HAEMORRHOIDS
or PILES
This is a varicose condition of veins of the anorectum that become
congested, dilated, elongated and tortuous.
INTERNAL PILES
The veins are covered by mucous membrane and are proximal to the
anorectal line.
EXTERNAL PILES
The enlarged veins are covered by skin and are distal to the anorectal
line and occur as small, hard tubercles. The blood is poured out into the
cellular tissue, soon becoming entirely absorbed, or remaining coagulated in a
distinct adventitious sheath.
There may be a combination, when the veins are covered by mucosa above
and skin below known as interno-external piles.
External piles may be
In association with an internal piles
In association with an anal fissure
Dilatation of the veins of the anal verge, as is seen in persons of
sedentary life, during straining
Peri-anal haematoma or thrombotic pile
CAUSES
The predisposing causes are of two kinds; one dependant upon causes that
determines an increased amount of blood to the neighborhood of the anus, and so
frequently repeated that the operation may be considered permanent. This
includes - sedentary pursuits, or long standing, as hair-dressers, dentists,
school-teachers, and the like; as well as mechanical impediments, such as
habitual constipation, tumors, pregnancy, or morbid processes of various kinds.
The other class of predisposing causes are of a more constitutional
character, as hepatic derangement, or any impediment to the portal circulation;
and a peculiar hereditary tendency, which is either due to a similarity of
pursuits or to causes of a more vital character, dependant upon some functional
peculiarity.
The exciting causes are very various. Among them we may include
cathartic medication; frequent employment of enemata; violent exercise on
horseback; immoderate sexual indulgence.
Etiologically piles may be
Primary - There is no definite cause to explain the varicosity. The
condition often runs in families. Long continued strain, e.g. constipation,
over-purgation, colitis, dysentery may play a role in its development.
Secondary - The haemorrhoids are secondary to pressure effects, caused
be some other pathology like carcinoma, pregnancy, uterine tumors, enlarged
prostate and portal hypertension.
CLINICAL FEATURES
The patient typically complains of fresh blood coming out with stool -
bleeding piles. The condition is usually painless. There is usually a history
of constipation.
As the veins get heavier in weight due to varicosity, the overlying
mucosa tends to hang down through the anal opening, together with the varicose
veins underneath. When frequent attacks occur the tissues are thickened, the
blood is not absorbed, and a permanent tumor remains, hard, not particularly
sensitive but liable to sudden attacks of inflammation, when the pain becomes
excessive. Depending on this, piles are graded as follows -
1st Degree - No associated mucosal prolapse
2nd Degree - Prolapse occurring during defaecation, but spontaneously
reduces after defaecation
3rd Degree - Prolapse needs to be reduced manually
4th Degree - The piles always keep prolapsed
COMPLICATIONS OF
PILES
Haemorrhage
Strangulation
Thrombosis, in a strangulated pile
Ulceration, on a strangulated and thrombosed pile
Fibrosis, an after-effect of thrombosis
Gangrene
Suppuration, due to infection
MANAGEMENT
General Treatment
Abstinence from anything that would have a tendency to increase or
maintain the causes operating either as exciting or predisposing. Purgatives
must be avoided. Sedentary people should take exercise and change their habits
of life. In short a removal of the cause must be the first indication.
Improvement of anal hygiene. No fat or rich food likely to upset the
liver should be taken, and nothing that has a constipating tendency; no
alcoholic drinks of any kind, and no pepper. The bowels should be attended to
regularly; after every stool the parts should be washed with cold water, and
any protrusion should be returned.
In severe cases absolute rest in bed will be necessary, and in all cases
the patient should walk as little as he can help, and should lie down as much
as possible. Much sitting is bad; a hard chair, or cane-bottomed chair, is
preferable to a soft-cushioned one. The diet should be light and unstimulating.
Homeopathic
Approach
The homoeopathic approach to a case of haemorrhoids is constitutional.
Acute cases need to be sometimes approached with acute, superficial
acting medicines. The rightly chosen homeopathic medicine should stop the
bleeding and pain, if present. Cases with prolapse [3rd and 4th degree] may
have to be referred to surgery. But surgery is not the permanent cure for
piles. In any case, the underlying constitutional state has to attended to by
deep-acting homoeopathic similimum.
