Ayurvedic treatment for Piles

Piles is called arsha in Ayurveda. The literal meaning of the term arsha is- a pain like the pricking of needles. It is a digestive disorder caused due to the accumulation of waste material in rectum. Some other factors that make a person prone to piles are constipation and pregnancy.

As per Ayurveda, many factors are responsible for the imbalance in the tridoshas that leads to arsha. Irregular or improper ahara (diet) and vihara (lifestyle) along with other factors like heredity that lead to the vitiation of doshas, cause piles. Ayurveda classifies arsha into two types,

• Sahaja (inherited)
• Jatottara (acquired during the life after birth).

In addition, piles can also be classified as:

Shushkarsha (non-bleeding piles)- Shushkarsha is a haemorrhoid that does not bleed and occurs due to the dominance of vata and kapha. 

Raktarsha (bleeding piles)- Raktarsha is the haemorrhoid in which blood is seen in the stool and which occurs due to the predominance of pitta and rakta (impure blood).

The condition may present itself in different ways and the associated features such as discharge, bleeding, morphology of the pile mass, etc., may vary depending on the predominance of the dosha.

• Abhyanga
  • This is an Ayurvedic therapy in which plain or medicated oil is used to treat a part of the body or the entire body.
  • Ayurveda suggests using jatyadi taila to perform abhyanga for piles management.
  • It acts as a rejuvenator and prevents the degenerative changes that occur due to this disease.
  • It is predominantly prescribed in vata-dominant piles where oiling along with sweating reduces the aggravated vata.

• Basti
  • Basti is a procedure in which a herbal suspension is inserted into the rectum. Apamarga kshara basti is found to be effective in the treatment of piles due to the astringent effect of apamarga (chaff-flower), which stops bleeding and promotes wound healing.
  • Matra basti using jatyadi taila, kasisadi taila or apamarga kshara is also recommended. Matra basti is a basti in which medicated oil is given in small doses and is safe enough to be used every day.
  • It is safe and effective for individuals of all age groups, but the dose would vary depending on the age and condition of the individual. Basti treatment is useful in reducing rectal bleeding, protrusion mass, and pain in the anus.
• Sitz bath
  • It is performed by making the individual sit in warm and shallow water. It soothes pain, itching and other anal symptoms.
  • It cleanses and relaxes the anal and genital area and increases blood flow to these areas.
  • Sitz bath is generally done to relieve pain and itching due to piles and clean the anal and genital area if the individual is unable to take a bath.
  • The sitz bath generally requires 10 to 20 minutes and should be performed two to three times a day.
  • Sometimes the individual may feel dizzy and lightheaded after this bath, hence it is recommended to hold on to a railing or take help from someone to get up once the bath is done. The genital and anal area should be gently patted with a towel and not rubbed. Hands should be washed thoroughly, and any medication prescribed by the doctor should be applied.

• Ksharasutra (medicated thread)
  • In this procedure, the swollen haemorrhoid tissue is ligated at its base with a ksharasutra, and the ligated mass is kept inside the rectum. The mass will separate within a week. The procedure may require local, spinal or general anaesthesia.
  • It can be performed as a day care procedure or as an inpatient treatment for both external and internal piles.
  • It is contraindicated in certain types of piles and in certain conditions like diseases of the heart, stomach, head, and diabetes.
• Shastra karma (surgical treatment)
  • The pile mass is removed by means of excision. This procedure requires hospitalisation and the surgery is done under general, spinal or local anaesthesia.
  • It is very useful in large, bleeding piles and also in intero-external piles.
  • Surgery is contraindicated in certain types of piles and in certain conditions like diseases of the heart, stomach and head,and diabetes.

The common post-operative measures prescribed are daily dressing with jatyadi ghrita, triphala guggulu tablets, gandhaka rasayana, and shatsakara churna. Matra basti for 15 days and sitz baths twice a day until wound healing are prescribed after the procedure.

Ayurvedic Herbs for Piles

• Manjishtha
  • Manjishtha is the best Ayurvedic herb that can be used for blood purification. It is useful in many diseases like piles, diarrhoea, dysentery, cancer, amenorrhoea, and kidney stones.
  • The decoction, powder, paste or ghee made of manjishtha has antitumour and astringent properties and it also promotes wound healing. The wound-healing property makes it useful in the treatment of piles.
  • This herb has antioxidant properties and also regulates blood clotting, blood pressure, and blood vessel constriction.
  • It should be used with caution in individuals with aggravated vata dosha and severe chills.
• Haridra
  • The rhizomes of turmeric have many benefits and properties like antibacterial, anthelmintic, wound healing, carminative and stimulant tonic.
  • It should be used with caution in pregnant women, individuals with excess pitta, and individuals with acute jaundice or hepatitis.
  • Haridra can be used as a decoction or a milk decoction. It can also be used externally as a paste with sandalwood.
• Haritaki
  • The fruits of haritaki are useful in many diseases including digestive system ailments.
  • Haritaki is a rejuvenator, astringent (constricts tissues), laxative (increases bowel emptying) and anthelmintic.
  • In small doses, it is useful in treating both diarrhoea and constipation by improving digestion. It is also helpful in the treatment of bleeding and non-bleeding haemorrhoids.
  • Precautionary measures should be taken when using haritaki for pregnant women and dehydrated and exhausted individuals.
• Kutaja
  • Ayurvedic doctors suggest fine powder of kutaja stem bark for the treatment of bleeding piles, which has antibacterial and amoebicidal activity when consumed in specific doses.
  • Kutaja stops the bleeding quickly, but for complete cure and prevention of recurrence, long-term treatment with this herb is necessary.
  • It should be used with caution in pregnant women.
• Suran
  • The corms of suran are known to possess anti-inflammatory, pain relieving, appetising, carminative, anthelmintic, anti-haemorrhoidal and rejuvenating properties.
  • It is used in the treatment of abscesses in the lower rectum and anus and for alleviating haemorrhoids.
  • It can be used for correcting vitiated conditions of vata and kapha doshas.

