Hemorrhoids (Piles)

Piles also known as ‘Hemorrhoids’, are Small, Bluish, Swellings, Comprising of Enlarged Blood Vessels situated either just inside or just outside the anus, commonly called internal piles and external piles. In case of bleeding, they are termed as bleeding piles.


• Persistent constipation due to poor dietary habits.

• Sitting on hard seats for prolonged periods.

• Lack of exercise.

Because of all these factors straining is needed to pass the small hard stools, which causes congestion in the network of blood vessels located inside the anal cushions. Gradually, these vessels enlarge and form piles. If the constipation further continues, they become large enough to be called second or third degree piles.

Signs & Symptoms

Internal Piles: These are found inside the anal canal and lined by mucous membrane. Depending on the chronicity of the disease and prolapse these can be;

First-degree Piles:

Many people have these without even being aware of them. These are located just inside the anus, occasionally causing some discomfort when a motion is passed. Rarely, slight bleeding in the form of drops may also occur during evacuation.

Second-degree Piles:

They usually appear as pea-sized swellings outside the anus after a bowel motion has been passed. They are usually retained inside the anus spontaneously when strain of defecation is removed and may bleed and cause discomfort during passing stool with some degree of itching.

Third-degree Piles:

The swollen blood vessels are so enlarged that they remain outside the anus permanently. The piles masses need to be pushed inside the anus by fingers. Soreness and persistent irritation are the common features besides occasional bleeding.

External Haemorrhoid Or Fourth-degree Piles

This is less common than internal haemorrhoids. An external haemorrhoid is a small lump that develops on the outside edge of the anus. It is covered by skin, not by mucous membrane. Many do not cause symptoms. However, if a blood clot forms in the haemorrhoid (a thrombosed external haemorrhoid) it can suddenly become very painful and need urgent treatment. The pain due to a thrombosed external haemorrhoid usually peaks after 48-72 hours, and then gradually goes away over 7-10 days. A thrombosed external haemorrhoid may bleed a little for a few days. It then gradually shrinks to become a small skin-tag.

Some people develop internal and external haemorrhoids at the same time.

Ayurvedic Surgical Treatments: (Kshara-sutra and Agnikarma)

When internal piles bleed profusely or they are in 2nd or 3rd or 4th degree, medicines do not have much benefit. In such case the piles masses have to be removed surgically. In Ayurveda Ksharasutra ligation and Agnikarma excision are the procedures which can be used to remove the piles masses (Internal as well as external) thus leading to a permanent cure of the problem. One should not hesitate or have any kind of fear of surgical procedures and should consult a qualified expert Ayurveda doctor to get rid of the problem. Delay may sometimes lead to serious complications like severe anemia due to continual bleeding and shock and so on.

External piles if get Thrombosed need immediate surgical intervention because of severe pain. Kshara sutra ligation and Agnikarma are equally beneficial in curing external piles permanently.

NOTE: Ayurvedic medicines and treatments including surgical procedures like Ksharasutra and Agnikarma etc. should be taken under Qualified Ayurvedic Doctor/Physician/Surgeon. The drugs described in this article are for general information/educational purpose only. Anyone should not use these without consulting a qualified Ayurveda Doctor/Physician.

Fistula is a Latin word which means ‘Reed’ or ‘Pipe’. In Medical use the term pertains to ‘Tract’ or ‘Tube’. It is usually inflammatory in origin and either end. In surgery, it implies a chronic granulation track communicating two epithelial lined surfaces. These Surface may be cutaneous or mucosa. Bailey & Love (1980) has stated that Fistula-in-ano is a tract lined by granulation tissue which opens deeply in the anal canal or rectum and superficially on the skin around the anus.


It is divided into two types-

Non Specific- Caused by Crypto Glandular Infection & Previous Anal Abscess.

Specific- A small number of fistulas may less frequently be caused by other processes such as Tuberculosis, Crohn’s disease, foreign, Ulcerative Colitis, Anal Fissure, Carcinoma, body sexually transmitted diseases, Pelvic inflammation, Radiation, Trauma, or diverticulitis.


