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Piles or Hemorrhoid

Written and reviewed by
Dr. Jagdish Prasad Mehrotra 91% (1740 ratings)
MBBS, D.P.H
General Physician, Gurgaon  •  44 years experience
Piles or Hemorrhoid

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.


Symptoms:
    Itching
    Rectal pain
    Rectal bleeding
    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.


Causes: 
    Mechanical causes: any activity that puts sustained pressure on the tissue in the anal or pelvic floor area e. G.
    
 Constipation
 Pregnancy
 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.

Management:


    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.
 Sitz bath.
        
    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

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