Piles or hemorrhoid
Hemorrhoid in physiological state act as a cushion composed of arterio-venous channels and connective tissue in the rectum that aid the passage of stool, but due to excess pressure in the abdominal area or pelvic area blood vessels near the anus are engorged and swollen and their walls becomes stretched, thin and irritated by passing stool.
Classification: it is of two types
Internal hemorrhoid is located higher in the inside lining of the rectum cannot felt unless they are substantially enlarged. It usually presents as painless bleeding. Sometimes internal hemorrhoids prolapsed or protrude outside the anus you may be able to see or feel them as moist of skin. Prolapsed hemorrhoids may hurt because the anus is dense with pain sensing nerve. Prolapsed hemorrhoids usually recede into the rectum on their own or by gently pushed back into place.
External hemorrhoids are located underneath the skin that surrounds the anus and can be felt when they swell. Blood clots sometimes form within prolapsed external hemorrhoids, which is extremely painful (thrombosis). It present with pain in anal area with blood or without blood.
Hemorrhoid is generally not dangerous unless they become infected. Complication can include thrombosed or strangulated hemorrhoids, bacterial infection and skin fissures. Rely bleeding from hemorrhoid lead to anemia.
Mechanical causes: any activity that puts sustained pressure on the tissue in the anal or pelvic floor area e. G.
Carrying or lifting heavy loads
Sitting or standing for long periods, long distance driving, prolong working on the desk or bicycling
Dietary factors: e. G. Low fiber diet, oily spicy and processed food, food in low micro minerals etc.
Aging: connective tissue becomes less resilient in aged person.
Overweight and obesity: this leads to poor vascular health as result of inflammation and poor nutrition.
Predisposing factors: deficit in anti-inflammatory foods combined with an over consumption of inflammatory food contributes to unhealthy blood vessel function throughout the body including anal area.
Low fiber diet
High in refined carbohydrate and animal products.
Diet low in essential fats e. G. Omega 3
Diet low in micro minerals including zinc & chromium
High alcohol consumption.
Obesity or overweight
All the above are the risk factors for inflammation which is aggravated by constipation, pregnancy, standing for long period or prolong sitting on desk.
Reduction of constipation and soften stool by consuming enough fiber and water.
Strengthen and fortify vascular and connective tissue in the anal area and elsewhere by consumption of anti inflammatory diet.
Lifestyle measures to avoid hemorrhoids e. G. Good bowel function, exercise and healthy evacuation posture.
Reducing constipation and softening stool:
Consume high fiber foods as a part of high biber diet. < >Grain products: (6-11 servings of grain product in your diet is required daily) whole grain breads, whole wheat, whole grain rye, mixed grain, cracked wheat, buns, muffins. Brown ricewhole wheat pasta or brown rice pastacereals made from whole grain oatmeal ground flax, wheat germ or wheat bran in baked goods vegetables: (3-5 servings daily) dark green leafy vegetables contain heigest amounts of fiber e. G. Spinach, broccoli, green peas, green beans, turnip greens. Fruits: (2-3 serving of fruits) apples. Oranges, pears, peaches. Berries (strawberries, raspberries, blueberries, and blackberries) dried fruits (dates, prunes (alu bukhara), apricots (khubaanee) legumes, nuts and seeds:
Black bean, green beans, peas, kidney bean, lentils, peanut, soy bean
Walnuts, peanuts, cashews, sunflower seeds
High fiber food relieves the constipation which ultimately reduces the abdominal and colonic pressure resulting low incidence of hemorrhoid.
Plenty of water as a part of a hemorrhoid diet: water is key for fiber to function as an antidote to constipation
Avoid a diet high in refined carbohydrate as part of your hemorrhoid diet.
Avoid saturated fats, non vegetarian food, trans-fats which leads to inflammation.
Strengthen and fortify vascular and connective tissue in the anal area and elsewhere by consumption of anti inflammatory diet.