The following may be symptoms or signs of an anal fistula,

  • Recurrent anal abscesses.
  • Pain and swelling around the anus.
  • Pain with bowel movements.
  • Bleeding.
  • Bloody or foul-smelling drainage (pus) from an opening around the anus. The pain may decrease after the fistula drains.
  • Irritation of the skin around the anus due to persistent drainage.
  • Fever, chills, and a general feeling of fatigue. (However, these may be symptoms of many conditions.)

You should see your physician if you notice any of these symptoms.


Diagnosis is by examination, either in an outpatient setting or under anesthesia. The examination can be an Anoscopy.

Possible findings:

  • The opening of the fistula onto the skin may be seen
  • The area may be painful on examination
  • There may be redness
  • A discharge may be seen
  • It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the fistula.

Ayurvedic View: (Ksharsutra Therapy)

Kshara Sutra is utilized in the treatment of fistula in Ayurveda.


KsharaSutra is a seton thread medicated with organic alkalis,such as Apamargakshara (Achyranthesaspera), Arkakshara (Caltropisgigantea) or Snuhikshara (Euphorbia lingularia). The alkali is repeatedly coated on the seton thread 15 – 21 times. Apart from this, natural antibiotic like haridra powder, guggulu, etc are also used to make Ksharasutra. The mechanical action of the threads and the chemical action of the drugs coated , collectively do the work of cutting, curetting, draining, and cleaning the fistulous track, thus promoting healing of the track/ wound. This also acts both as the antiseptic and fibrotic agent to induce healing. The process of healing starts from deeper tissues and moves towards the periphery. This can be applied and changed periodically till the thread cuts the fistulous tract. Since the sphincter heals by fibrosis, there is no incontinence.

Under local anesthesia, the ksharsutra is inserted into the tract and the two ends of the thread are tied forming a loop. The alkalis coated on the thread are continuously released throughout the length of the track there by cutting, curetting, draining cleansing and healing the track. This therapeutic action of the thread lasts for seven days. The old thread is then replaced with a new thread following the same procedure. Depending on the length of the tract and the extent of damage, the ksharsutra may be changed up to 5 times. The changing of the thread is a simple procedure taking about 1 to 2 minutes and requires no anesthesia.

An anal fissure is a tear in the lining of the anus or anal canal (the opening through which stool passes out of the body). The fissure can be painful and may bleed.

Signs & Symptoms :

  • Pain during and even hours after a bowel movement.
  • Constipation.
  • Blood on the outside surface of the stool.
  • Blood on toilet tissue or wipes.
  • A visible crack or tear in the anus or anal canal.
  • Burning and itching that may be painful.
  • Discomfort when urinating, frequent urination or inability to urinate.
  • Foul-smelling discharge.


Causes :

Anal fissures can be caused by trauma to the anus and anal canal. The cause of the trauma can be one or more of the following:


  • Chronic constipation.
  • Straining to have a bowel movement, especially if the stool is large, hard, or dry.
  • Prolonged diarrhea.
  • Anal sex or anal stretching.
  • Insertion of foreign objects into the anus.


Other causes of anal fissures (other than trauma) include:

  • Longstanding poor bowel habits.
  • Overly tight or spastic anal sphincter muscles (muscles that control the closing of the anus).
  • Scarring in the anorectal area.
  • Presence of an underlying medical problem : such as Crohn’s disease and Ulcerative colitis [types of inflammatory bowel disease], anal cancer, leukemia, infectious diseases (such as tuberculosis), sexually transmitted diseases (such as syphilis, gonorrhea, Chlamydia, chancroid, HIV).
  • Decreased blood flow to the anorectal area.


Anal fissures are also common in women after childbirth and in young infants.

How is an anal fissure diagnosed?

Usually your doctor can diagnose an anal fissure by visual inspection of the anus or by gentle exam with the tip of the finger.

Toggle Content