Management of Haemorrhoids with Homoeopathy – A Case Report
A Case of Hemorrhoids’ Treated With Aesculus Hippocastanum
Abstract
A female patient presented with the complaints of bright red bleeding from rectum, lump in anus, constipation since childhood, she had not taken any treatment before. Considering the totality of symptoms, Aesculus Hippocastanum 30CH was prescribed which proved effective and resulted general improvement and relief was observed from first follow up.
Keywords
Homoeopathy, Hemorrhoids, Constipation, Aesculus Hippocastanum,
Introduction-
Hemorrhoids are enlarged veins located in the lower part of the rectum and the anus. External hemorrhoids originate below the dentate line, while internal hemorrhoids are above the line and are classified according to their degree of prolapse from the anal canal. [1]
Grades of Hemorrhoids
Grade I – Visualized by anoscopy, there is bulge into the lumen but do not extend below the dentate line,
Grade II- prolapse out of the anal canal with defecation or with straining but reduce spontaneously Grade III – prolapse out of the anal canal with defecation or straining, and require reduction,
Grade IV – are irreducible and may strangulate. [2][3]
It is important to differentiate a hemorrhoids from other growths like anal papillae or polyps. Polyps are usually asymptomatic but occasionally grow large enough to be felt by the patient or are likely to prolapse. Hypertrophied anal papilla, composed of a smooth mass located near the anal verge, is also considered a differential diagnosis especially in a patient with a history of chronic anal irritation or infection. [4]
About 75% of people have hemorrhoids at some point in their lives [5]. Hemorrhoids is most common among adults aged 45-65. [6]
About 80% of people in India develop hemorrhoids and about 80% aged over 50 have some form of symptomatic hemorrhoidal disease.
Over three-quarters of individuals in the United States have hemorrhoids at some point in their lives, and about half of the population over age of 50 requires treatment [10] Some common symptoms include bleeding from the rectum, anal itching, general discomfort and an external anal protrusion. Patients who are suffering from this condition should be treated quickly and monitored carefully in order to prevent the development of infections associated with the condition for which homoeopathy is effective. [7]
Surgical procedures like haemorrhoidectomy open method, closed method, stapler haemorrhoidectomy, Doppler guided hemorrhoidal arteryligation are available but some severe complications can occur. [10]
Septic complications following both conservative and surgical treatment of hemorrhoids are rare but may be catastrophic. [8]
Globally, over 600 million people use homoeopathy as a system of medicine to treat ailments. Of this, about 100 million are Indians and by 2017. [11]
Under classical Homeopathic treatment, hemorrhoid patients improve considerably in their symptoms severity. [9]
Case Report
A 35-year-old married woman, housewife,presented with bleeding per rectum, Stitching type of pain++ in the anal region
Intolerable pain
No discharge or bleeding
Sensation as if the mass is protruding and blocking the anal canal
Aggravated while walking+ and sitting
Amelioration–none
Local examination
On inspection, there was a protrusion of a mass, possibly two with swelling around the anal orifice and blue in colour. No discharge/bleeding from the affected site [Figure 1].
She reported intense pain and tenderness
Diagnostic assessment
Complaints of the patient and local rectal examination suggested a diagnosis of external haemorrhoids. The BPRST classification was used to evaluate and grade the most frequent complaints.
Totality of symptoms
- Mass protruding from the anal canal without bleeding or discharge
- Mass protruding from the anal canal is bluish in colour
- Sensation as if a mass is protruding and blocking the anal canal
- Stitching type of pain in the anal region
- Aggravation from walking and sitting
Constipated stools were difficult to evacuate
Repertorial totality
- Rectum – Haemorrhoids – External
- Rectum – Haemorrhoids – Protruding – Prolapsed
- Rectum – Haemorrhoids – Bluish
- Rectum – Haemorrhoids – blind
- Rectum – Pain – stitching, sharp
- Rectum – Haemorrhoids – Walking – Aggravation
- Rectum – Haemorrhoids – Sitting – Aggravation
- Rectum – Constipation – Difficult stool.
Repertorial analysis was done with complete repertory using Hompath classic version 8.0
Figure 2: Repertorial sheet using hompath classic software,
Therapeutic intervention
After acute case taking and repertorial analysis, A. hippocastanum, Sulphur and Muriaticum acidum were found to cover the symptoms of the patient. The patient did not complain about itching and burning, therefore, Sulphur was ruled out. Muriaticum acidum is mostly indicated in involuntary evacuation of faeces while urinating along with itching and bleeding haemorrhoids, which were not seen in the patient. Finally, after thorough Materia Medica differentiation A. hippocastanum was prescribed as a pathological prescription considering its action on the rectal veins; the haemorrhoidal vessels become intensely congested. This leads to violent inflammation of the anus and rectum, producing haemorrhoids in their most aggravated form. Aesculus also covers most of the symptoms like large blue-coloured haemorrhoids which block up the rectum, with sharp stitching pain in the anus, and no tendency to bleed, all of which were seen in our patient.
Accordingly, in this case, 30C potency was prescribed for a day with three doses
Follow-ups and outcomes
Changeability in symptoms, BPRST classification and staging were done at every follow-up. Details are shown in [Table 3].
Table 3: Follow-ups and outcomes
| S. No. | Date of visit | Symptoms | Prescription |
|---|---|---|---|
| 1 | First visit 29 November 2023 | Intolerable stitching type of pain and tenderness in the anal region with feeling as if some mass is protruding and blocking the anal canal, aggravated by walking and sitting with constipation for a long time | Aesculus hippocastanum 30C Thrice a day |
| 2 | 30 November 2023 2nd day | After two doses of medicine, pain had reduced to 50%, Bowels were satisfactory. No any new complaints were noted | Placebo 30/2 days/Thrice a day. The patient was asked to report after 2 days |
| 3 | 1 December 2023 4th day | Pain in anal region still persists. No new complaints were noted | Aesculus hippocastanum 30C/3 doses/thrice a day./7d |
| 4 | 10 December 2023 | After taking one dose of medicine, Pain and tenderness in rectum is reduced. Feeling of protrusion of mass from anal canal only during passing stools and spontaneously reduced after passing stools. Bowels: clear | Placebo/thrice a day/1 month |
| 5. | 18 January 2024 | All complaints recovered. No new complaints were noted | Placebo/1 week/Thrice a day |
Figure :18 January 2024
Discussion
External haemorrhoids are always considered to be effectively managed with surgery. However, in this case, the patient opted for homoeopathic treatment. Consideration of the patient’s most peculiar presenting symptoms and pathological changes indicated A. hippocastanum.In this case, after the third visit, the complaints had not improved further; hence, we repeated the same medicine and potency with the instructions to stop the medicine once the pain reduces. Later, a single dose of medicine helped to improve the patient’s complaints subjectively; objectively, changes were observed as well.
CONCLUSION
This case experience emphasises the role of homoeopathy in cases of haemorrhoids, preventing surgery. Consideration of pathological phenomena in the evolution of disease helped
Reference-
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