids and constipation esp. in females
- Piles during pregnancy with pruritis
- A sensation of sharp sticks in rectum with constipation from the inertia of lower bowel
- Most obstinate constipation stool is dry and hard with protruding piles
- Painful bleeding piles
- Chest pain alternates with haemorrhoids
- After heart symptoms, relieved piles return
- Prolapse of uterus complicated with haemorrhoids
- In heart disease complicated with piles when cactus, digitalis, and other remedies fail to think of Collinsonia.
Hamamelis
- Hamamelis is said to be Aconite of the venous
capillary system.
- This remedy has a special affinity for bleeding piles and so used for stopping bleeding from piles
- Bleeding Piles with marked soreness
- Passive haemorrhage which is dark.
- because of bleeding patient suffers from Prostration but it is out of proportion to the amount of blood lost.
- Back feels as if it would break.
- Anus feels raw and sore. This soreness is a keynote symptom in prescribing this drug and second is passive haemorrhage which occurs from any orifice of the body.
Nitric Acid
- Nitric acid patient is irritable headstrong and sensitive to noise, pain, and touch.
- The main seat of action of this remedy is the-junction of skin and MM-ie ANUS
- Bleeding piles, the character of blood is bright red blood in color.
- There is a protrusion of piles with every stool.
- Violent cutting pain after stool lasting for hours after stool.
- A sensation of splinters or sticks in the anus. Rectum feels torn
- The patient suffers from constipation that leads to the development of piles and fissure.
- Ineffectual urging for stool.
- After the stool pt is irritable and exhausted.
- General weakness and debility, feeble reaction, extreme sensitivity are marked features of this remedy.
- All symptoms in nitric acid patients are better by riding in a carriage.
Paeonia
- The main seat of the action of this remedy is rectum and anal canal.
- Indicated in haemorrhoids Fissures, fistula with Great oozing from anus keeping anus damp and disagreeable all the time. There is itching and biting at anus with swelling of anal orifice.
- There is great Burning in anal orifice after stools which are lasting for hours after stool, and to get relief patient must walk the floor all night.
- Diarrhoea with anal burning and chillness
Ratanhia
- Haemorrhoids temporary relieved with cold water
- Recommended for fissure in ano when there is great constriction of anal orifice.
- The stool which requires great efforts to pass, anus aches and burns for hours, Burning as like fire.
- Typical sensation in the rectum as if the rectum is full of broken glass pieces.
- Burning before and after stool lasting for hours after motion.
- This remedy is frequently used in cases of the fissure to relieve the typical burning pain in a fissure in ano
References:
- Bailey and Love’s, short Practice of surgery( 23rd edition)
- SRB’s Manual of SURGERY, Shriram Bhat M(2nd edition)
- Pocket Manual of Homoeopathic Materia Medica with Repertory, William Boericke(Indian edition)
- Miasmatic Prescribing, Dr. Subrata Kumar Banerjea( 2nd extended edition)
- Lectures on Homoeopathic Materia Medica, J.T.Kent(reprint edition1993)
- Clinical Materia Medica, E.A Farrington(fourth edition)
