Free
piles diagnostic camp on world piles day (20th November
2013).
Know more about
Hemorrhoids / Piles.
Hemorrhoids or Piles as is
generally known is a very common disease. About 70%
of the population have at some time in their lives suffered
from piles or have had experienced some symptoms related
to it.
We
will first try to understand what Piles / Hemorrhoids
are. Piles or Hemorrhoids are actually, distended
veins in the anal canal. Veins tend to stretch
under pressure. When veins in the lower part
of the rectum or anus stretch, swell or descend
in to the anal canal, i.e. when they prolapse
or protrude in to the canal they are considered
as Piles/Hemorrhoids.
The
set of veins inside the rectum when distended
result in internal hemorrhoids and the set of
veins under the skin around the anus when distended
result in External Piles.
Some other factors also contribute
to the prolepses of the veins. They are long standing
constipation, leading to straining while passing stool,
pregnancy, weakening of the muscles supporting the veins
due to ageing etc. One may also have a hereditary tendency
to develop piles.
If you have any of the following symptoms
you are probably suffering from Hemorrhoids- Piles.
1. Bleeding from the anus :
after defecation (passing stool)
during defecation
during and after defecation
usually without pain but in some conditions with pain.
2. Constipation
3. Itching
4. Protrusion of a mass from the anal canal (can be
felt digitally).
Causes
As described earlier, hemorrhoids develop because of
increasing pressure in the veins of the lower part of
the rectum and anus. This increasing pressure can be
due to various reasons like -
Pregnancy
Straining during chilled birth
Obesity
Lifting heavy weights over a long period
Sitting or standing for a long time
Chronic constipation accompanied with straining
to evacuate the bowels
Repeated diarrhea and dysentery
A habit of suppressing the urge to defecate
There may also be an inherited tendency to develop
Hemorrhoids / Piles.
1. First degree hemorrhoids
2. Second degree hemorrhoids
3. Third degree hemorrhoids
4. Fourth degree hemorrhoids
First degree Hemorrhoids: Is the condition
when the mass (The structure with the veins) projects
slightly into the anal canal, but only when the veins
are congested i.e. during defecation / passing stool.
In this stage the patient will have no mass protruding
from the anus.
Second degree Hemorrhoids: The mass protrudes
out of the anus, but only during defecation. The hemorrhoidal
mass returns into the anal canal spontaneously after
passing stool as soon as the accompanied straining
stops.
Third degree hemorrhoids: The hemorrhoidal
mass protrudes from the anus during defecation or
on exerting force and remains protruded until forced
back into the anus digitally ( with fingers) .
Fourth degree hemorrhoids: The hemorrhoidal
mass (Piles) remains protruded (out of the anus) at
all times and can not be forced into the anal canal
with the help of the fingers.
Treatments
1. Oral medicines, like laxatives, stool softeners
etc and local anti inflammatory creams and warm water
sits bath can help to reduce the symptoms. However second,
third and fourth degree piles can not be cured with
just oral treatment.
2. Barran band ligation: One or two special kind
of rubber bands are tied around the base (slipped to
the base with the help of a special instrument,) of
the internal hemorrhoids. The pressure exerted by the
rubber band stops the circulation in the tied off pile
mass. Gradually, within seven to ten days, the pile
mass falls off. This is comparatively a simple procedure
and is usually painless. It is performed under anesthesia
or even without anesthesia. This treatment is indicated
in most cases of second and third degree hemorrhoids.
3. Sclero therapy: A chemical solution is injected
around the veins of the hemorrhoids. This treatment
is indicated in first to second degree piles. Sclero
therapy is not preferred by most surgeons now.
(See detail)
4. Crayo surgery: The affected part is freezed
by nitrous oxide or carbandioxide gas. This cuts off
the circulation and destroys the pile mass. This is
indicated in first to third degree hemorrhoids. This
method is now not preferred by most surgeons.