Omega 3 fat: it plays important role in maintaining healthy skin and mucus membrane. It has important anti inflammatory function which is extremely useful when it is consumed in a condition like hemorrhoids. As the consumption of omega 3 fat increases ratio of omega 6 and omega 3 lowers. It is abundant in cold water fish and their oils and in seeds and their oils e. G. Flax seeds
“flax seeds (alsi)- soak ¼ cup of flax seeds overnight in a glass of water and drink the gel on next day or boil it till the water become half and drink the gel on same day.”
Vitamin c: it maintains the healthy blood vessels and maintain tissue matrix. And increases the body immunity also. Rich source are blackberries, raspberries, broccoli, spinach, guavas, amla, lime melon, orange, papaya, pineapple, tomato.
Vitamin e: it is a fat soluble vitamin which maintains healthy cell membrane as well as the prevention of inflammation. It is helpful in healing the inflamed tissue and trying to shrink the hemorrhoids. Rich source of it are nuts and seeds.
Magnesium: it is a key mineral for vascular tone and integrity as well as nerve and muscle function. It increases the peristaltic action of the colon that propels feces towards the anus. Dark leafy vegetables are rich source of magnesium.
Zinc: it plays important role of anti inflammatory diet and beneficial for hemorrhoid. Nuts and grains are rich source. You can supplement with 9mg /day (adult dose) aaaa
Lifestyle measures to avoid hemorrhoids:
Proper defcation technique: avoid straining when seated on the toilet. “posture key factor is that your bent knees remain higher than your hips.” this posture promotes easier elimination and avoid strain or pressure in the anal are thus contributes in minimizing hemorrhoids.
Exercise: it is an important factor to maintain the tone of abdominal and pelvic floor muscle to avoid hemorrhoids. Kegel exercise strengthen the pelvic floor muscle which is done as follow
First step – locate the pelvic floor muscle “ stop urination in midstream, now you have located the pelvic floor muscle.
Second step- lye down & contract these muscle for a slow count of five.
Third step- release the muscles to a slow count of five
Repeat this exercise for 10 times three times daily
Avoid activities that put pressure on your back e. G. Prolong standing, sitting on desk for long time, strenuous work, lifting or carrying heavy materials.
Avoid stress which is a risk factor for hemorrhoids as it aids in constipatin and inflammation. Stress release the harmones which inhibit bowel movement.
Chew food slowly which helps in digestion and absorption of nutrients.
Take small and frequent meals.
Dinner should be light and 2 hour before retiring to bed.
Morning walk for 35 minutes daily
Meditation and exercise daily for 30 minutes without strain.
No smoking, no alcohol no tobacco
Non oily, non spicy and processed food is to be avoided.
No hurry worry and curry
Treatment: it is symptomatic. (as per advice of physician exclusively) e. G.
Pain- local application of xylocain gel, proctocydel ointment etc. Analgesic and anti-inflammatory drug like ibugesic after meal or turmeric with milk
Infection- antibiotic e. G. Terramycin sf 500 mg 6 hourly for 5 days and metronidizol 400 mg 1 tab. Thrice daily for 5 days.
