Hemorrhoid Treatment in Ayurveda

Hemorrhoid Treatment in Ayurveda

Hemorrhoids are essentially varicose veins of the rectum and anus. People between 45-60+ years of age have shown to be more likely to develop them, although they can occur much earlier in life.

Internal hemorrhoids are typically not visible and manifest above the anal orifice within the rectal canal. They are often asymptomatic unless they become large enough to prolapse and protrude, which is commonly noticed after having a bowel movement. If they become engorged they can occasionally bleed and ache due to downward pressure.

External hemorrhoids are visible and are often reddish to purple in color, and cause a feeling of fullness, dull to sharp aching pain, stinging and itchiness.  

Common Causes of Hemorrhoids

Hemorrhoids are commonly caused by a disturbance or increased pressure to the anus due to the following factors:

  • Digestive problems
  • Constipation
  • Child birth
  • Prolonged sitting or standing a long time
  • Lifting heavy weight or Powerlifting 
  • Hereditary predisposition
  • Dietary Factors
  • Obesity 

An Ayurvedic Perspective

According to Ayurveda, there are six varieties hemorrhoids (Arsha) referred to in the classical text Nidana Panchakam.

  • The first three involve the disturbance of one of the three doshas (bodily humors)- vata, pitta or kapha, although two doshas can be involved. 
  • Tri-Doshic (involving all of three dosha combined)
  • The disturbance of rakta dhatu (blood).
  • Genetic or hereditary factors (khavaiguniya)

When one or more of the doshas becomes aggravated or increased, they can disturb the Agni (digestive fire) and eventually exert a negative influence upon the entire gastrointestinal tract based of the qualities of the doshas that are involved, ie. cold, dry, hot sharp, stagnant, damp etc. It should also be noted that certain activities, by their nature, are provoking to a specific dosha and over time can lead to the development of this condition, including improper diet and lifestyle. At other times a there may be a specific cause, such as the pressure created in the pelvic floor during child birth or a certain activity, or lack of activity, such as prolonged sitting.

Below are some general classifications of Hemorrhoids (Arsha) according to each of the six classifications mentioned above.

Vata related hemorrhoids are mainly caused by excessive dry quality in the colon causing constipation. Here, sitting for long periods on the toilet while straining in order to pass stool is often a causative factor. Traditionally, excessive sitting while riding on an animal such as a horse or elephant was considered to provoke such conditions, whereas nowadays excessive sitting while driving long distances can be seen as the modern equivalent. Avoiding Vata provoking food such as too much dried or dehydrated foods, and excessive raw or cold foods is a good start. Also, a diet low fiber, such as eating excessive meat and not enough vegetables. Increasing dietary fiber from fruits and fresh vegetables will also aid to improve the bulk, tone, consistency and regularity of the bowel. When waste products sit for too long in the colon, the stool becomes increasingly hard, dry and difficult to pass.

Here, hemorrhoids are often external and accompanied by much pain and discomfort, but can also manifest internally, depending on the individual tendencies and predisposition. Here, one’s appetite and digestion is often variable with increased gas and bloating and there is a possibility of increased pain in the low back, pelvic or naval area. I’ve also seen patterns of sciatic present themselves in cases of Vata related hemorrhoids.

Healing approaches include developing regularity with bowel movements, gentle laxatives that cleanse, nourish and tone such as triphala compound, rather than irritate the bowels with drastic laxative such as senna. Getting moderate daily exercise such as yoga, swimming and walking is quite helpful to promote good circulation. Other herbs and formulations are helpful to provide tone to the vascular tissue and promote proper circulation to the perineal floors, and specifically the rectum. Below is a general list, but not specific to each individual, which general lists can’t provide.

Herbs and traditional formulations used to treat vata related hemorrhoids include Triphala churna (haritaki, bibhitaki, amalaki), chirtak, nagkesha, kankayana arsha bati, manjista, horse chestnut, psyllium seed husk, soaked prunes, flax seed meal and more. The selection is of herbs and remedies should be based on individual needs. 

