Haemorrhoids is a very common anorectal diseases which we encounter daily in our clinical practice. The prevalence of haemorrhoids is extremely high with millions affected worldwide. However, the true burden of many patients is difficult to capture because of various personal, cultural and socio-economic reason. It is very essential to measure the various symptoms of patient quantitatively in any study in order to understand the condition more extensively and for valid statistical inferences. This article focuses on understanding the various tools or parameter used in probing for the assessment of haemorrhoidal symptoms and important homoeopathic remedies in the treatment of haemorrhoids.
Haemorrhoids, diagnostic criteria, assessment tools, homoeopathic medicine.
Haemorrhoids is defined as the symptomatic enlargement or distal displacement of anal cushions.1 The word ‘haemorrhoid’ is derived from the Greek word haema meaning blood and rhoos as flowing. It was probably Hippocrates who was the first to apply this name to the flow of blood from the veins of the anus around 460 BC.2 Unlike usual belief it is not a varicose veins.3 Worldwide, the prevalence of haemorrhoids in the general population is estimated to be 4.4% and is mostly seen in the age group of 30-60 years.2 In India, with the advent of western culture and lifestyles the condition seems no better despite diet being richer in fibres, that is, 2.4 – 40%.4 Common symptoms include pain, itching, swelling, anal discomfort, and rectal bleeding. Heamorrhoids may be internal or external based on its location above or below the dentate line in the anal region. The condition affects 39%-52% of adults.5The natural evolution of haemorrhoids is benign but haemorrhoids tends to get worst over time and if untreated can potentially pose serious medical problems and can be a symptom of a bigger problem.6 Temporary relief and complication of modern medication and surgery has made many to seek permanent safe alternative system of medication. In homoeopathy, haemorrhoids are treated not as a local affection but as a derangement in the vital energy that result in diseased condition, for which the concept of individuality is considered in each cases. Aphorism 12 of 6th edition Organon of medicine states that “It is the morbidly affected energy alone that produces diseases.”7 It is essential and important for every clinicians to understand and consider certain factors and parameters used for the overall clinical decision making or in any clinical researches for studies. Diagnostic criteria:
• Bright red painless bleeding.
• Perianal pain.
• Mucus discharge and soiling.
• Itching or soreness around the anus.
• History of constipation and straining during defecation.2
• Internal haemorrhoids are graded based on appearance and degree of prolapse:
Grade 1: bleed only, no prolapse.
Grade 2: prolapse, but reduces spontaneously.
Grade 3: prolapse and have to be manually reduced.
Grade 4: Permanently prolapsed.
• Per digital rectal examination and
• Proctoscopic or anoscopy examination.
• Rectal pain can be assess according to visual analogue scale of 0-10 (0= no symptoms and 10= worst possible symptoms).
• Symptoms of heaviness, pruritis, discharge, pain (including discomfort and tenesmus during and other than at the time of defecation) and bleeding can be assess using a pain score ranging from 0(no symptoms)-10(worst pain), where a symptom score between 8-10 regarded as 2 points, between 5-7 as 1 point and between 1-4/no symptoms as 0 points.8
• The Severity of bleeding can also be assess on a scale of 0-2 (2= severe, if it occurred more than 5 times a week, absent, 1= mild, if it occurred 3 to 5 times a week, 0=mild or absent, if it occurred less than 3 times a week.8
• Severity of bleeding can also be assessed on a scale of 0-3 (3= severe, if it occurred more than 5 times a week, absent, 2= moderate, if it occurred 3 to 5 times a week, 1=mild, if it occurred 1 to less than 3 times a week, 0=no bleeding)4
• Pain, heaviness, discharge and itching can also be measured on a Visual Analogue Scale ranging from 0-10 (0=no symptoms and 10=worst possible symptoms).4
• Anoscopic examination on a scale of 0-2 (o=no sign of inflammation,1=mild anitis and 2=severe anitis).4
• World Health Organization Quality of Life-BREF (WHOQOL-BREF) to measure the changes in quality of life.
