HEMORRHOIDS - AYURVEDIC, YOGA, PANCHAKARMA & KSHAR SUTRA MANAGEMENT, DAILY REGIMEN, HOME REMEDIES, DIET, CAUSATIVE FACTORS

AYURVEDIC MANAGEMENT OF ANO RECTAL DISORDERS – BLEEDING & DRY PILES, FISSURE, FISTULA

Drugs recommendation	Types of Drug		Dosage	Duration	Contra Indications
Single Drugs
Haritaki (Terminilia Chebula) - Fruit		Churna	3-6 gm twice daily	15-30 days	Avoid in pregnancy
Durva (Cyanodon Dactylon) – Wh. Plant		Swaras / Kwath	10-15 ml twice daily	15-30 days	N/A
Bilwa (Aegle Marmelos) – Fruit Pulp of Ripe Fruits		Juice	30-35 gm in 1 glass sharbat twice daily	15-30 days
Amlaki (Embilica Officinalis) - Fruit		Churna	3-6 gm twice daily	15-30 days
White Pumpkin (Benincasa Hispida) – Fruit Pulp		Churna	3-6 gm twice daily	15-30 days
Sesame Seeds + Jaggery + Haritaki + Shunthi		Kalka (Paste)	Make paste & apply externally to stop bleeding of piles	-
Yastimadhu / Mulethi		Churna	3 gm twice daily	10-15 days	Avoid diabetic patients
Eranda		Taila	10 ml at bedtime with warm milk	15-30 days	Should not consume by lactose intolerant patients
Compound Drugs
Arshkuthar ras	Tablet		250 mg twice daily	15-21 days	Avoid in pregnancy
Arshahara vati	Tablet		1 tab twice daily	15-21 days
Kankayan gutika	Tablet		500 mg twice daily	15-21 days
Abhyaristha	Aristha (Panak)		15-20 ml twice daily	15-21 days
Sonitagral ras	Tablet		500 mg twice daily	15-21 days	Avoid in pregnancy
Jatyadi taila / Kasisadya taila	Taila		External use	-
Virechan churna / Panchshakar churna	Churna		6 gm at bedtime	30 days
Triphala guggul	Tablet		1 gm twice daily	15-21 days
Pranada gutika	Tablet		500 mg twice daily	15-21 days
Chandraprabha vati	Tablet		500 mg twice daily	15-21 days	Avoid in pregnancy

 

YOGA FOR HAEMORRHOIDS

Pranayam	Nadi sodhan Pranayam (alternate nostril breathing) Bhramari Pranayam (Bee breath) Kapal bhati Pranayam (skull shinning breathing) should avoid in bleeding piles
Mulabandhasana	This asana helps in contraction of pelvic floor muscles, rejuvenates and restores the function of anal region.
Sishuasana	Helps to get relief from constipation.
Ashwini mudra	Shrinks the sphincter, regulates the muscle of anus.
Padahastasana	Stretches abdominal muscles and helps in bowel movement.
Paschimuttanasana	Improves digestive activity and stimulates pelvic organs.
Pavanamuktasana	By strengthens abdominal muscle promotes digestion & relieves constipation.
Viparita karani	Increase circulation and elevate the venous drainage.
Bhujangasana	Improves digestion.
Uttana padasana	Prevents acidity, indigestion and constipation, strengthens abdominal organs.
Sasakasana	Helps in digestion and tones pelvic nerves.
Ardha matsyendrasana	Remove the wastes and improve digestion.
Urdha hastasana	By stretching digestive tract digestion and bowel movement improves.

 

DINACHARYA FOR ANO RECTAL DISORDERS

Brahma muhurta jagaran	Wake up before 45 minutes of Sunrise
Ushapaan (store overnight in copper vessel)	Take dawn water after waking up. It helps in flushing ama (toxins) & cleanses intestines
Gandusha (gargle)	Rinse mouth with arimedadi taila or kwath for 1-2 minutes & thrown away
Nasya	Drop 2-4 drops of little warm anu taila or ksheerbala taila or sesame oil or goghrita at each nostril at empty stomach in morning at lying posture by keeping a thin pillow under neck
Morning walk	Walk in morning as per your health ability, walking of 4-5 km is preferable
Yogasana	As described above
Kwath pana	Drink 30 ml triphala kwath (decoction) at empty stomach.
Nidra (Sleep)	Take 7-8 hours sleep at night, sleep at daytime must be avoided

