Haemorrhoids also known as piles, are three-column clusters of vascular tissue, smooth muscle, and connective tissue that run down the anal canal. They are present in healthy people as cushions that aid incontinence. The major cause of haemorrhoids is an increase in pressure in the veins of the network known as hemorrhoidal plexus. Straining leads to pressure in veins and is the beginning of symptomatic haemorrhoids. The causes of this are due to physical exertion or pregnancy but are mostly due to Irritable Bowel Syndrome’s (IBS) recurrent constipation or diarrhoea. The longer the time between motions, the harder the stool. This causes straining, which leads to haemorrhoids. In rare cases, harm to the delicate skin in the anal canal, resulting in a painful condition i.e fissure in ano.
The degree of prolapse of haemorrhoids is graded. “Grade I” prolapse does not occur below the dentate line and is detectable on anoscopy or colonoscopy. “Grade II” prolapse occurs below the dentate line but resolves on its own along with proper medications. “Grade III” prolapse necessitates manual reduction. “Grade IV” prolapses with a dentate line below the dentate line. They cannot be reduced. While Irritable bowel syndrome (IBS) is of two types, IBS- C and IBS-D; (IBS) – C is characterised by constipation, whereas IBS – D is characterised by diarrhoea-predominant symptoms. Almost half of the patients have a variety of symptoms. Most patients have had symptoms for more than ten years, and many have IBS-C symptoms that date back to their adolescent years or earlier.
A 60-year-old female came with complaints of irregularity in passing stools with a frequency of bowel 4-5 times a day along with a coating of mucus over the stools. She had a feeling of incomplete evacuation after defecation and pricking pain in the anal area for the last 1.5 years since 2019.
She was taking Allopathic and Ayurvedic medications for a few years for the issue, but none that she was taking helped her much for relief. She has no history of any major illness.
Blood pressure: 126/80 mmHg
Radiological findings, findings if any: NA
Local examination per anal.
- Anal spasm: ++
- Anal tenderness: Posterior part, ++
- Position of Haemorrhoids: 3,7 ad 11 O’clock (Grade II)
- Fissure in ano: Posterior part +++
The following diagnosis was established after a thorough checkup, understanding health history of the patient as well as the patient’s personal and family medical history:
Arsha and Grahani / Grade II Haemorrhoids with Posterior fissure-in-ano and IBS
Initially, the following treatment plan was planned for the first 15 days:
- Sitz bath twice a day
- Chitrakadi Vati 2BD before meals.
- Bilwadi churn 3 gm BD with food
- Malhar yog 2gm BD before food
- Abhyarista 20ml HS with an equal amount of water
- Takaraista 15ml BD with an equal amount of water
Preventive guidelines are recommended to the patient during the management period;
- Reduce consumption of hot, spicy and heavy meals.
- Avoid sitting in the same position for lengthy periods of time.
- Avoid excessive exertion and minimise consumption of alcoholic beverages.
- Avoid vata-inducing foods and lifestyle variables that have dryness in nature – lack of lubrication.
- Consume a high-fiber diet and drink plenty of water.
- Self-oil massage to the head and body should be done on a regular basis.
- To quiet the mind, practice yoga and pranayama.
The patient was satisfied and stable after following the treatment protocol. Bilwadi churna gave phenomenal results as an adjuvant in curing IBS conditions within 24hrs of its consumption.
- The frequency of the motions decreased to 1-2 times a day from 4-5 times
- Satisfactory evacuation
- No mucus discharge was present while passing stools
- No pain in the anal area
Agnimandhya (poor digestion) is the primary root cause of IBS illness, which results in stool distortion. It gets tough along with mucus coating and difficult to expel. Eventually, the individual begins to strain to expel feces. To lessen the stain, the patient was suggested to take Chitrakadi vati and Malhar yog, which aid in the correction of digestive strength, the reduction of gas and bloating the improvement of bowel evacuation, and the promotion of a sensation of lightness in the belly. Internal administration of Bilwadi churna assisted in reduction of pain and oedema. Abhaya Arishtam is the herbal supplement of choice for this disease since it helps to stimulate bowel movements, relieve discomfort, and improve digestive power. Takrarista has a moderate laxative effect. Within 15 days of treatment, the patient began to feel better and was free of all the symptoms, as well as the enlarged haemorrhoids.
The cause of haemorrhoids is unknown. Constipation and a low-fiber diet have long been said to increase the risk of haemorrhoids. Bleeding, discomfort, pruritus, faecal seepage, prolapse, and mucus discharge are the symptoms of haemorrhoids. Intestinal straining, constipation, diarrhoea, pregnancy, and irregular bowel habits are among the dangers. The symptoms of haemorrhoids differ depending on the kind. If there are external haemorrhoids, people may feel itching in the anus and a firm, sensitive bump around its location. They also have anal pain, particularly when people sit for an extended period. The pain gets aggravated while stretching, massaging, or scrubbing the region around the lumps.
Dietary and lifestyle changes are the foundation of treatment whether the patients of haemorrhoids opt for surgery or not. The key to help with the issues was to take fiber supplements, drink lots of fluids, and exercise. All of this is intended to control, rather than soften the bowel motions. The objective is to prevent both extremely hard stools and diarrhoea. This form of stool appears to be the most effective in preventing practically all types of anal disorders.
Bilwadi Churna has its pain-relieving and anti-inflammatory properties coupled with Vijaya which is incredibly useful. The Ayurvedic drug, along with the additional impact of cannabinoids in Bilwadi churna, creates positive benefits for the human body through its analgesic, antioxidant, and anti-inflammatory actions in treating haemorrhoids as well as Irritable Bowel Syndrome (IBS). Cannabis has a key function in treating certain types of constipation and modulating intestinal secretion, resulting in more regular, healthy bowel motions through normal gastrointestinal motility.
Case Study by: Dr. Ashish Jaiswal
Published by: Hempstreet