The Anal canal is the end part of the digestive tract. It is distinguished from the rectum because of the transition of its internal surface from a mucous membrane layer is called endodermal to one of skin like tissue called ectodermal. It is 2.5 to 4 cm in length. In diameter, it is narrower than that of the rectum to which it connects. The canal is divided into three parts: the upper part, with longitudinal folds, called rectal columns; the lower portion, with internal and external constrictive muscles which are also called sphincters which control evacuation of feces; and the anal opening is a third part.
Piles is another term for hemorrhoids which is an inflammation of tissues and veins in the anal canal. Piles contain blood vessels, support tissue, muscle, and elastic fibers.
The size of piles can vary, and they are found inside or outside the anus. So they are also termed as internal and external piles according to their position.
Hemorrhoids are graded on a scale from I to IV on their severity. Mostly surgery is required on grade 3 and grade 4.
CAUSES OF PILES
- Piles occur due to chronic constipation
- Genetic
- Low fiber food
- A Chronic diarrhea
- Lifting heavy weights
- Pregnancy
- Obesity
- Prolonged sitting
- Prolonged Straining when passing a stool.
- Chronic cough
- Lack of physical activity
- Excessive spicy diet
PATHOGENESIS
Due to above causes blood vessels of internal anal canal got constricted which leads to their inflammation along with the connective tissues inside the anal canal. Hemorrhoidal venous cushions are normal structures of the anorectum and are resent universally unless a previous intervention or above- mentioned causes has taken place. Because of their rich vascular supply, highly sensitive location, and tendency to engorge and prolapse, hemorrhoidal venous cushions are common causes of anal pathology which lead to the formation of hemorrhoids or piles. They mostly occur in three anal cushions at 3,11,7 position. When there is excessive pressure exerted on these inflammated veins they swell more and comes out of the anus sometimes. They also block the passage of stool during defecation which becomes difficult and painful process. During the excessive pressure and chronicity of these piles sometimes bleeding also start coming out.
TYPES OF PILES
- Internal (आभ्यन्तर)
- External (बाह्य)
Internal Hemorrhoids: (आभ्यन्तर) Clinical Features
When arteriosclerosis occurs on the top of the peritoneal line (Dentate line), it is called internal hemorrhoids. It has the following 4 stages:
- The First Stage - At this stage, the Arshankur (pile mass) only swell at its place, and does not come out on defecation.
- Second Stage – Arshankur (pile mass) comes out on defecation in this condition, but then automatically goes in.
- Third Stage – Arshankur (pile mass) comes out on the patient's anus in this condition, but then the patient has to put them in with his hands.
- Fourth Stage - Arshankur (pile mass) comes out from the anus in this condition, but the patient is unable to keep them in with his hands.
Internal hemorrhoids are inside the rectum. Usually, they are not painful but may bleed. Prolapsed hemorrhoids are the type of internal hemorrhoids that sometimes bulge outside of the anus. It is possible to push these hemorrhoids back inside, but they may go back inside without any intervention. During the passing of stool sometimes mucus also comes out with stool during internal piles. Patients often have painless bleeding when there is internal hemorrhoids in which the blood coming out is of bright red color. Blood often comes into drops or as a current. Stool passed is usually of normal color. If the disease is in the second, third, or fourth stage then the patient can feel pile mass coming out of anus while passing stool.
External Piles: (बाह्य) Clinical Features
When pile mass develops below the dentate line the Dentate line is very painful in nature, it is called External hemorrhoids. External hemorrhoids are hemorrhoids that affect veins which are outside the anus. These hemorrhoids can cause itching, bleeding and cracking. External hemorrhoids are different from other hemorrhoids due to their location.
External hemorrhoids protrude outside of the anus. They are more painful than internal hemorrhoids because the outside of the anus is more sensitive than the inside.
In Ayurveda line of treatment for piles is as follow:
- Aushad (bheshaj)
- Agni karma
- Kshar Sutra
- Shalya
DRUG MANAGEMENT OF PILES (भेषज चिकित्सा)
In both external and internal hemorrhoids with no complications then a line of treatment should as follow:
1. Anti-hemorrhoidal Drugs (अर्शोहर औषधियाँ)
Below- mentioned herbs can be used in a single formulation or in combination.
- Euphoria thymifolia (दुग्धिका), Aconitum ferox (अतिविषा), Berberis aristata (दारुहरिद्रा) - These medicines compress the veins-blood vessels (Sinusoids) within the anal canal, they compress them, bring mildness to the stool and normalize the intestinal movements. They also help in reducing the size of the pile mass and bring the condition to normal.