1. Aesculus hippocastanum
Indicated for person with haemorrhoidal tendencies and who suffer with gastric, bilious or catarrhal troubles. Dryness and heat of rectum feels as if full of small sticks knife-like pain shoot up the rectum (Ign,Sulph). Blind haemorrhoids, rarely bleeding, burning, purlish.9 Engorged haemorrhoidal veins with characteristic backache (severe dull backache in lumbosacral articulation) and absence of actual constipation.10 Useful after Nux vomica have improved, but failed to cure piles. After Collinsonia has improved piles, Aesculus often cures.9
2. Aloe socotrina
Adapted to indolent ‘weary’ persons, old people, especially women of relaxed phlegmatic habit, who averse to either mental and physical labor. Haemorrhoids protrude blue like a bunch of grapes (Murc acid)9 constant bearing down in rectum, bleeding, intense itching and burning in anus preventing sleep (Indg)9 relieved by cold water. Feeling of weakness and loss of power of sphincter ani, sense of insecurity of rectum when passing flatus.Complementary: Sulphur. Antidote: Opium and Sulphur.10
The pelvic and portal congestion resulting in haemorrhoids and constipation, especially in females. Sensation of sharp sticks in the rectum, very obstinate constipation with protruding haemorrhoids, itching in the anus (Teucr,Ratahnia).10 Haemorrhoidal dysentery with tenesmus,chronic,painful,bleeding pile,sensation as if sticks,sand or gravel had lodged in rectum (Aesc). In heart diseases complicated with haemorrhoids consult Collinsonia when Cactus, Dig. And other remedies fail.9 antidote: Nux vomica.
4. Hamamelis virginiana
Indicated to patient subjected to varicose veins, taking cold easily from every exposure especially in warm, moist air and venous haemorrhage from every orifice of the body.9 Venous congestion and haemorrhoids with bruised soreness of the affected parts seems to be special sphere of this remedy. Anus feels sore and raw, bleeding profusely, pulsating in the rectum.10 Complementary: Ferrum. In hemorrhages and the hemorrhagic diathesis. Antitode: Arnica.
It is best adapted for light-haired person, skin and muscles lax. Ailments after insect stings, vapours of arsenic or copper, diseases occurring in winter.9 greenish, bloody and slimy, aggravated worse at night, from warm of bed, damp, cold, rainy weather, during perspiration, pain and tenesmus, never get done feeling.10Follows well after: Sulphur, Lachesis, Hepar sulph., Bell. But should not be given before or after Silica.9
6. Muriaticum acidum
Person with black hair, dark eyes, dark complexion. If anus be very sensitive either with or without haemorrhoids anus sore during menses. Haemorrhoids blue, swollen very sensitive and painful to touch, even sheet of toilet paper is uncomfortable and prolapse while urinating.9Aggravated more during pregnancy, bluish, hot with violent stitches. Antitode: Bryonia.10 Follows well after: Bryonia, Rhus tox and Merc.
7. Nitric acidum
Suited to thin person of rigid fibre, dark complexions, black hair and eyes, the brunette rather than the blonde nervous temperament. Person suffering with chronic diseases who take cold easily, disposed to diarrhoea, rarely to those who suffer with constipation. Pain as if rectum were torn or fissured (Nat mur.), aggravated after stool, violent cutting pain, lasting for hour (Ratanhia and Suplhur).9 As Nitric acid patient begins to improve, skin symptoms may appear for a time, a favourable indication.10 Inimical: Lachesis. Complementary: Arsenic, Caladium, Lac can., Sepia.
