Piles

1. Internal haemorrhoids 2. External haemorrhoids 3. Rectum 4. Anal canal 5. Normal cushions of tissue

Piles or haemorrhoids are swellings and inflammation of veins in the rectum and anus, which are technically defined as 'cushions of tissue filled with blood vessels at the junction of the rectum and the anus'. However, all varicosities of haemorrhoid tissues are popularly known as piles. Itching, pain and bleeding are the connected symptoms.

These occur as a result of too much pressure on the internal haemorrhoid veins. Specifically, they are varicosities of veins draining the territory of branches of the superior rectal arteries. There might be very little pain, as pain receptors are few here, and the only external sign would be blood stain on stool or in the toilet bowl. Untreated internal haemorrhoids can lead to two severe forms of haemorrhoids, viz, prolapsed and strangulated haemorrhoids: Prolapsed haemorrhoids are internal haemorrhoids that are so distended that they are pushed outside the anus. If the anal sphincter muscle goes into spasm and traps a prolapsed haemorrhoid outside the anal opening, the supply of blood is cut off, and the haemorrhoid becomes a strangulated haemorrhoid.

These appear when the external haemorrhoid veins around the anus become swollen. Specifically they are varicosities of the veins draining the territory of the inferior rectal arteries, which are branches of the pudendal artery. These will easily bleed from straining or rubbing and there may be irritation from draining mucus in the anal area. External haemorrhoids are prone to thrombosis: if the vein ruptures and/or a blood clot develops, the haemorrhoid becomes a thrombosed haemorrhoid.

Over straining during bowel movements which may be caused by constipation or diarrhoea may lead to formation of haemorrhoids. Women experiencing premenstrual syndrome or menstruation disorders suffer from constipation due to water retention and this may cause piles. Piles may also be caused due to hypertension, particularly portal hypertension, due to the connections between the portal vein and the vena cava in the rectal wall. Obesity and related behavioural changes can cause piles. Sitting for long periods at a time, combined with poor muscle tone and poor posture, can result in too much pressure on the rectal veins resulting in piles. Pregnancy increases hypertension which, in turn, increases strain during bowel movements and this may cause piles. Excessive alcohol and caffeine intake can cause diarrhoea which causes haemorrhoids. It has also been proven that cigarette smoking during bowel movements may worsen the condition of the haemorrhoids leading to internal bleeding of veins inside the rectum. In women, hypertension during pregnancy leading to constipation and resultant strain during bowel movements may cause the formation of haemorrhoids.

Most common grading system of the stages of piles was developed by Leon Banov Jr. and is related to the degree of prolapse. It is applied in the case of internal haemorrhoids as external haemorrhoids can be visibly graded without difficulty. The grades are:

	Grade I The haemorrhoids do not prolapse.
	Grade II The haemorrhoids prolapse upon defecation but spontaneously reduce.
	Grade III The haemorrhoids prolapse upon defecation, but must be manually reduced.
	Grade IV The haemorrhoids are prolapsed and cannot be manually reduced.

Usually, internal haemorrhoids do not show any symptom in the early stages. As pain receptors are few inside the rectum, pain is not felt. The most common symptom of internal haemorrhoidal radiation is patches of bright red blood on the faeces, on toilet paper, and/or in the toilet bowl. When the internal haemorrhoids protrude through the anus in the advanced stages, it is visible and become easily irritated and painful.

External haemorrhoids are easily recognised as they include painful swellings or hard lumps around the anus that result when a blood clot forms. This condition is known as a thrombosed external haemorrhoid. Besides, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching. Draining anal mucus may also cause itching.

In the advanced stages, there may be cough, thirst, acidity, burning sensation, vomiting, constipation, dry and undigested stool, physical and mental weakness, anaemia due to bleeding continuously from the haemorrhoids, etc.

Prevention of piles depends on our willingness to change our behavioural patterns, outlook, life style, etc. We have to guard against the causes like hypertension, obesity, constipation, diarrhoea, excessive alcohol consumption and smoking during bowel movements. Intake of fibrous vegetables and plenty of water are good guarantees for prevention of piles. Though not yet universally accepted by doctors, there is strong evidence that the traditional squat toilets have prevented the occurrence of piles among the people of developing countries, as shown in an Israeli study.

Haemorrhoids are known as Arsha Shoola (which literally means 'pricking with needles') in Ayurveda. There are three types of piles related to the three doshas (Vata, Pitta, Kapha)

• Vata type haemorrhoids are hard and dark and the pain is acute. Constpation is always present with it.
• Pitta type haemorrhoids are soft and reddish with bleeding. Thirst, fever and diarrhea accompany these.
• Kapha type haemorrhoids are slimy to the touch. They are large and soft and whitish. Digestive problems accompany them.

There are several medications in Ayurveda that can be taken, like Abhayarishta, or applied externally like turmeric and mustard oil. But there are very few formulae that assure fast and complete cure whatever the stage of the disease.

If you take every day, on an empty stomach, early in the morning, a small dose of a kashayam (concoction) containing cyclea peltata, cocculus hirsutus, holoptelea integrifolia, plumbago zeylanica, cyperus rostundus, zingiber officinale and boerhaavia diffusa, in combination with the powdered forms of cinnamonium zeylanica, veteveria zizanoids, piper nigrum, abies webbiana, piper longum, zingiber officinale, amorphophallus commutatus, mixed with sacharum officinarum and honey, for a permanent cure. All the above medicines are now available in a tablet form, named Swasthi, manufactured and marketed by Gurukripa Pharmaceuticals of Kerala, which can be taken in sour milk or tender coconut water. Swasthi is the only medication available in the market that can be taken with the confidence that any type of piles of any advanced stage will be cured speedily and permanently. Besides, Swasthi is a 100% pure Ayurvedic medication.

This tasty tablet may be taken early in the morning, on an empty stomach, in clean sour milk from which cream has been removed completely or in the water of a tender coconut. With a continued use of this medication for 45 days any type of piles of any stage can be permanently cured. With the first dose itself, the bleeding will stop and, after 15 days, all pain, burning sensation, itching, etc, will cease and motions will be trouble-free. Continuous use of 45 days will shrink completely all the piles and a total and permanent cure will be experienced.

Some dietary restrictions are compulsory during the complete period of treatment. All types of meat, fish, eggs, tubers, food items containing strong masala and food items which are very pungent and sour should be excluded from the diet. Fibre-rich food including onions, tomato, ash gourd, etc with milk and milk products are recommended.

Swasthi is a very effective medication also for ulcer, gas trouble, and for restoring the firmness of the belly after delivery. In cases of chronic forms of piles and in piles which have reappeared after removal by operation, it may be necessary to take increased dosages of the medication for an increased period according to the prescriptions of an ayurvedic physician.

In very rare cases, the use of Swasthi may cause itching. In such cases and in cases of suspected cases of allergy, for scientific and proper advice, according to the peculiarities of each individual case, use the following phone number and/or E-mail address.