 

HOME REMEDIES

Aloe Vera	Apply aloe vera gel externally for healing in case of external piles Drink aloe vera juice at empty stomach in case of internal piles
Sitz bath/Warm bath and decoction water bath	Dip the anal area in a tub filled with warm water for 10-15 minutes after bowel movement and pat gently afterwards to dry, it reduces inflammation & discomforts. At post operative stages you should take sitz bath of medicated decoction along with turmeric powder.
Witch Hazel	Apply externally, it reduce both itching and pain as it is natural anti inflammatory
Ice pack/Cold compress	Apply ice packs or cold compresses to the anus for 15 minutes to relieve swelling. Always wrap ice inside of smooth cloth or paper towel before apply.
Coconut oil	You may apply externally; it helps in itching caused by drying of piles.
Carrot juice	Make juice by 3 parts of carrots and 1 part of spinach; helps to reduce bleeding piles
Radish juice	Drink 1/4th to 1/2th cup radish juice twice daily for 30 days
Drinking water	Water should consume 4-5 liter daily to keep body hydrate
Niranjan phal (Sterculia lychnophora)	Moisten bowel. Soak 3 fruits in 50 ml water, keep overnight; remove the mucilaginous gel from seed and drink at empty stomach in morning for 4-5 days Ref:- Ethnopharmacology, phytochemistry and pharmacology of Sterculia lychnophora; Chinese journal of natural medicines 2018,16(10):0721-0731
Ashwini mudra	Described above
Wearing appropriate clothing	Wear loose fitting, breathable, cotton clothing and under wear; helps wound healing reduces irritation and prevents inflammation.
Fiber rich diet	Fibrous food prevents constipation, softens stools.

 

DIET

Food should intake

Food should avoid

Legumes, lentils (moong, masoor), whole grains, broccoli, cruciferous vegetables, pumpkin, elephant foot, drumstick, carrot, cucumber, spinach, celery, beetroot, cluster beans, coriander, green long beans, corn, pointed gourd, ivy gourd, bitter gourd, snake gourd, bottle gourd, Malabar spinach, red spinach(amaranth), radish, ridge gourd, wild spinach, butter milk, cows ghee, sprouts, turmeric, jaggery, soya chunks

Ginger, red chili, white rice, tamarind, egg, fish, dairy products (curd, cheese, paneer, milk cream), white flour, processed meat, caffeinated drinks, ice cream, alcohol, brinjal, tomato, potato, cabbage, ladies finger, beans, kidney beans, fried-heavy-spicy-salty food, noodles, unripe banana No refrigerated and storage food

 

Fruits should intake	Fruits should avoid
Grape, squash, ripe mango, ripe wood apple, watermelon, pears, raspberry, ripe banana, apple, mudapple (sapodilla), blackberry, guava, custard apple, coconut water, sugarcaine	Citrus fruits, orange, pineapple, papaya, jackfruit, pomegranate, kiwi,

 

CAUSATIVE FACTOR

Heavy Weight Lifting	Lifting heavy weight continuously may become a reason for piles as more pressure is exerted on the lower portion
Stress & Long Sitting	Constantly sitting for longer time at one place and having more stress cal also lead to piles
Indigestion & Prolong Constipation	Causes intestinal abnormalities and hard bowel causes fissure, develops piles
Lack of Fiber Diet & less drinking water	Having less fiber food, junk  or spicy food, improper eating habits and consuming less water may also become reason for piles
Lack of physical activities	Physiological actions of body reduce due stagnant life style causes anorectal issues.

 

CLASSIFICATION OF PILES

Internal Piles: Found inside the rectum, cant seen or feel from outside as it located deep inside of anus. When it enlarges causes bleeding and pain as there is a friction between piles & faeces.

Grade – I : In this stage piles are still in the interior anal canal. In this initial grade little itching and pain occurs.

Grade – II : Similar to grade I, but bleeding may experienced and small protrusion may come outside while bowels & reverts back to its original position.

Grade – III : All the discomforts of earlier stages along with prolapsed or outgrowth that will not return to its original position must be manipulated back into anal canal manually.

Grade – IV : Final stage, have all symptoms of earlier stages. Only haemorrhoids can be manipulated back into place in rectum.