REPERTORIAL
REFERENCE
Aesc., Agar., Aloe., Ars., Carb-an., Carb-v., Caust., Coll., Graph., Ham., Kali-ar., Kali-c., Kali-s., Lach., Lyc.,
Merc-i-r.,
Mur-ac., Nit-ac., Nux-v.,
Paeon., Phos., Puls., Sep., Sulph.,
Am-c., ant-c., apis., ars-i., bar-c., bell., brom., bufo., cact., calc-p., calc-s., calc., caps., card-m., chel., cimx., coca., coff., coloc., dios., erig., eug., ferr-ar., ferr., fl-ac., hell., hep., hydr., ign., iod., ip., kali-bi., lept., mag-m., merc., nat-m., nat-s., petr., phyt.,
podo., psor., rat., rhus-t., sabin., sang., sil., staph., sul-ac., ter., thuj., tub., zing.
Abrot.,
acet-ac., acon., aeth., agn., alum., alumn., am-m., ambr., anac, anan., ang.,
ant-t., apoc., arg-n., arn., arum-t., aur-m., aur., bapt., berb., bor., bov.,
bry., cann-s., canth., carb-ac., carb-s., carl., casc., cham., chim., chin-a.,
chin., chr-ac., cic., cimic., clem., cocc., colch., con., croc., crot-h.,
cycl., elaps., euphr., ferr-m., ferr-p., gels., grat., hyos., kali-n., kali-p.,
kreos., lact., lil-t., lob., manc., med., mez., mill., mosch., ph-ac.,
phys., plan., plat., plb., rhus-v., rumx., ruta., sec., stann., stront., sumb.,
syph., ther., verat-v., verat., zinc.,
:
Aloe., Dios., mur-ac., sabin., sulph.,
sumb., thuj.
:
Alum., coll.
.
: Graph., rumx.
: Aloe., kali-bi., petr., sulph.
:
Aesc., aloe., alum., am-c., ant-c., ars., carb-an., carb-v., coll., euphr.,
ferr., graph., merc., phys., puls., rhus-t., Sulph.
: Coll.
: Aloe.
.
: Aloe., bry., ferr., nux-v., rhus-t., Sulph.
as soon as the rheumatism is better : Abrot.
: Aesc., ant-c., ars., brom., calc-p., caps., cham., coll., ferr., grat., ign., nit-ac.,
nux-v., podo., puls., rhus-t., sulph., verat.
: Aesc., aeth., ars., Carb-v.,
dios., ham., Lach.,
lyc., manc., Mur-ac.,
phys., sulph., verat-v.
: Mur-ac.
: Aesc., aloe., am-c.,
calc., carb-s., carb-v., caust., Coll., dios., graph., lach.,
lyc., Merc-i-r.,
nit-ac., Nux-v.,
petr., phos., phyt., podo., Sulph.,
tub.
:
Aloe., brom.
: Acon., agar., aloe.,
alum., apoc., arg-n., ars., bell., carb-v.,
caust., cham.,
hep., Kali-c.,
kali-n., merc., mur-ac.,
Nux-v., Paeon.,
podo., puls., rhus-t.,
sil., sulph., verat-v., zing.
: Ars., carb-v., Nux-v.,
sul-ac.
:
Arg-n., gels., hyos., nat-c., nux-v., sumb.
:
Abrot., Aesc., all-c., Aloe., alum., am-c.,
anac., ang., ant-c., apis., apoc.,
arn., ars-i., ars., aur., bar-c., bar-m., berb., brom.,
bry., cact., calc-p., calc-s., calc., caps., carb-ac., carb-an., carb-s., carb-v., caust.,
coll., coloc., dios., ferr-ar., ferr-i., ferr-p., ferr., fl-ac., gran.,
graph., grat., Ham.,
hep., iod., kali-ar.,
kali-c., kali-n., kali-p., kali-s., Lach.,
lyc., med., merc.,
Mur-ac., nat-m., nit-ac., nux-v., paeon.,
ph-ac., phos., phys., plat., podo., puls., Rat.,
rhus-t., rumx., sep., sil., sul-ac.,
Sulph., ter.,
thuj., tub., verat., zinc.
: Bar-c., phos.
