Types of Hemorrhoids Piles &Treatment options

What are hemorrhoids?

Hemorrhoids are commonly known as Piles. They are swollen, distended veins found protruding out of the anus or inside the anal canal.

Types of hemorrhoids

Hemorrhoids or Piles can be classified into three types, based on the anatomy.

  1. Internal Hemorrhoids.

  • They are above the dentate line*.
  • They are located inside the rectum.
  • Painless but may cause pruritus (itching around the anus).
  • Tends to bleed.
  1. External Hemorrhoids.

  • They are below the dentate line.
  • Located around the anus.
  • Painful, itchy, and may bleed.
  • May develop a blood clot leading to thrombosed hemorrhoids.
  1. Intro-external Hemorrhoids.

  • They are both above and below the dentate line.

The Internal Hemorrhoids are further classified into four categories based on physical examination & proctoscopy (examination of the anal canal with the help of a proctoscope). The grading is based on the extent of prolapse of the hemorrhoids.

Grade 1 / 1stDegree Hemorrhoids: The hemorrhoid faintly projects into the anal canal. During defecation/passing stool, (especially if the patient strains) bleeding occurs however, there is no pain and no prolapse.

Grade 2 / 2nd Degree Hemorrhoids:The pile mass / hemorrhoid prolapses on straining (when passing stool)but the mass returns inside the canal spontaneously once the straining stops.

Grade 3 / 3rd Degree Hemorrhoids: The hemorrhoid once out of the anal canal does not go back into the canal even after the straining stops. It has to be reduced manually, i.e. it has to be pushed inside.

Grade 4 / 4th Degree Hemorrhoids: The hemorrhoid protrudes out of the anal canal and stays out, i.e. it cannot be reduced manually.

What are the available treatments?

The treatment varies based on the type, grading, and the general condition of the patient. Often, more than one method may be indicated in a case.

Conservative treatment:

  1. Plenty of fluids.
  2. High fiber diet.
  3. Applying a cold compress on the affected area.
  4. Sitting in warm water for about 10 minutes (Sitz Bath).
  5. Some Ayurveda medicines are beneficial especially in first and second degree hemorrhoids.
  6. Bulk forming laxatives and stool softeners.

Minimal Invasive Surgery:

  1. Rubber band or Barron Band Ligation–A rubber band is put around the hemorrhoid with the help of a specially designed ‘gun’. This treatment is beneficial only in certain types of piles. The blood supply to the pile mass is obliterated and hence the hemorrhoid falls off in a few days.
  2. Infrared/laser coagulation – the heat caused by the infrared light destroys the hemorrhoid.
  3. Sclerotherapy – a chemical solution is injected into the hemorrhoid tissue. This will destroy the tissue. This method is mostly not used now due to availability of better options.
  4. Cryosurgery – using nitrous oxide or liquid nitrogen to freeze the affected area / concerned tissue. This method too is less preferable.

Surgical Treatments:

  1. Hemorrhoidectomy

Open:Removal of the entire structure (hemorrhoid). This surgical wound is left open.

Closed: Similar to the above mentioned procedure, but the surgical wound is closed.

Hemorrhoidectomy was considered the choice of treatment for prolapsed hemorrhoids in Ayurveda. Sushrut, the father of surgery has advocated “chedana” (exision) in the treatment of Hemorrhoids/Arsha.

  1. Stapler–A specially designed gadget (stapler) removes a ring of anal mucosa, the upper and lower margins are stapled together. Stapler hemorrhoidectomy is indicated in selective cases.
  2. Laser ablation of the hemorrhoid. This is essentially hemorrhoidectomy, but using a laser beam to cut it.
  3. KsharPatan – This is a very specialized treatment of Ayurveda. A Kshar (extract of the water soluble part of the ash of certain herbs) is used in this method. KsharPatan or Kshar Karma as it is sometimes called is very cost effective and is a minimal invasive technique. The Kshar destroys the concerned tissue. The procedure may or may not require anesthesia. The procedure required special types of proctoscopes and high quality kshar. This should only be performed by an experienced proctologist. Even the preparation of the Kshar is a complicated and time consuming procedure. After the KsharPatan, it is very important to neutralize the remaining Kshar otherwise the surrounding tissues may get damaged.
  4. Kshar Sutra-Many Ayurvedic specialists of this field use a KsharStura to ligate the hemorrhoid. This cuts off the blood supply to the tissue and the piles mass drops off within a few days. This procedure is performed under anesthesia. The Kshar Sutra cuts through the tissues, destroying the hemorrhoid. The Kshar Sutra is a special type of thread which is created withKsharans other herbs which helps in cutting & keeping the wound clean. The Kshar Sutra treatment may be a little painful.

Thus there are various types of treatments for hemorrhoids. Specific treatments are indicated in specific types of piles and in specific conditions.

ShreyasAno Rectal Hospital and Research Center offers all these treatments (except the ones which are no longer advisable due to the progress and research made in this field)

KsharPatan&Kshar Sutra ligation are based on Ayurveda principles and hence are available only in India and practiced by Ayurveda experts. Even excision/chedana/’hemorrhoidectomy’ as it is called in modern day surgery is performed by Ayurveda experts, incorporating the use of Ayurveda drugs both orally and locally to correct the basic pathology of diseases.

*Dentate line – the line that divides the upper and lower part of the anal canal.