- Panchamrit parapti (पञ्चमृत-पर्पटी), Aconitum ferox (अतिविषा), Conch shell (शंख), Piper longum (पिप्पली) - These medicines, making intestines and duodenum strong, strengthen the gastric digestion, digestion of food, and induce digestion, thus narrowing the intravenous blood vessels (Sinusoids) within the anal canal. This gives benefits in the piles.
2. Hepato-corrective Drugs (यकृत्-बल्य औषधियाँ)
It is necessary for the liver to be healthy in this disease. Because blood from the anus reaches the heart only through the liver. There is a possibility of some interruption in the movement towards the heart of the blood when the liver becomes distorted. Therefore, the use of drugs that promote the liver helps in this disease. For this, the following drugs can be used in a single or mixed form -
- Phyllanthus niruri (भूम्यामलकी), Solanum nigrum (काकमाची), Tephrosia purpurea (शरपुंखा)
- Picrorhiza kurrooa (कटुकी), Cichorium intybus (कासनी), Tinospora cordifolia (गुडूची), Boerrhavia diffusa (पुनर्नवा)
3. Laxative Drugs (स्रंसन औषधियाँ)
These drugs increase the peristaltic movement of the intestine and help in the constipation thus helping in the easy eradication of hard stool. As stool becomes loose so pressure on the piles mass decreases which also helps in the reduction of pile mass size. For this, the following drugs can be used in a single or mixed form
- Hedychium spicatum (शटी), Glycyrrhiza glabra (मधुयष्टी), Eclipta prostrate (भृंगराज), Muktashukti (मुक्ताशुक्ति)
- Cassia fistula (अमलतास), Senna Alexandria (सनाय), Operculina terpanthum (निशोथ), Terminalia chebula (हरीतकी), oil of Ricinus communis (एरण्डतैल), Plantago ovata (ईसबगोल)
4. Antibacterial Drugs (जीवाणुहर औषधियाँ)
It is common in piles (Arshankuars) to be inflamed due to bacterial infection. In this case, the use of antibacterial drugs becomes very necessary, for which the following drugs can be used in a single or mixed form -
Swertia chirata (चिरायता), Aconitum ferox (अतिविषा), Purified sulphur (गन्धक), Purified zinc (यशद) - These medicines help in resolving various types of bacteria present in the intravenous (sinusoids) within the anal canal, by direct (self) or indirectly (ozone). There are other herbs too which can also be used in a single form or in combination like guggul Commiphora mukul (गुग्गुलु), Rubia cordifolia (मञ्जिष्ठा), Emidesmus indicus (सारिवा), Azzadirachita nimb(निम्ब), Tinospora cordifolia (गुडूची), Semecarpus anacardium (भल्लातक).
5. Anti-inflammatory Drugs (शोथहर औषधियाँ)
It is also necessary to remove inflammation due to Bacterial infection in piles. This not only provides quick relief to the patient but also helps in the functioning of these medicines. For this, the following drugs can be used in a single or mixed form -
Boswellia serrata (शल्लकी), Ricinus communis (एरण्डमूल), Myristica fragrans (जातीफल) -These drugs quickly provides benefit from arthritis, while decreasing inflammation and pain in the intestinal (sinusoids) within the anal canal.
Some other drugs can also be used in a single or mixed form are-
Commiphora mukul (गुग्गुलु), Pluchea lanceolata (रास्ना), Curcuma longa (हरिद्रा), Gingiber officinalis (शुण्ठी), दशमूल (a group of ten herbs)
6. Topical drugs (स्थानिक औषधियाँ)
In the treatment of piles, topical medicines have special significance, and the use of them according to their functions has special benefits. For this, medicines can be used singly or mixed in the following manner.
If there is no infection or ulcer in pile mass, then the oil/oil made from the following medicines can be used.
Nerium indicum (करवीर), luffa echinata (देवदाली), Euphorbia hirta (दुग्धिका), Curcuma zedoaria (कर्चूर), Mimosa pudica (लज्जालु), Gloriosa superba (लांगली), Cinnamomum camphora (कर्पूर).
Use oil or lotions made from the following drugs in Infection-borne inflammation.
Glycyrrhiza glabra (मधुयष्टी), Tamarix gallica (झावुक), Rubia cordifolia (मञ्जिष्ठा), Azadirachta nimba (निम्ब), Curcuma longa (हरिद्रा), Mimosa pudica (लज्जालु).
CONCLUSION
Pharmacopoeia has a special significance in the treatment of piles, especially in new ones, uncomplicated, and mild-moderate severity. With the introduction of appropriate medical treatment in the initial stage of the disease, and continuing till the proper period, the benefits of this treatment are expedited more and more, and very few patients require surgery.
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