:
Ail., alum., ambr., Caust., lach., lyc., phys.,
sep.
: Aesc., alum., ant-c.,
arn., Ars., bor., Brom., calc., caps., caust., Cham.,
cimic., Coloc., hep., Ign., kali-ar., kali-c., kali-p., kali-s., lach., lyc., Nux-v.,
petr., ph-ac.,
phos., plan., Podo., Puls.,
rhus-t., sep., stront., Sulph., ter., verat.
: Aesc., agar., Aloe.,
alum., ang., arn., ars., bry., cact., calc., caps., Carb-an.,
carb-s., carb-v.,
Caust., clem., coloc., cycl., dios.,
euphr., ferr-ar., ferr., gall-ac., graph., Ham.,
kali-ar., Kali-c., kali-n., kali-s., lach., lyc., manc., merc.,
mur-ac., nat-m., Nit-ac., Nux-v., podo., puls., sep.,
sul-ac., Sulph., thuj., tub.
:
Cocc., phos., puls.
during, agg. : Aloe., am-c.,
calc., carb-s., carb-v.,
cocc., coll., graph.,
ign., lach., lyss.,
phos., puls., sulph.
after, agg. : Cocc.
suppressed, during : Phos., sulph.
: Caust., nat-c.
: Hep., sul-ac.
.
: Sep.
: Apis., carb-an., euphr., merc., mur-ac., nat-m., puls.
:
Carb-v., manc., med.
.
: Ign., Kali-c.,
lil-t., mur-ac.,
podo., puls., sep.,
sulph.
:
Nit-ac.
: Aesc., am-m., ant-c.,
caps., coll.,
lach., lyc., nat-m., nux-v., sep.,
sulph.
:
Aloe., nux-v.
:
Abrot.
: Kali-c.
: Aesc., am-c., caust., sulph.
: Aesc., caust., lach., paeon., sul-ac.,
thuj.
protrude during : Alumn., am-c., bar-c., Calc-p., calc.,
fl-ac., kali-bi., kali-c., lach., mur-ac., nit-ac., ph-ac.,
phos., plat., Rat., rhus-t., sil.
: Aesc., Aloe.,
ars., bell., ign.,
Lach., nux-v.,
Paeon., sil.,
sulph.
: Ars., calc., caps.,
carb-v., euphr., Nux-v., phos., puls., Sulph.
:
Anan., carb-v., hep.,
ign., merc., Sil.
: Caust.
:
Abrot., Bell., berb., calc., carb-an., carb-s., Caust.,
graph., hep., kali-c.,
lil-t., lyc., merc., Mur-ac.,
nit-ac., nux-v., phos., Rat., sep., sil.,
sul-ac., Sulph., syph., Thuj.
: Cham., hep., ign., kali-c., lach.,
nit-ac., paeon., phos., Sil., staph., syph.
:
Aloe., Bar-c., bar-m., canth., kali-c., merc.,
mur-ac., nit-ac.
after agg. : Merc.
: Aesc., agn., alum., ars., Brom., calc., Carb-an.,
Caust., cycl., kali-ar., kali-c., Mur-ac., nit-ac., phos., phys., rumx., sep., sil.,
Sulph., sumb., ther., thuj.
amel. : Ign.
: Ars., mur-ac.
warm weather agg. : Nit-ac.
amel. : Aesc.
: Aesc., Graph.,
Mur-ac., Paeon.,
puls., sulph.
after :
Caust
Therapeutic
Indications
Aesculus
Haemorrhoids arising from portal congestion, abdominal plethora. They
may or may not bleed, but there is a feeling in the rectum as of splinters or
sticks. Hemorrhoids accompanied by a feeling of dryness in the rectum and through
little sticks, splinters or burrs were sticking in the mucous membrane. Other
indicating symptoms are aching in the lumbar region, protruding purple piles
with severe pains in the sacrum and small of the back and fullness in the
region of the liver. Dryness, burning and itching are good indications.
Haemorrhoids from chronic constipation may be cured with Aesculus.
