Haemorrhoids and its homoeopathic management

July 5, 2020 admin Homeopathy Articles 1

Dr. Ashok Yadav1, Dr. Kanika Agarwal2, Dr. Yogita Kumari2, Dr. Apurva Dixit

1 Professor & Head of Department, Department of Practice of Medicine, Dr. MPK Homoeopathic Medical College, Hospital & Research Centre (under Homoeopathy University), Jaipur, Rajasthan, India

2 PG Scholar (Part-I), Dr. MPK Homoeopathic Medical College, Hospital & Research Centre (under Homoeopathy University), Jaipur, Rajasthan, India

ABSTRACT
Hemorrhoids or “piles” are enlarged or slided down vascular cushions within the anal canal that have been described for many centuries and continue to form a large part of a colorectal surgeon’s workload. This article deals with an overview of haemorrhoids, its classification, causation, presenting complaint and its treatment with emphasis on homoeopathic past researches, therapeutics and reportorial approach.

KEYWORDS – Haemorrhoids, piles, homoeopathy

INTRODUCTION
Haemorrhoids are dilated plexus of superior haemorrhoidal veins, in relation to anal canal. It is a normal sliding down of  anal cushions due to straining or other causes.[1,2]

 CLASSIFICATION

 Classification 1[2]

 Primary haemorrhoids  Located at 3, 7, 11 o’clock position related to branches of superior hemorrhoidal veins ( primary site)
 Secondary haemorrhoids  One which occurs between primary sites

 Classification 2[2]

 First degree haemorrhoids   Piles within,  that may bleed but do not  prolapse
 Second degree haemorrhoids  Prolapsed during defecation but returned back spontaneously
 Third degree haemorrhoids  Prolapsed during defecation, can be replaced by manual help
 Fourth degree haemorrhoids  Permanently prolapsed piles

 Classification depending upon location2[1]

 Internal haemorrhoids  Above  the dentate line, covered with mucous membrane
 External haemorrhoids  At anal verge,  covered with skin
 Interno- external haemorrhoids  Both varieties together

ETIOLOGY

  • Hereditary
  • Morphological cause- superior rectal veins have no valves, so blood column without walls causes high pressure and more congestion as  veins in lower rectum  are in loose mucosal plane, but the veins above enter the muscular layer, which on contraction increases the venous congestion below.
  • Other causes are straining, diarrhea, constipation, over purgation, carcinoma rectum, pregnancy, portal hypertension.[2]

CLINICAL FEATURES

  • Bleeding as ‘ splash in pan’  which is bright red  in colour,  occurs during defecation
  • Mass per annum
  • Mucoid discharge
  • Pruritis
  • Pain may be due to prolapsed piles, infection or spasm

 Clinical examination/ Investigations

  • On inspection-  prolapsed piles can be visualized
  • On proctoscopy –  exact position of piles can be seen as cherry red mass
  • Sigmoidoscopy, Colonoscopy or barium enema should be done if there is any suspicion of associated malignancy.[1][2]

 COMPLICATIONS OF HAEMORRHOIDS

  • Chronic anaemia
  • Strangulation of prolapsed piles
  • Ulceration 
  • Secondary infection [1]

MANAGEMENT AND TREATMENT

General Management
It includes fibre supplementation; increase fluid intake; use of bulk purgative, laxative like isabgol,  husk etc.  for easy purgation.; sitz bath

Specific Management
 It includes injection of sclerosant, barons band application and hemorrhoidectomy.[1]

Homoeopathy in Haemorrhoids
Homeopathy is a system based on “Law of Similars” which means it treat the disease with medicine producing similar symptoms when given in healthy individuals. Therefore medicines are selected on the basis of Totality of Symptoms.

Controversies and disagreement exist on conventional treatment strategies of hemorrhoids due to relapse, inefficacy, and complications however it can be concluded from past studies that homoeopathy is effective in managing hemorrhoids. In an open, prospective, observational, pilot study intended to evaluate the role of individualized homeopathic treatment in hemorrhoids was conducted on 73 patients at two homoeopatic hospitals in West Bengal,India. Hemorrhoids patients were assessed using five standardized scales measuring complaints severity and anoscopic score  and followed up every month up to 6 months. Statistically significant reductions of mean bleeding, pain, heaviness visual analogue scales and anoscopic score were achived in 3 months, itching VASs reduced significantly only after 6 months and no significant lowering of discharge VASs was achieved after 3 and 6 months.[3]