8. Nux vomica
One of the best remedies with which to commence treatment of cases that have been drugged by mixtures, bitters, vegetable pills, etc but only if symptoms correspond. Adapted to thin, irritable, careful, zealous person of ardent character with dark hair and bilious or sanguine temperament.9 Blind haemorrhoids, itching with ineffectual urging to stool, feeling as if a part remained unexpelled. Constriction of rectum, irregular, peristaltic action. Absence of all desire for defecation is a contraindication. Complentary: Sulphur and Sepia.10 Inimical: Zinc, must not be used before or after.
9. Paeonia officinalis
The rectal and anal symptoms are most importantly marked. Itching, bitting, orifice swollen, burning in anus followed by internal chilliness. Ulceration of the anus and oozing offensive moisture on the perineum, purple, covered with crusts. Atrocious pains after stool. Antitode: Ratanhia and Aloes.10
10. Ratanhia peruviana
Aches as if full of broken glass. Dry heat in the anus with sudden knife like stitches. Burns for hours after stools. Temporarily ameliorated by cold water application. Bowel inactive, constipation, stool hard with great straining, protrution of haemorrhoids followed by long lasting aching and burning in anus (Sulphur).9 locally, the cerate has proved invaluable in many rectal complaints.10
Ailments after abuse of mental generally, indicated to persons of scrofulous diathesis, subjected to venous congestion especially of portal system. Haemorrhoids that have been treated with ointments. Itching and burning, oozing and belching. Piles dependent on abdominal plethora. Redness around the anus with itching. Morning diarrhoea, painless, drives him out of bed with prolapse recti. Complementary: Aloe. and Psorinum. Calcarea must not be used before Sulphur.
Homoeopathy plays a very vital role in the management of haemorrhoids.
To give a valid outcomes more scientifically it is certainly essential for every clinicians to make use of specific tools and parameters for an accurate interpretation and results.
1. Lohsiriwat V.Treatment of haemorrhoids: A coloproctologist’s view. World Journal of Gastroenterology. 2015; 21(31): 9245-9252.
2. A.F Najar, M. Faisal, A. Khesal, A.T Ansari. Prevalence of haemorrhoid among the patients visiting surgery opd at NIUM hospital. Ejbps.2018;5(1): 435-437.
3. Pande K.P, Dhruv Y. A study of surgical profile of patients undergoing haemorrhoidectomy. International Surgery Journal. 2017; 4(9):2947-2951.
4. Chakraborty P.S, Varanasi R, Majumdar K.A, Banoth K, Prasad S, Ghosh S.M, et al. Effect of homoeopathic LM potencies in acute attack of haemorrhoidal diseases: A multicentric randomized single-blind placebo-controlled trial.Indian Journal of Research in Homoeopathy.2013;7(2):72-80.
5. Das D.K, Ghosh S, Das K.A, Ghosh A, Monda R, Banerjee T, et al.Treatment of haemorrhoids with individualized homeopathy: An open observational pilot study. Journal of Intercultural Ethnopharmacology. 2016; 5(4):335-342.
6. Gami B. Hemorrhoids- A common ailment among adults, causes & treatment: A review. Int J pharm pharm sci.2011; 3(5):05-12.
7. Hahnemann S. Organon of medicine. Sixth edition. New Delhi: Indian books and periodicals publishers;2010.
8. Yuksel C.B, Armagan H, Berkem H, Yildiz Y, Ozel H and Hengirmen S. Conservative management of haemorrhoids: A comparison of venotonic flavonoid micronized purified flavonoid fraction (MPFF) and sclerotherapy. Surgery today.2008;38:123-129.
9. Allen H.C. Allen’s keynotes rearranged and classified with leading remedies of the material medica and bowel nosodes including reportorial index. Tenth edition. New Delhi: B. Jain publishers(P) ltd;2017.
10. Boericke w. Boericke’s new manual of homeopathic materia medica with repertory.Third reviews and augmented edition. New Delhi: B. Jain publishers (P) ltd; 2014.
Author with correspondence address:
Dr. Eyingthung Odyuo
Dept of Organon of Medicine
Govt. HMC&H, Bengaluru