Collinsonia
Collinsonia is indicated in obstinate cases of haemorrhoids, which bleed
incessantly. It is of special use in females with inertia of the rectum and a
congestive tendency to the pelvic organs. It suits pregnant women who suffer
from piles, and pruritus may be a marked symptom. The indicating symptoms are
chiefly a sensation of sticks in the rectum, with constipation from inertia of
the lower bowel. It is especially applicable to heart pains resulting from a
suppression of a habitual haemorrhoidal flow.
Hamamelis
It has bleeding haemorrhoids, and the flow of blood is quite copious,
and the great characterizing indication is excessive soreness.
Aloes
It is indicated where the piles protrude like a bunch of grapes,
bleeding often and profusely, and are greatly relieved by the application of
cold water. There is a very marked burning in the anus the bowels feel as if
scraped. There is a tendency to diarrhoea, with loss of control over sphincter
ani. This tendency to diarrhoea will distinguish from Collinsonia, which has
the tendency to constipation.
Ratanhia
Ratanhia has burning in the anus and protrusion of varices after a hard
stool. The characteristics of this remedy are burning and fissure of the anus,
great painfulness and sensitiveness of rectum. Rectum seems as if full of
pounded glass. Anus aches and burns for hours after stools.
Sulphur
This remedy corresponds to ailments producing haemorrhoids and to the
troubles resulting from piles that have stopped bleeding, and as a result
fullness in the head and uneasiness in the liver; constipation is present; a
desire for stool and itching of the anus. Nux and Sulphur dominate the therapeutics
of haemorrhoids. Sulphur has constipation and itching about the anus, worse at
night, which may be considered as keynotes for its use.
Nux vomica
If the haemorrhoids be large and blind, with a burning, stinging and
constricted feeling in the rectum and a bruised pain in the small of the back,
and especially if excited by sedentary habits or abuse of stimulants, then Nux
may be prescribed with confidence. Itching haemorrhoids keeping the sufferer
awake at night, relieved by cold water, or bleeding piles with constant urging
to stool, and a feeling as if the bowel would not empty itself are further
indications.
Capsicum
Bleeding piles with burning pain, itching, smarting and stinging in anus
during stool are characteristic of Capsicum.
Arsenicum
Indicated in bluish piles with burning pain, prostration and debility.
Muriatic acid
Great sensitiveness of the anus, cannot make use of the softest toilet
paper; the piles are so sore and sensitive that the slightest touch is
unbreakable. Haemorrhoids in the aged.
Graphites
Haemorrhoids which burn and sting, anus sore, worse sitting. The rectum
seems to have lost its contractile power, and the varices protrude.
Lycopodium
A very useful remedy for piles that do not mature, but remain as hard
bluish lumps, and also for bleeding piles containing large quantities of blood.
Sepia
Haemorrhoids from retarded portal circulation; bleeding haemorrhoids
with fullness in the rectum; oozing of moisture with great soreness.
Verbascum thapsus
Inflamed and very painful piles, scanty evacuation of faeces in small,
hard bits, like sheep's dung, with pressing; frequent or copious urination.
Ignatia
Haemorrhoids characterized by sharp, stitching pains, shooting up the
rectum.
Alumina
During evacuation blood spurts out of the rectum, followed by soreness
all along the rectum; stool hard and dry, shaped like laurel berries blood
passes away from the haemorrhoidal tumors when walking; tumors always burn;
perineum sweats, and is tender to the touch. Worse in the evening; also when
walking and on being touched; Better after night's rest.
Ammonium muriaticum
Bleeding from the rectum, with lancinating pains in the perineum,
especially in the evening; stinging and itching in the rectum, during and
before the stool; piles surrounded by inflamed pustules.
Bryonia alba
Hard, tough stool, with protrusion of the rectum; long lasting burning
in the rectum after hard stool; sharp burning pain in the rectum with soft
stool, white and turbid urine; sensation of constriction in the urethra when
urinating. Worse in the morning; also from motion, and from heat. Better while
lying down, or on getting warm in bed.
Calcarea carb
Discharge of blood from the rectum; prolapsus ani, with constipation;
itching of the anus; varices smaller, protruding, and burning violent pressure
in the rectum; burning in the rectum; pricking of the rectum as if from
ascarides; grape-like eruption around the anus, painful and burning; frequent
micturition also at night; during micturition burning in the urethra.
DR. SUMIT GOEL M.D. (Hom)