Role of Dynamic Science in Haemorrhoids

Abstract

Haemorrhoids/Piles are common benign diseases that affect millions of people worldwide. It’s a common condition that a physician would encounter in day to day practice.

Haemorrhoids are the most common and painful condition, While conventional treatment often focuses on symptom relief, Homoeopathy offers a holistic approach to address the underlying causes. This article reviews the homoeopathic perspective on haemorrhoids, including key remedies, diagnostic criteria for haemorrhoids as well as homoeopathic treatments strategies and case studies demonstrating the efficacy of this approach. 

Epidemiology 

Worldwide, around 50% to 85% of people suffer from haemorrhoids.

• Gender: Both women and men are affected but women are more likely to develop haemorrhoids during pregnancy and childbirth.
• Age: Prevalence increase with age, with most cases occurring in people over 40 year old.Peak prevalence in the 6th decade of life (50-59 years old)

Keyword – Hemorrhoids, Homoeopathy

Introduction

Haemorrhoids/Piles are swollen and inflamed veins around anus or lower rectum.

Types:- 

1. Internal- Lies beneath mucosa. above the dentate line.
2. External- Simmilar condition of the external plexus below the dentate line and covered by skin.
3. Combined:-Intro-external which starts as an internal piles then grows downwards to involve the anal skin.

Classification of Hemorrhoids

Classification – 1 

Primary haemorrhoids – Located at 3, 7 or 11 o’clock positions related to the branches of the superior haemorrhoidal vessel which divides on the right side into two, the left side continues as one.

Secondary haemorrhoids – one which occurs between the primary sites.

Classification- 2

1ST Degree – Early stage when they bleed but the piles do not prolapse even during defecation.

2nd Degree – Piles prolapse during defecation but it returns back with or without manual help.

3rd Degree – Piles that permanently prolapsed.

Etiology 

1. Hereditary
2. Increased pressure:  Straining during bowel movements, prolonged sitting or heavy lifting.
3. Poor diet: Low fiber intake, spicy food and alcohol consumption.
4. Constipation: Hard stools straining during bowel movements.
5. Pregnancy: Increased pressure on rectum and anus.
6. Obesity: Excess weight increases pressure on the rectum and anus
7. Age: Haemorrhoids are more common in people over 40
8. Sedentary lifestyle: Lack of physical activity.
9. Portal hypertension: High blood pressure in portal veins.
10. Anal sex: Increased pressure on the anus and rectum.

Other causes are staining, Diarrhoea, Constipation, Overpurgation, Carcinoma of rectum.

Complication:

• Bleeding (Most common) which may require blood transfusion.
• Strangulation piles being gripped by anal sphincter.
• Thrombosis Piles appear dark purple/black, and feel solid and tender.
• Pylephlebitis (portal pyemia) is rare, but occur in 3rd degree piles after surgery.
• Pain
• Itching
• Fecal incontinence
• Anemia(rare)
• Ulceration
• Gangrene
• Fibrosis
• Stenosis
• Suppuration, leads to perianal or submucosal abscess.

Clinical Features:

1. Bleeding- 1st symptom –‘splash in the pen’- ‘bright red and fresh’—occurs during defecation 
2. Mass per anum
3. Discharge – A mucoid discharge
4. Pruritus
5. Pain- may be due to prolapsed, infection or spasm.
6. Anaemia
7. Itching- intense itching sensation in anus (pruritus ani)
8. Swelling- Lumps or swelling around the anus.
9. Discomfort- feeling of fullness, pressure or discomfort in the rectum or anus.
10. Urgency- sudden, intense need to have a bowel movement.
11. On inspection prolapsed piles may be visualized 
12. On P/R examination, only thrombosed piles can be felt.
13. Through proctoscopy, exact position can be made out as a bulge into the proctoscope.
14. Sigmoidoscopy or Colonoscopy or barium enema should be done if there is any suspicion of associated malignancy.

Symptoms can range from mild to severe and may depending on the grade of haemorrhoids:

• Grade 1: Bleeding and mild discomfort
• Grade 2: Prolapse with spontaneous reduction
• Grade 3: Prolapse requiring manual reduction
• Grade 4: Permanent prolapse.

Homoeopathic Remedies For Haemorrhoids:-

• Terminalia Chebula:-  It’s specially indicated in Bleeding piles. In that case frequent desire for stool but passes only small quantities with great force or nothing comes out; sweat during stool; itching and sensation of fullness in the rectum. 

• Jonosia Asoca or Saraca Indica:– Due to obstinate constipation ; Blind or Bleeding piles with itching and smarting pain; Large hard stool covered with mucus.

• Ficus Religiosa:–  Specially indicated in bleeding piles.

• Aegele Folia:- Especially for Bleeding piles worse in afternoon; constipation; wind comes out with loud noise. There is no desire for food.

• Nux Vomica:– Head remedy for bleeding and non bleeding piles to be given when there is burning pain and constipation with ineffectual desire.

• Nitric acid:– Haemorrhoids that have ceased to bleed, but are very painful and hanging down loosely with sharp pricking pains in rectum.

• Phosphorus:- With a small stream of blood after every stool.

• Calcarea Carbonicum:– Piles protruding, painful when walking, better when sitting, cause pain during stool with profuse bleeding.

• Acetic Acid:- Profuse bleeding from bowels after checked metrorrhagia or otherwise.

• Mucuna:– Specific for bleeding piles. 

• Hamamelis:- Painless bleeding followed by prostration which is out of all proportion to the loss of blood. The blood is of dark colour. There is anaemia, breathlessness and weakness notwithstanding good appetite.

• Aloe socotrina: When blood passes like water from the hydrant, piles protrude like a bunch of grapes. Better by cold water; violent itching and burning in anus; constantly putting fingers in anus on that account. The ointments increase the burning.

• Sanguinaria :- Persistence bleeding from the bowel, mood being watery.

• Ignatia:- Blind piles, painful while standing and sitting. Pain reduced while walking sharp pressing pain in the rectum.

• Carbo veg:- Protruding piles blue, even suppurating, offensive, swelling, burning in the rectum; oozing of fluid from rectum.

• Collinsonia:- Haemorrhoids with backache and obstinate constipation. Prolapse of rectum. Piles bleeding or blind and protruding. There may be alternate constipation and diarrhoea. 

• Rhus tox:- Blind piles protruding after every stool with backache and pressure outward in rectum.