(See detail)
5. Cauterization: The pile mass is shrunk with
the help of bursts of electric current. Indicated in
second to third degree piles. This method is not now
practice by most surgeons. (See
detail)
6. Infrared photo coagulation: Infra red rays
are given to an internal hemorrhoid which cuts off the
circulation in it. Some heat may be experienced during
the procedure. The pile mass falls off within a few
days. There may be some bleeding. Indicated in second
to third degree piles. (See
detail)
7. Laser therapy: The hemorrhoid mass is vaporized
by a laser beam. Using laser beams for surgery is beneficial
since it minimizes pain and bleeding. Indicated in second
to fourth degree piles. (See
detail)
8. Conventional surgery: (Open and closed hemorrhoidectomy)
An operation is performed under suitable anesthesia,
the vein in the pile mass is tied / legated and the
mass is cut off with a surgical knife or scissors. The
wound caused is closed or kept open. The surgery requires
24 to 48 hours hospitalization. Indicated in 3rd to
4th degree piles. (See
detail)
9. Kshar Patan (Ksharkarma): Ksharpatan is a
non surgical procedure of Ayurveda used to effectively
treat hemorrhoids. A medicine (chemical) derived from
a combination of various herbs is applied to the pile
mass with the help of a special slit proctoscope. It
is a type of chemical cauterization. This method is
highly effective, cost effective and can be performed
on OPD level.
The patient may require more that one sitting. The Ksharpatan
method of treating piles has been described in detail
in the ancient Shusrut Samhita. The details of preparation
of the herbal combination used can also be got from
the Shusrut Samhita. This method of treating piles-
hemorrhoids was forgotten for years, but thanks to the
research in the field of Ayurveda Surgery, it has made
a comeback.
This simple procedure is so effective and safe that
it is now slowly becoming popular in India like the
Kshar-sutra legation method of treating Ano-rectal fistulae.
This method is indicated in 2ndo 3rd degree Piles- Hemorrhoids
(See
detail)
Hemorrhoid Classification Chart
Classification
Treatment Options
1st
Degree : Hemorrhoidal mass projects slightly
into the lumen of the canal when the veins are
congested at defaecation.
- No rectal prolapse
Diet
Local & general drugs
Sclerotherapy
Infrared coagulation
2nd
Degree : Hemorrhoidal mass appears externally
while the patient is straining but returns spontaneously
into the anal canal when the motion has been passing
and the defecating effort has ceased.
- Rectal prolapse
is spontaneously reducible
Sclerotherapy
Infrared coagulation
Banding
Procedure for Prolapse and
Hemorrhoids (PPH)]
Kshar Patan (Ksharkarma)
3rd
Degree : Hemorrhoidal mass protrude during
defaecation and also on exertion of any kind of
force and remain protruded until digitally replaced
within the anus .
- Rectal prolapse
is manually reducible
Banding
Hemorrhoidectomy
Procedure for Prolapse and
Hemorrhoids (PPH)
Kshar Patan (Ksharkarma)
4th
Degree : Large Hemorrhoidal mass remains
protruded almost permanently and cannot be properly
returned into the anal canal digitally
-
Rectal prolapse irreducible
Hemorrhoidectomy
Procedure for Prolapse and
Hemorrhoids (PPH)
Kshar Sutra
Kshar Patan (Ksharkarma)
Prevention
To prevent hemorrhoids or Hemorrhoidal
flare-ups:
Eat high-fiber
foods.
Fiber (roughage) is the part
of plant food that is not digested. It stays in
your gut and is passed in the stools (faeces).
Fiber adds bulk to the stools. This helps your
bowels to work well, and helps to prevent some
bowel and anal conditions.
Why is fibre important?
Stools (sometimes called faeces or motions) are usually
soft and easy to pass if you eat enough fibre, and drink
enough fluid. A diet with plenty of fibre will help
to:
Prevent constipation.
Prevent diverticulosis (a common bowel condition).
Prevent hemorrhoids (piles) and anal fissure (a
painful condition of the anus).
Reduce weight. Fiber is filling but not fattening
as it has no calories and is not digested.
Possibly reduce the risk of developing bowel cancer.
30 grams of fiber per day is recommended. However,
the average person in the UK eats only about 20 grams
of fiber each day.
High fiber foods include the following
Whole meal or whole-wheat bread and biscuits.
Whole meal flour used for baking and cooking.
Fruit, vegetables, and nuts.
Whole-grain breakfast cereals such as All Bran,
Bran Flakes, Weetabix, Shredded Wheat, muesli, etc.