Supplement with vitamins e & c, mineral zinc and magnesium
Stool softener like softovac sf, mucain gel
Aurvedic medicin like pilex aesculus hippocatanum
Homeopathic medicin like aesculus hippocastanum
Govt bans 344 drugs, including phensedyl, corex
Sr. No. Product name (irrational fdc)
1 aceclofenac + paracetamol + rabeprazole
2 nimesulide + diclofenac
3 nimesulide + cetirizine + caffeine
4 nimesulide + tizanidine
5 paracetamol + cetirizine + caffeine
6 diclofenac + tramadol + chlorzoxazone
7 dicyclomine + paracetamol + domperidone
8 nimesulide + paracetamol
9 paracetamol + phenylephrine + caffeine
10 diclofenac+ tramadol + paracetamol
11 diclofenac + paracetamol + chlorzoxazone + famotidine
12 naproxen + paracetamol
13 nimesulide + serratiopeptidase
14 paracetamol + diclofenac + famotidine
15 nimesulide + pifofenone + fenpiverinium + benzyl alcohol
16 omeprazole + paracetamol + diclofenac
17 nimesulide + paracetamol injection
18 tamsulosin + diclofenac
19 paracetamol + phenylephrine + chlorpheniramine + dextromethorphan + caffeine
20 diclofenac + zinc carnosine
21 diclofenac + paracetamol + chlorpheniramine maleate + magnesium trisillicate
22 paracetamol + pseudoephedrine + cetrizine
23 phenylbutazone + sodium salicylate
24 lornoxicam + paracetamol + trypsin
25 paracetamol + mefenamic acid + ranitidine + dicylomine
26 nimesulide + dicyclomine
27 heparin + diclofenac
28 glucosamine + methyl sulfonyl methane + vitamini d3 + maganese + boron + copper + zinc
29 paracetamol + tapentadol
30 tranexamic acid + proanthocyanidin
31 benzoxonium chloride + lidocaine
32 lornoxicam + paracetamol + tramadol
33 lornoxicam + paracetamol + serratiopeptidase
34 diclofenac + paracetamol + magnesium trisilicate
35 paracetamol + domperidone + caffeine
36 ammonium chloride + sodium citrate + chlorpheniramine maleate + menthol
37 paracetamol + prochlorperazine maleate
38 serratiopeptidase (enteric coated 20000 units) + diclofenac potassium & 2 tablets of doxycycline
39 nimesulide + paracetamol suspension
40 aceclofenac + paracetamol + famotidine
41 aceclofenac + zinc carnosine
42 paracetamol + disodium hydrogen citrate + caffeine
43 paracetamol + dl methionine
44 disodium hydrogen citrate + paracetamol
45 paracetamol + caffeine + codeine
46 aceclofenac (sr) + paracetamol
47 diclofenac + paracetamol injection
48 azithromycin + cefixime
49 amoxicillin + dicloxacillin
50 amoxicillin 250 mg + potassium clavulanate diluted 62.5 mg
51 azithromycin + levofloxacin
52 cefixime + linezolid
53 amoxicillin + cefixime + potassium clavulanic acid
54 ofloxacin + nitazoxanide
55 cefpodoxime proxetil + levofloxacin
56 azithromycin, secnidazole and fluconazole kit
57 levofloxacin + ornidazole + alpha tocopherol acetate
58 nimorazole + ofloxacin
59 azithromycin + ofloxacin
60 amoxycillin + tinidazole
61 doxycycline + serratiopeptidase
62 cefixime + levofloxacin
63 ofloxacin + metronidazole + zinc acetate
64 diphenoxylate + atropine + furazolidonee
65 fluconazole tablet, azithromycin tablet and ornidazole tablets
66 ciprofloxacin + phenazopyridine
67 amoxycillin + dicloxacillin + serratiopeptidase
68 azithromycin + cefpodoxime
69 lignocaine + clotrimazole + ofloxacin + beclomethasone
70 cefuroxime + linezolid
71 ofloxacin + ornidazole + zinc bisglycinate
72 metronidazole + norfloxacin
73 amoxicillin + bromhexine
74 ciprofloxacin + fluticasone + clotrimazole + neomycin is
75 metronidazole + tetracycline
76 cephalexin + neomycin + prednisolone
77 azithromycin + ambroxol
78 cilnidipine + metoprolol succinate + metoprolol tartrate
79 l-arginine + sildenafil
80 atorvastatin + vitamin d3 + folic acid + vitamin b12 + pyridoxine
81 metformin + atorvastatin