Ayurvedic Medicines for Piles

• Kankayana vati
  • It is a complex preparation consisting of many ingredients like haritaki, pippali (long pepper), shunthi (dried ginger), etc.
  • Almost all the ingredients of kankayana vati have pain-relieving properties and they also increase appetite.
  • Its contents such as haritaki treat constipation thereby decreasing the pressure on the pile mass.
  • As per Ayurveda, piles is the congestion of a vein, and this medicine dissolves this congestion.

• Triphala guggulu tablet
  • It consists of amalaki (Indian gooseberry), haritaki, vibhitaki (belleric myrobalan), pippali, and guggulu (Indian bdellium-tree).
  • Along with improving digestion and acting as a mild laxative, triphala is known for its wound-healing power.
  • Guggulu has anti-inflammatory and anti-infective properties.
  • Therefore, triphala guggulu acts as one of the best oral remedies in the treatment of bleeding piles.

As treatments vary according to an individual’s prakriti (constitution) and numerous other factors, consult a qualified Ayurvedic doctor for the appropriate medications and treatments for your specific complaints.

Do’s

• Include cereals like a special variety of rice called sathi rice, wheat and barley in your diet.
• Include pulses like kulattha (horse gram) and green gram in your regular diet.
• Eat more fruits and vegetables such as bottle gourd, pointed gourd, spinach, green vegetables, papaya, apples, grapes, cucumber, amalaki (Indian gooseberry) and mango in your diet.
• Consume food items like buttermilk, sugar candy, cow's milk, goat's milk, clarified butter, sour vinegar and rock salt to manage piles.
• Regular physical exercise along with the Ayurvedic treatments.

Don’ts

• Do not eat pulses like black gram and chickpea.
• Do not eat spices, pickles, sesame, and potato and other tubers.
• Do not sit for long hours.
• Do not overeat and keep sufficient gap between meals.
• Avoid sleeping in the daytime and the suppression of natural urges.
• Avoid straining while defecating.

A clinical study evaluating the effect of apamarga kshara basti and triphala guggulu on 129 participants with bleeding piles indicated that this combination could be used successfully in treating the condition. Apamarga kshara basti was given 2 g in 10 mL of water in the form of matra basti once a week along with oral triphala guggulu 500 mg twice a day for two weeks. Bleeding in all the subjects was under control, and haemoglobin level was found to be increased.

Another clinical study involving 40 participants reported the effectiveness of kankayana vati. It improved constipation because of the laxative effects of the herbs in it and also reduced the congestion of veins, thus relieving the condition. All participants were given 2 g of the vati for three weeks, and it was found that 37 participants were fully cured and a marked improvement was observed in the remaining three participants.

A clinical study involving 28 participants from different backgrounds compared the effectiveness of kasisadi taila and jatyadi taila for piles treatment. It was indicated that both these oils used in the form of basti are capable of providing significant relief from bleeding, pain in the anus, protruding mass, and constipation. However, only kasisadi taila was effective in providing a significant reduction in the size of the haemorrhoid mass.

Further studies report that administration of 4g  kutaja, twice a day, is effective in balancing tridoshas and reducing the initial treatment process. It was also found to stop bleeding, though, long-term therapy was required for a complete cure.

Most herbs and medicines do not have any side effects. However, necessary precautions should be taken while using herbs like manjishtha where the dosha predominance needs to be checked depending on the clinical condition of the individuals. Also, kutaja has an excessively bitter taste that may lead to some side effects like nausea and vomiting. The medicines, herbs and treatments should be employed only after consulting an Ayurvedic physician to avoid any risks and side effects.

Piles are caused due to various factors primary including lifestyle and diet. Secondary factors like pregnancy and constipation can also cause and aggravate this condition Ayurveda states that piles occur due to the simultaneous vitiation of all three doshas. The treatment procedures, herbs and medicines, and lifestyle and dietary changes prescribed by an Ayurvedic physician help in the efficient management and balancing of the doshas, thus uprooting the cause and relieving the condition.