Brown rice, and whole meal spaghetti and other
whole meal pasta.
A simple thing like changing your regular breakfast
cereal can make a big difference.
Fiber supplements
You may need to take extra fibre supplements if you
have constipation or other bowel problems. Several are
available. You can buy them at pharmacies or health
food shops.
Unprocessed bran is
the most common (and cheapest) fibre supplement. If
you take bran, it is best to build up the amount gradually.
Start with 2 teaspoons a day, and double the amount
every 5 days until you reach about about 1-3 tablespoons
per day. You can sprinkle bran on breakfast cereals,
or mix it with fruit juices, milk, stews, soups, crumbles,
pastries, scones, etc.
Some people find bran unpalatable, and you may want
to try other fibre supplements such as ispaghula
husk or methylcellulose.
Ispaghula husk is also gluten-free.
Have lots to drink
when you eat a high fibre diet or fibre supplements.
Drink at least 2 litres (about 8-10 cups) per day.
You may find that if you eat more fibre, you may have
some bloating and wind at first. This is often temporary.
As your bowel becomes used to extra fibre, the bloating
or wind tends to settle over a few weeks.
Eat more fruits, vegetables and grains. Doing so
softens the stool and increases its bulk, which will
help lessen the straining that can cause hemorrhoids.
Drink plenty of liquids.
How much water
and other fluids should you drink daily ? The
National Research Council (NRC) uses a sliding scale
of 1 milliliter (ml) of water for every calorie burned.
This scale is not for women who are pregnant or breast-feeding,
infants, children and older adults who are unhealthy.
The NRC says the average man — who burns about
2,900 calories daily — needs 2,900 ml, or about
12 cups, of water each day. The average woman —
who burns 2,200 calories daily — needs about 2,200
ml, or about 9 cups, of water each day. For your own
calculations: One measuring cup (8 fluid ounces) of
water equals 236 ml. But these cups don't have to be
filled with water. Solid food contains water. In an
average diet, food provides about 3 to 4 cups of water
each day. Men, because they generally are bigger and
have more lean muscle tissue, on average need more water
each day than women do.
Try fiber supplements
Over-the-counter products such as Metamucil
and Citrucel can help keep stools soft and regular.
Check with your doctor about using stool softeners.
If you use fiber supplements, be sure to drink at least
8 to 10 glasses of water or other fluids every day.
Otherwise, fiber supplements can cause constipation
or make constipation worse. Add fiber to your diet slowly
to avoid problems with gas.
Exercise
•
Stay active to reduce pressure on veins, which can occur
with long periods of standing or sitting, and to help
prevent constipation. Exercise can also help you lose
excess weight.
• Avoid long periods of standing or sitting. If
you must sit for long periods, don't use an inflatable
doughnut cushion to pad your chair. It can increase
the pressure on the veins in the anus.
Don't Strain
•
Straining and holding your breath when trying to pass
a stool creates greater pressure in the veins in the
lower rectum.
• Go as soon as you feel the urge. If you wait
to pass a bowel movement and the urge goes away, your
stool could become dry and be harder to pass.
Self - Care
You
can temporarily relieve the mild pain, swelling and
inflammation of most Hemorrhoidal flare-ups with the
following self-care measures :
Apply an over-the-counter hemorrhoid cream
or suppository containing hydrocortisone, or use pads
containing witch hazel or a topical numbing agent.
Keep the anal area clean. Bathe (preferably) or
shower daily to cleanse the skin around your anus
gently with warm water. Soap isn't necessary and may
aggravate the problem. Gently drying the area with
a hair dryer after bathing can minimize moisture,
which can cause irritation.
Soak in a warm bath several times daily.
Apply ice packs or cold compresses on the anus
for 10 minutes up to four times a day.
If a hemorrhoid has prolapsed, gently push the
hemorrhoid back into the anal canal.
Use a sitz bath with warm water. A sitz bath fits
over the toilet. You can get one at a medical supply
store or some pharmacies.
Use moist towelettes or wet toilet paper after
a bowel movement instead of dry toilet paper.
These self-care measures may relieve the symptoms,
but they won't make the hemorrhoid disappear. See
your doctor if you don't get relief in a few days.
Free piles diagnostic camp on world
piles day (20th November 2013).