82 clindamycin + telmisartan
83 olmesartan + hydrochlorothiazide + chlorthalidone
84 l-5-methyltetrahydrofolate calcium + escitalopram
85 pholcodine + promethazine
86 paracetamol + promethazine
87 betahistine + ginkgo biloba extract + vinpocetine + piracetam
88 cetirizine + diethyl carbamazine
89 doxylamine + pyridoxine + mefenamic acid + paracetamol
90 drotaverine + clidinium + chlordiazepoxide
91 imipramine + diazepam
92 flupentixol + escitalopram
93 paracetamol + prochloperazine
94 gabapentin + mecobalamin + pyridoxine + thiamine
95 imipramine + chlordiazepoxide + trifluoperazine + trihexyphenidyl
96 chlorpromazine + trihexyphenidyl
97 ursodeoxycholic acid + silymarin
98 metformin 1000/1000/500/500mg + pioglitazone 7.5/7.5/7.5/7.5mg + glimepiride
99 gliclazide 80 mg + metformin 325 mg
100 voglibose+ metformin + chromium picolinate
101 pioglitazone 7.5/7.5mg + metformin 500/1000mg
102 glimepiride 1mg/2mg/3mg + pioglitazone 15mg/15mg/15mg + metformin 1000mg/1000mg/1000mg
103 glimepiride 1mg/2mg+ pioglitazone 15mg/15mg + metformin 850mg/850mg
104 metformin 850mg + pioglitazone 7.5 mg + glimepiride 2mg
105 metformin 850mg + pioglitazone 7.5 mg + glimepiride 1mg
106 metformin 500mg/500mg+gliclazide sr 30mg/60mg + pioglitazone 7.5mg/7.5mg
107 voglibose + pioglitazone + metformin
108 metformin + bromocriptine
109 metformin + glimepiride + methylcobalamin
110 pioglitazone 30 mg + metformin 500 mg
111 glimepiride + pioglitazone + metformin
112 glipizide 2.5mg + metformin 400 mg
113 pioglitazone 15mg + metformin 850 mg
114 metformin er + gliclazide Mr. + voglibose
115 chromium polynicotinate + metformin
116 metformin + gliclazide + piogllitazone + chromium polynicotinate
117 metformin + gliclazide + chromium polynicotinate
118 glibenclamide + metformin (sr)+ pioglitazone
119 metformin (sustainded release) 500mg + pioglitazone 15 mg + glimepiride 3mg
120 metformin (sr) 500mg + pioglitazone 5mg
121 chloramphenicol + beclomethasone + clomitrimazole + lignocaine
122 of clotrimazole + ofloxaxin + lignocaine + glycerine and propylene glycol
123 chloramphennicol + lignocaine + betamethasone + clotrimazole + ofloxacin + antipyrine
124 ofloxacin + clotrimazole + betamethasone + lignocaine
125 gentamicin sulphate + clotrimazole + betamethasone + lignocaine
126 clotrimazole + beclomethasone + ofloxacin + lignocaine
127 becloemthasone + clotrimazole + chloramphenicol + gentamycin + lignocaine ear
128 flunarizine + paracetamole + domperidone
129 rabeprazole + zinc carnosine
130 magaldrate + famotidine + simethicone
131 cyproheptadine + thiamine
132 magaldrate + ranitidine + pancreatin + domperidone
133 ranitidine + magaldrate + simethicone
134 magaldrate + papain + fungul diastase + simethicone
135 rabeprazole + zinc + domperidone
136 famotidine + oxytacaine + magaldrate
137 ranitidine + domperidone + simethicone
138 alginic acid + sodium bicarbonate + dried aluminium hydroxide + magnesium hydroxide
139 clidinium + paracetamol + dicyclomine + activated dimethicone
140 furazolidone + metronidazole + loperamide
141 rabeprazole + diclofenac + paracetamol
142 ranitidine + magaldrate
143 norfloxacin+ metronidazole + zinc acetate
144 zinc carnosine + oxetacaine
145 oxetacaine + magaldrate + famotidine
146 pantoprazole (as enteric coated tablet) + zinc carnosine (as film coated tablets)
147 zinc carnosine + magnesium hydroxide + dried aluminium hydroxide + simethicone
148 zinc carnosine + sucralfate
149 mebeverine & inner hpmc capsule (streptococcus faecalis + clostridium butyricum + bacillus
Mesentricus + lactic acid bacillus)
150 clindamycin + clotrimazole + lactic acid bacillus
151 sildenafil + estradiol valerate
Avoid this combinations and be safe.