Also in   a multicenter randomized controlled single-blind parallel group trial conducted at six centers under the Central Council for Research in Homoeopathy, the patients were randomized to receive either individualized homoeopathic medicine or placebo for a period of 90 days. A significant difference (P = 0.0001) was found for bleeding , pain, itching and in World Health Organization Quality of Life-BREF (WHOQOL-BREF) physical domain, psychological domain and environmental domain between the Homoeopathy and placebo groups. It was concluded that homoeopathic intervention relieved acute haemorrhoidal symptoms early compared to the placebo group.[4]

Symptomatic indications of some commonly indicated homoeopathic medicines- 

  1. AESCULUS HIPPOCASTANUM –haemorrhoids blind,painful, burning, purplish,rarely bleeding;feels as if rectum is full of small sticks, knife like pains shoot up the rectum. After collinsonia has improved piles  Aesculus often cures. Characteristic backache with absence of actual constipation [5] [6]
  1. ALOE SOCOTRINA –Haemorrhoids are blue, like bunch of grapes; constant bearing down in rectum; bleeding, sore, tender, hot, relieved by cold water; intense itching [5]
  1. ANACARDIUM – hypochondriac individuals with painful haemorrhoids and constipation; sensation of plug in various parts. [5][6]
  1. ANTIMONIUM CRUDUM- From anus, ichorous, oozing, staining yellow; mucous piles[5]
  1. ARSENIC ALBUM-Haemorrhoids  stitching pain when walking or sitting, not at stool; preventing sitting or sleep; burning pain aggravated by heat[5]
  1. CAPSICUM- bleeding with soreness of anus, bloody mucus with burning[6]
  1. CARBO VEGETABILIS – white haemorrhoids; excoriation of anus. Bluish,burning piles,pain after stool[6] 
  1. COLLINSONIA CANADENSIS – chronic painful bleeding piles, sensation as if sticks, sand or gravel has lodged in rectum; haemorrhoidal dysentery with tenesmus; after heart is relieved old piles reappear; in heart disease is complicated with haemorrhoids when other remedies failed [5]
  1. HAMAMELIS VIRGINIANA- Piles bleeding profusely; with burning, soreness, fullness, heaviness; as if back would break; urging to stool; anus feels sore and raw [5]
  1. IGNATIA AMARA – Haemorrhoids prolapse with every stool, has to be replaced, sharp stitches shoot up the rectum, aggravate for hours after stool. Stitches in haemorrhoids during cough[5][6]
  1. LACHESIS – Piles with scanty menses; at climaxis, strangulated;with stitches shooting upwards[5]
  1. LYCOPODIUM CLAVATUM – Haemorrhoids very painful to touch[5]
  1. MURIATICUM ACIDUM – swollen, blue, sensitive and painful to touch; appear suddenly in children; too sore to bear least touch, even the sheet is uncomfortable. Prolapse while urinating. [5]
  1. NITRICUM ACIDUM – Haemorrhoids bleed easily, pain in anus as id anus is torn open;voilent cutting pains after stool, lasting for hours[5][6]
  1. NUX VOMICA – Itching,blind haemorrhoids with ineffectual urging to stool; very painful [6]
  1. PAEONIA -Rectal and anal symptoms predominant; haemorrhoids, fissures, ulceration of anus and perineum, purple, covered with crusts; atrocious pains with and after each stool [6]
  1. PHOSPHORUS – Bleeding haemorrhoids [6]
  1. RATANHIA – Protrusion of haemorrhoids followed by long-lasting aching and burning in anus; bowels inactive; pain after stool as if splinters of glass were sticking in anus and rectum[5]
  1. SEPIA – Sense of weight or ball in anus not relieved by stool; haemorrhoids; stool hard,knotty,  in balls with pain in rectum during and after stool [5]
  1. SILICEA – Haemorrhoids painful with spasm of sphinter; stool comes down with great difficulty, receds again after being partly expelled [6]
  1. SULPHUR – Sensation of burning in rectum; in anus, and itching piles; Haemorrhoids oozing[5][6]
  2. SULPHURIC ACID-  piles burn and fill up the rectum[7]
  3. THUJA OCCIDENTALIS – Piles swollen, pain more severe when sitting [5]
  4. GRAPHITIS –hemorrhoids which burn and sting, anus sore, worse sitting.  Rectum seems to have lost its contractile power, and the varices protrude[7]
  5. VERBASCUM THASUS –  inflamed and very painful piles, scanty evacuation of faeces in small, Hard bits, like sheep dung,with pressing;  frequent or copious micturation. [7]
  6. PETROSELINIUM –  indicated in hemorrhoids when intense itching is present. [7]

