Piles or haemorrhoids are normal structures of anal canal. They are made-up of sinusoids, connective tissues and smooth muscle fibres. Since they are normal anatomical structures of anal canal, they serve a definite function. Actually, they are blood filled cushion-like structures which are compressed while stool passed through and are filled up with blood as soon as the stool is out. This procedure is synchronized with relaxation and contraction of internal anal sphincter. In this way the, the haemorrhoids act as a set of cushions in anal canal which prevent the Gastro-intestinal fluid to come out continuously. They allow air (flatus) to pass through them in normal condition but do not allow faecal matter or fluid to pass through it. Without haemorrhoidal plexus, fluid or faecal matter would come out through anus constantly.
All human beings are having haemorrhoids. Confused? How come a normal structure be termed as a disease? Let me clear your confusion. Haemorrhoids are short term of the disease. The full name is “Haemorrhoidal Disease”. When somebody has symptoms, it is said that, he/she is suffering from haemorrhoidal disease.
There is a common belief in Indian society that, piles are very painful condition. But the fact is different. Piles are painless conditions unless it is complicated. The main feature of piles is painless rectal bleeding which may occur before, during or after passing of stool. Sometimes pile masses come out during passing stool which may go in spontaneously or needs manipulation. Depending on this, haemorrhoidal diseases are graded from first degree to fourth degree. There may be internal or external haemorrhoids. Seldom they get infected and strangulated which cause pain and swelling.
Piles are most commonly diagnosed by clinical examination. The surgeon may perform digital rectal examination and proctoscopy. Sometimes flexible sigmoidoscopy and/or colonoscopy are advised to confirm the diagnosis as well as to exclude other colonic diseases like polyp, cancer and ulcers.
The first- and second-degree haemorrhoids are mostly treated with medicines and minimal invasive procedures like injection sclerotherapy, IRC, laser, rubber band ligation etc. In advanced condition, surgery like haemorrhoidectomy is done. In selective cases, stapled haemorrhoidopexy is performed. Doppler-guided haemorrhoidal artery ligation (DGHAL) is the latest modality of treatment.
Ksharasutra ligation is a minimal invasive Ayurvedic procedure for piles. It is not done in all cases but is performed selectively in advanced internal piles. Ligation of external piles with ksharasutra is not an admirable procedure as it causes severe post-operative pain, laceration in anoderm and loss of perianal skin. They may often cause stricture. Bleeding internal piles in early stages may also be treated safely with ksharakarma which is a non-invasive procedure of sclerotherapy.
Remember, chandshi / madrasi / bangali procedures are not Ayurvedic procedures. Ksharasutra ligation of piles and ksharakarma should be performed by a very skilled surgeon to avoid complications like post-operative bleeding and anal stricture.
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