
Abstract
HAEMORRHOIDS (Greek: haima = blood; rhoos = flowing, synonym: Piles, Latin : pila = a ball ) . Haemorrhoids or Piles are one of the common diseases encountered in our practice these days. Sedentary Lifestyles with inclination towards Fast food , diet lacking Fibre , Mental stress leads to Constipation causing undue stress at Anal verge and thereby causing bleeding per rectum i.e Haemorrhoids .
Homoeopathy is based on Holistic approach where we consider the Patient as Whole including his Mental , Physical and Particular Symptoms in toto. This Article is Focused on the management of cases of Haemorrhoids with Homoeopathic therapeutics.
Keywords: – Haemorrhoids, Piles , Homoeopathy , Holistic approach .
Introduction
Haemorrhoids are defined as the dilated plexus of superior haemorrhoidal veins, in relation to anal canal. It is due to displacement of anal cushion and mucosal trauma. In general terms it is also referred to as swollen veins of rectum around the anal verge .
Both male and female have almost equal frequency of having haemorrhoids while old age , obesity , pregnancy , constipation and people with sedentary lifestyle are more disposed to have haemorrhoids.
Dr. hahnemann in aphorism 80 of organon of medicine (5th and 6th edition of ) mentions psora as the monstrous internal chronic miasm “the real fundamental cause and producer of all innumerable forms of disease” and also included haemorrhoids as a manifestation of psora itself.
Considering the surgical domain, hemorrhoids of grade 4 may be advised for surgical opinion due to having risk of complication associated with it. Even in those grade 4 haemorrhoids , after surgery , homoeopathic medicine can supplement a path for quick recovery of the patient.
Haemorroids of grade I , II , III can be managed efficiently by proper individualised examination of case and thereby selection of Homoeopathic simillimum based on totality of symptom of the case.
Aetiological Factors:
- Hereditary
- Mental Stress
- Sedentary lifestyles , lack of Dietary fibre intake leads to constipation and straining during act of passing stool leads to development of Haemorrhoids.
- Old age leads to loss of elasticity of the Anal cushion and thereby causes Piles.
- Pregnancy is also associated with development of piles due to increase in intra abdominal pressure .
Types of Haemorrhoids based on location :-
- Internal Haemorrhoids: – lies above the Dentate line, covered with mucous membrane.
- External Haemorrhoids: – lies at Anal Verge, covered with Skin.
- Interno – external: – both internal and external haemorrhoids together.
Classical Position
3, 7, and 11 o’ clock positions with the patient in the Lithotomy position (Left Lateral, Right Posterior and Right Anterior position respectively.)
Clinical Features
- Bright –red, Painless bleeding (fresh splash in the pan)
- Mucus discharge
- Prolapse
- Pain only on prolapse
Degrees of Haemorroids
1) First Degree – Bleed only, No prolapse.
2) Second Degree – Prolapse but Reduce Spontaneously.
3) Third Degree – Prolapse and have to be manually reduced.
4) Fourth Degree – Permanently prolapsed.
Investigations
- Per –Rectal Examination: – Mainly to rule out Carcinoma rectum and other causes of bleeding per rectum.
- Proctoscopy: Haemorrhoids appear in the proctoscope as CHERRY RED MASSES.
General Management
- Take 3 -4 litres of water daily.
- Take Green- Leafy vegetables , cucumber and fibre rich food in Diet.
- Avoid fried , Spicy food.
- Do not strain during defecation, do not ignore the urge for defecation.
Case Report
A Female of age 60 years with Registration No.: – 38195, Hindu, resident of Raaja Paakar District Vaishali visited OPD of RBTS Govt. Homoeopathic Medical College and Hospital, Ramdayalu Nagar Dist.- Muzaffarpur, Bihar with Complain of: –
Presenting Complaint:
- Pain in Anal region while passing stool since 20 days
- Pain at Lumbo –Sacral region since 20 days
History of Presenting Complaint:
Patient was apparently well 20 days back when she started complaining of:
- Pain in Anal region while passing stool with protrusion of mass per rectum on straining which reverts back of its own.
Onset – Sudden
Sensation – Stitching Type of Pain
Modality: – aggravation after passing stool
Concomitant: – N.S
Bleeding: – Absent at present (previous history of bleeding per rectum few months back as per patient)
2) Pain at Lumbo –sacral region.
< walking
>lying down
Past History: Hysterectomy done in 1995 due to Fibroid?
Family History: Nothing Specific.