Representation of nasal polyp related rubrics in Repertories-

KENT REPERTORY-[8]

Chapter and rubric – RECTUM- HAEMORRHOIDS

SUB-RUBRIC INDICATED MEDICINES
 morning agg  Aloe., Dios., mur-ac., sabin., sulph., sumb., thuj
morning amel Alum., coll
morning bed, in, agg. Graph., rumx
morning waking him Aloe., kali-bi., petr., sulph.
 night agg Aloe., kali-bi., petr., sulph.
 alternating with palpitation Coll.
alternating with lumbago Aloe
 beer agg  Aloe., bry., ferr., nux-v., rhus-t., Sulph.
 blind  Aesc., ant-c., ars., brom., calc-p., caps., cham., coll., ferr., grat., ign., nit-ac., nux-v., podo., puls., rhus-t., sulph., verat.
 bluish Aesc., aeth., ars., Carb-v., dios., ham., Lach., lyc., manc., Mur-ac., phys., sulph., verat-v
 children in Mur-ac.
 chronic  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.
 cold amel Aloe., brom.
 congested 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.
 drunkards,in  Ars., carb-v., Nux-v., sul-a
 excitement Arg-n., gels., hyos., nat-c., nux-v., sumb
 external  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.
 flatus, protrude when passing  Bar-c., phos.
 hard  Ail., alum., ambr., Caust., lach., lyc., phys., sep.
 internal  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.
 large  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.
  menses before Cocc., phos., puls.
 menses, during Aloe., am-c., calc., carb-s., carb-v., cocc., coll., graph., ign., lach., lyss., phos., puls., sulph.
 menses, after Cocc.
 menses, suppressed, during  Phos., sulph.
 mental exertion Caust., nat-c.
 Mercury, after abuse Hep., sul-ac.
 milk agg Sep.
 morning agg Apis., carb-an., euphr., merc., mur-ac., nat-m., puls.
 offensive Carb-v., manc., med.
parturation agg Ign., Kali-c., lil-t., mur-ac., podo., puls., sep., sulph.
 pendulus Nit-ac.
 pregnancy, during Aesc., am-m., ant-c., caps., coll., lach., lyc., nat-m., nux-v., sep., sulph.
 purgations, after Aloe., nux-v.
 rheumatism abate,after  Abrot.
 riding amel Kali-c.
 standing agg Aesc., am-c., caust., sulph.
stool, preventing 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.
strangulated Aesc., Aloe., ars., bell., ign., Lach., nux-v., Paeon., sil., sulph.
suppressed  Ars., calc., caps., carb-v., euphr., Nux-v., phos., puls., Sulph.
suppurating  Anan., carb-v., hep., ign., merc., Sil.
thinking of them agg. :  Caust.
touch agg.  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.
ulcerating Cham., hep., ign., kali-c., lach., nit-ac., paeon., phos., Sil., staph., syph.
urination, protrude during  Aloe., Bar-c., bar-m., canth., kali-c., merc., mur-ac., nit-ac.
urination, after,agg Merc.
walking agg.  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.
walking amel. Ign.
warmth, external, amel. Ars., mur-ac.
warm weather agg.  Nit-ac.
amel. Aesc.

BOERICKE REPERTORY[6]

Chapter – ABDOMEN

HÆMORRHOIDS (piles) — Abrot., Acon., Æsc. gl., Æsc., Aloe, Am. c., Am. m., Apis, Ars., Aur. m., Bar. c., Bell., Brom., Calc. fl., Caps., Carbo an., Carbo v., Card. m., Caust., Cham., Chrom. ac., Collins., Cop., Diosc., Ferr. p., Fluor. ac., Grat., Ham., Hep., Hydr., Hyper., Ign., Kali m., Kali s., Lach., Lyc., Mag. m., Millef., Mucuna, Mur. ac., Negundo, Nit. ac., Nux v., Pæonia, Pinus sylv., Pod., Polyg., Puls., Radium, Ratanh., Sab., Scrophul., Sedum, Sep., Semperv. t., Sul., Sul. ac., Thuja, Verbasc., Wyeth., Zing.