External Piles: External hemorrhoids present on the mouth of anus or on the surface from where faeces come out and usually seen as lumps on the anal surface. Symptoms of external and internal piles are same but discomfort to sit and doing physical activities may feel and the time of passing stools.

Prolapsed Piles: lump may come out of anus and swell. These are swollen red coloured causes pain, itching, irritation, burning and bleeding.

Thrombosed Piles: Blood clot (thrombosis) in haemorrhoidal tissue occurs, it is usually outside of anus in swelled up form. Lot of pain, swelling, redness, itching are the complication of this.

 

PANCHAKARMA

Matra Basti

Apply matra basti of 40-50 ml Jatyadi taila if itching, cuts & inflammation occurs in rectum (only for 1st & 2nd grade piles) Not applicable for 3rd & 4th grade haemorrhoids.

 

KSHAR SUTRA (AYURVEDIC PARASURGICAL TREATMENT)

Khar Sutra is the safe and cost effective method of treatment for haemorrhoids, fistula-in-ano, sentinel piles, pilonidal sinus, rectal or anal polyps & warts. Advantages of this procedure are no surgical complication like incontinence, stenosis and stricture, systemic diseases are also undergoing this procedure.

It is prepared by 11 coatings of Snuhi latex, 7 coatings of Snuhi latex and Apamarga kshara & 3 coatings of Snuhi latex and Haridra churna.

The standard ksharsutra is prepared by repeated coatings of Snuhi ksheera (latex of Euphorbia nerrifolia), Apamarg kshar (ash of Achyranthus aspera) & Haridra churna over a surgical linen thread no. 20. This thread is spreaded throughout lengthwise in hangers. Each thread on the hanger is then smeared with Snuhi latex with the help of gauze piece soaked in the latex. This wet hanger is transferred in kshar sutra cabinet. Same process is repeated next day. Eleven such coatings with Snuhi ksheera alone should be accomplished. Twelfth coating is done by first smearing the thread with ksheera and in wet condition thread is passed through the Apamarg kshar. It is again transfer into the cabinet for drying. This process is repeated till seven coatings of Snuhi ksheera and Apamarg kshar is achieved. Final three coating are completed with Snuhi ksheera & fine powder of Haridra (turmeric) in the same way. Thus twenty one coatings over thread are completed.

According to Sushruta Samhita there are many kinds of Khars like Karaveera, Palasa, Kadali etc. most remarkable are Guggul ksharsutra, Udambara ksharsutra, Papaya ksharsutra, Ficus carica latex ksharsutra etc.

 

KSHARSUTRA IN FISTULA
Application	Mechanism
Patient is anaesthetized with local or spinal or general anesthesia, malleable probe is passed through the external opening of the fistula to the internal opening in the canal and probe is gently taken out through anal opening to outside along with a ksharsutra in the groove of the probe. Later both ends of the ksharsutra are tied together. This is replaced by new one after an interval of one week. This process gradually cuts and heals the tract and finally the whole fistulous tract heals after cutting.	1) Helps is cutting, draining & healing of fistulous track 2) Destroys & removes unhealthy tissue, promotes healing of the fistulous track due to caustic action 3) Controls infection by the microbial action 4) Separation of debris & cleaning the wound 5) Drainage of pus in fistulous tract & heal 6) Cutting through the tissue & laying the track open

 

KSHARSUTRA IN HAEMORRHOIDS
Application	Mechanism
Patient is anaesthetized with local anesthesia. Pile mass holds with pile holding forceps and bring them out of the anal orifice, provide incision at mucocutaneous junction. Then pull exerted over the pile mass and transfixed by ksharsutra at the base. Ligated pile mass replaced inside the rectum and rectal pack with Madhuyasthi ghrita or taila.	1) Chemical cauterization and mechanical strangulation of the blood vessel 2) Local gangrene of the pile mass tissue 3) Ischemic necrosis and debridement of unhealthy tissue 4) Sloughing of mass within 7 days 5) Healing of resulting wound takes 10-15 days

 

KSHARSUTRA IN PILONIDAL SINUS

Application

Patient is anaesthetized with local anesthesia, then a malleable probe with ksharsutra is passed through the external opening of the Pilonidal Sinus to the skin. Both ends of the ksharsutra is tied together. Ksharsutra is replaced by new one after an interval of 7 days. This procedure cuts and heals the sinus tract.