Physical Generals
Appetite: 3 meal / day
Desire – sweet
Aversion – Nothing Specific
Thirst – 2-3 litre per day (drink 1 glass at a time at long interval)
Stool :- Day (twice), Night (0 – 1) , Satisfactory , Normal Consistency
Urine :- Day ( 5 – 6 times ) , Night ( 1-2 times ) , No characteristic odour
Tongue :- Clean, Moist
Perspiration :- Mostly in summer , whole body , non -offensive
Thermal Reaction: – Towards Hot
Totality of Symptoms
- Pain in anal region (< after passing stool)
- Sensation: – Stitching type of pain
- Haemorrhoids – Blind
- Pain in Lumbo-sacral region < Lying Down: < Walking
- Desire: – Sweet (+ 3)
Provisional Diagnosis: – Haemorroids (ICD- 11 Db 60)
Analysis, Evaluation and Miasmatic Analysis
S.N | SYMPTOMS | COMMON | UNCOMMON | GRADING | MIASMATIC ANALYSIS |
1) | Pain in Anal region after Passing Stool | + | +2 | Psoric | |
2) | Stitching type of Pain in Anal region | + | +2 | Psoric | |
3) | Blind Haemorrhoids | + | +3 | Psoric | |
4) | Pain in Lumbo-sacral <Lying | + | +2 | Psoric | |
5) | Pain in Lumbo-sacral <walking | + | +1 | Psoric | |
6) | Desire – Sweet | + | +3 | Psoric |
Repertory Used : Complete Repertory
Rubric taken:
- Rectum – Pain – Stool -after
- Rectum – Pain – stitching
- Rectum – Haemorrhoids – blind
- Back – Pain – Lumbar region – Lumbago – Lumbosacral region
- Back – Pain –Lumbar region –Lumbago- Lying while
- Back – Pain –Lumbar region –Lumbago- walking-while
- Generalities – Food and Drinks – sweet desire
Repertorial Analysis:
- Pulsatilla :- 16/ 7
- Aesculus Hippocastanum :- 16/ 6
- Rhus-tox :- 15/ 6
- Nitric –Acid :- 15/6
- Sulphur :- 16/5
- Kali –carb :- 14/5
- Ignatia :-11/5
First Prescription
Aesculus Hippocastanum 30 / 6 dose (Gtt. in 1 drachm), (4 globule of size 30 =1 dose ) / BD /3days .
Sac. Lac 30 / 4globules (1 drachm)/BD /7days.
Justification for selection of Aesculus hippocastanum
- Haemorrhoids Blind
- Stitching Pain in anal Region
- Haemorrhoids associated with Backache .
- Thermal reaction – towards Hot
Advic :
- Do not strain while passing stool.
- Take atleast 2-3 litres of water daily.
- Avoid spicy and fried food.
- Add cucumber to the meal.
Follow – Up
First (Dated 11/12/2023) | 1)Pain in Anal region while Passing stool – better (20%). 2)Pain in Lumbo-sacral region – better (25 %) No new Complain | Rx Aesculus Hippocastanum 200 / 4dose /B.D/ 2days Sac-lac 30 / B.D/ 7days |
Second (Dated 23/12/23) | 1)Pain in Anal region while Passing Stool – better (50%) 2)Pain in Lumbo-sacral region – better (60%) No new Complain | Rx Phytum 200/4dose/B. D/2days Sac-lac 30 /B. D/7 days
|
Third (Dated 09/01/23) | 1)Pain in Anal region while passing stool – relieved completely 2)Pain in Lumbo-sacral region – relieved completely No new Complain | Rx Sac-lac 30 /B.D/ 15 days |
Conclusion: –
- The patient had visited the OPD for her complain of pain in anal region and pain in lumbo –sacral region since last 20days.
- Detail Case taking was done and her Totality of symptoms was Evaluated based on Individualisation of the case , Repertorisation was done and final similimum was selected with reference to MATERIA MEDICA.
- The patient has shown gradual improvement in her complain with General well-being of her Health with Homoeopathic treatment.
References
1) Williams NS, O’Connell PR, McCaskie A, editors. Bailey & Love’s short practice of surgery. CRC press; 2018 Apr 27, 27th Edition.
2) Shenoy KR. Manipal Manual of surgery. Shenoy A, editor. CBS Publishers & Distributors; 2000 , 4th Edition.
3) Dudgeon R. E. , Boericke William ,Hahnemann’s. Organon of medicine. B. Jain publishers; 2005 , 5th and 6th Edition.
4) ICD-11 for Mortality and Morbidity Statistics (Version: 01/2023).
Author
- Dr. Alok Ranjan MD (HOM.)
Associate Professor / Reader – Department of Pathology
RBTS Govt. Homoeopathic Medical College and Hospital, Muzaffarpur , Bihar
- Dr. Santosh Anand Mishra (PG Scholar)
Department of Homoeopathic Pharmacy
RBTS Govt. Homoeopathic Medical College and Hospital, Muzaffarpur , Bihar