Bleeding — Acon., Æsc., Aloe, Am. c., Bell., Calc. fl., Caps., Card. m., Chrom. ac., Collins., Erig., Ferr. p., Ficcus, Ham., Hydr., Hyper., Kali m., Lept., Lycop., Millef., Mur. ac., Nit. ac., Nux v., Operc., Phos., Sab., Scrophul., Sep., Sul., Thlaspi. Dark, venous blood — Aloe, Ham., Hydr., Kali m., Sul.

Blind — Æsc., Calc. fl., Collins., Ign., Mucuna, Nux v., Puls., Sul., Wyeth.

Bluish, purplish — Æsc. gl., Æsc., Aloe, Ars., Caps., Carbo v., Ham., Lach., Lyc., Mur. ac.

Burning, smarting — Æsc., Aloe, Am. m., Ars., Calc. c., Caps., Carbo an., Carbo v., Caust., Fluor. ac., Graph., Ign., Mag. m., Mucuna, Negundo, Nux v., Psor., Ratanh., Sul., Sul. ac.

Inflamed — Acon., Æsc., Aloe, Bell., Caust., Cop., Ferr. p., Mur. ac., Verbasc.

Itching — Æsc., Aloe, Caps., Carbo v., Caust., Cop., Glon., Ham., Mur. ac., Nit. ac., Nux v., Petros., Puls., Sul.

Mucous piles, continually oozing — Aloe, Am. m., Ant. c., Caps., Carbo v., Caust., Puls., Sep., Sul. ac., Sul.

Protruding,Grape-like, swollen — Æsc., Aloe, Am. c., Caps., Carbo v., Caust., Collins., Diosc., Graph., Ham., Kali c., Lach., Mur. ac., Nux m., Nux v., Ratanh., Scrophul., Sep., Sul., Thuja.

Protuding when urinating  — Bar. c., Mur. ac.

Sensitive, exquisitely painful — Æsc. gl., Æsc., Aloe, Ars., Bell., Cact., Caps., Carbo v., Caust., Cham., Collins., Ferr. p., Graph., Ham., Hyper., Kali c., Lach., Lyc., Mag. m., Mur. ac., Nat. m., Nit. ac., Nux v., Plant., Puls., Ratanh., Scrophul., Sedum, Sep., Sil., Sul., Thuja, Verbasc., Zing.

White piles — Carbo v.

CONCOMITANTS
With Abdominal plethora  — Æsc., Aloe, Collins., Ham., Negundo, Nux v., Sep., Sul.
With Backache — Æsc gl., Æsc., Bell., Calc. fl., Chrom. ac., Euonym., Ham., Ign., Nux v., Sul.
With Constipation — Æsc. gl., Æsc., Am. m., Anac., Collins., Euonym., Kali s., Nux v., Paraf., Sil., Sul., Verbasc.
With Debility — Ars., Cinch., Ham., Hydr., Mur. ac.
With Epistaxis — Carbo v.
With Fissures, soreness of anus — Caps., Cham., Nit. ac., Ratanh., Sedum.
With Heart disease  — Cact., Collins., Dig.
With Hypochondriasis — Æsc., Grat., Nux v.
With Pelvic congestion  — Aloe, Collins., Ham., Hep., Mucuna, Pod., Nux v., Sep., Sul.
With Prolapsus ani et uteri — Pod.
With Spasm of sphincter — Lach., Sil.
With Stitches in rectum during cough — Ign., Kali c., Lach., Nit. ac.
With sudden development in marantic children– Mur. ac.
With tenesmus,,anal and visceral, diarrhœa — Caps.
With tenesmus,constriction, lancinating pains — Nux v.
With tenesmus,dysenteric stools — Aloe, Sul.
With tenesmus,in pregnant females– Collins.

With vicarious bleeding  — Ham., Millef

AGGRAVATION
After Confinement –Aloe, Apis.
After Stool for hours — Æsc., Am. m., Ign., Ratanh., Sul.
As Rheumatic symptoms abate — Abrot.
During Climacteric  — Æsc., Lach.
During Menses — Am. c., Lach.
During Sitting  — Graph., Ign., Thuja.
From Alcoholic abuse, in sedentary persons — Æsc. gl., Nux v.
From Coughing, sneezing  — Caust., Kali c., Lach.
From Leucorrhœa suppressed — Am. m.
From Talking, thinking of them  — Caust.
From Walking — Caust., Sep.

AMELIORATIONS

From cold water — Aloe, Nux v., Ratanh.
From  hot water  — Ars., Mur. ac.
From lying down — Am. c.
From  walking  — Ign.

REPERTORY OF  HERING’S GUIDING SYMPTOMS OF OUR MATERIA MEDICA[9]

Chapter – Stool and Rectum

Hæmorrhoids :- Absin., Acon., ÆSC., Aloe, Alumin., Am-c., Am-m., Ambr., ANAC., Anag., Ant-c., Apis, ARS., Aur., Aur-m., Bad., BAR-C., Bell., Berb., Calc., CAPS., Carb-ac., Carb-v., Card-m., CAUST., Cham., Chel., Chen-v., Chin., Chr-ac., Cimx., Coff., COLL., Coloc., Crot-h., Cub., Dios., Erig., Ery-a., Euphr., Ferr-p., GRAPH., Grat., HAM., Hell., Hydr., ¤ Hyper., Ign., Kali-bi., Kali-c., Kali-m., Kalm., Lach., Lept., Lob., Lyc., Lyss., Med., Merc-i-r., MUR-AC., Nit-ac., Nux-m., NUX-V., Pæon., Petr., Ph-ac., Phyt., Plan., Podo., Polyg., Puls., Rhus-t., Sang., Sep., Sul-ac., SULPH., Thuj., Tril., Tub

NASH IN THERAPEUTIC INDEX OF “LEADERS IN HOMOEOPATHIC THERAPEUTICS”[10]
Haemorrhoids: Nux-v., Ars., Sulph., Lach., Apis., Ign., Aesc., Millif., Mur Ac., Nit-ac., Caust., Ham., Collin., Melil., Gamb., Aloe

REFERENCES

  1. Shenoy K.R, Shenoy A.S. Manipal  manual of surgery. New Delhi: 4th ed. CBS  publishers and distributors Pvt Ltd; 2014 
  2. Bhat M Sriram. SRB’s Clinical Methods in Surgery. New Delhi :2nd ed. Jaypee Brothers Medical Publishers.(P)Ltd;2015
  3. Das KD, Ghosh S, Das AK, Ghosh A, Mondal R, Banerjee T, Ali SS, Ali SS, Koley M, Saha S. Treatment of hemorrhoids with individualized homeopathy: An open observational pilot study. J Intercult Ethnopharmacol[Internet]. 2016 Jun 25 [cited 2020 Jun 24];5(4):335-342.Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061475/. doi: 10.5455/jice.20160608030224. PMID: 27757262; PMCID: PMC5061475.
  4. Chakraborty P S, Varanasi R, Majumdar A K, Banoth K, Prasad S, Ghosh M S, Sinha M N, Reddy G R, Singh V, Nayak C. Effect of homoeopathic LM potencies in acute attacks of haemorrhoidal disease: A multicentric randomized single-blind placebo-controlled trial. Indian J Res Homoeopathy [serial online] 2013 [cited 2020 Jun 24];7:72-80. Available from: http://www.ijrh.org/text.asp?2013/7/2/72/116630
  1. Allen H.C.  Keynotes Rearranged And Classified  With Leading Remedies Of Material Medica added with other Leading Nosodes and Bowel Nosodes. New Delhi. Indian books and periodicals Publishers;2011
  2. Boericke W. New Manual of Homoeopathic Materia Medica and Repertory. Reprint Edition  New Delhi: B. Jain Publishers(P)Ltd.; 2011
  3. Dewey W.A.  Practical Homeopathic Therapeutics.New Delhi:3rd ed.B. Jain Publiishers (P) Ltd.;2012
  4. Kent JT. Repertory of Homeopathic Materia Medica. Reprint Edition. New Delhi: B. Jain Publishers (P) Ltd.; 2007.
  5. Knerr CB. Repertory of Hering’s Guiding Symptoms of our Materia Medica. Available from: http://www.homeoint.org/hering/nose-lr.htm
  6. NashE.B. Leaders in Homoeopathic Therapeutics. Therapeutic index. Available from: http://www.homeoint.org/books2/nashtherap/theraindex.htm

1 Comment

  1. collinsonia is pelvic and portal venous congestion extremeties swell due to weak organic heart,constipation due to atony intestines,piles,here use potency 30 or 200.if heart healthy only constipation very low potency.aesculus is general venous congestion with lower back aches and feeling of fullness in blood vessels,nose catarrhal mucous membranes feel dry raw.

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