Pitta related hemorrhoids are similarly external or internal, but can bleed more excessively and cause burning and stinging sensations. Here, constipation may contribute to the condition, due to a stagnant pitta energy of the liver as well as sluggish or under active gallbladder function, both relating to ranjaka pitta. Here, prolonged diarrhea as well as the inappropriate use of purgation therapies (virechana) used in Ayurvedic and Yoga cleansing practices, can create increased pressure to the vascular tissue as well as irritation to the anal orifice when not employed properly or at the appropriate times. Other pitta related symptoms on the physical or psychological levels may be present such as dizziness, fever, thirst, irritability or anger and can contribute to or accompany this type of condition.

Healing approaches for managing excess pitta include limiting excess pungent, salty and sour tastes and avoiding alcohol, deep fried food and excess sugary and baked goods. Moderate exercise similar to what was previously mentions for Vata, such as walking, swimming, and gentle to moderate forms of yoga is recommended, but heavy weight lifting should be avoided by all suffering from this conditions. 

Herbs to treat pitta related guduchi, shatavari, neem, kama dudha, chitrak, manjista, nagkeshar, daruharidra (barberry), kutki, bilva, arjuna, musta, amalaki, psyllium seed husk, yashti madhu, gotu kola, soaked raisins or prunes, pomegranate seeds or juice and more. Selections is based on the specific needs of the patient. 

Kapha related hemorrhoids have a round, large and pendular appearance; often multiple in number and can sometimes be lighter in color and mainly internal. They have little to no discharge, but can create a heavy feeling, dull ache and light bleeding if they become engorged. Often bleeding is not as extreme, unless pitta is involved. 

To managing Kapha types of hemorrhoids reducing excess carbohydrate consumption in the form of sweet, sugary treats, and refined grain flours, is key for weight management. Also, limiting salt intake and strictly avoiding deep fried foods and alcohol. Daily exercise is essential to promote good circulation and to burn excess calories. 

Herbs to support the healing of kapha relates hemorrhoids include chitrak, nagkeshar, daruharidra, horse chestnut, triphala churna, triphala guggulu, cumin, pippali, garlic, arjuna, haridra, manjista, kutki, gotu kola, punarnava, kankayana arsho bati, and more.

Herbal formulations used to treat hemorrhoids should be well structured balanced according to the particular needs of the client, since the treatment of hemorrhoids can take time. A well compounded herbal formula can be taken for extended periods with occasional adjustments based on season and changes in the conditions for best results. 

Mixed Dosha or Tri-doshic related conditions have a mixture of these signs and symptoms of Vata, Pitta and Kapha to varying degrees. Here, a thorough clinical assessment is the best way to determine the cause and proper treatment. 

Rakta dhatu/blood related situations often go hand and hand with Pitta types of hemorrhoids and can become aggravated by the excessive consumption of alcohol, excessive sugar, hot spicy foods, exertion during hot weather, and poor portal circulation.

Hereditary factors are quite common if ones mother or father also suffered from this hemorrhoids, but this isn’t alway a guarantee. There are multiple causes of many diseases and disorders, so a complete case history is needed along with an in-depth initial intake and follow ups. Here, the causes can become understood.

Considerations for Healing 

In all such conditions, diet, lifestyle and herbal medicine can be a valuable aspects to treatment. In both traditional and modern approaches, more severe cases may require surgery to correct the condition. Here, Ayurveda will serve as a foundation to treat the underlying cause and promote quicker and sustained healing. Internal hemorrhoids are not able to reabsorb as external ones can do, but they are typically not treated with surgery unless they interfere too much with normal quality of life. Here, they are best manage through diet, lifestyle and herbal medicines as needed. If they are treated surgically, the main modern method is called Band Ligation, and is a relatively painless outpatient procedure. This method is similar to the traditional cauterization method known as Kshar sutra used since ancient times. If internal hemorrhoids become too large, they can prolapse and bleed profusely. In more extreme cases transanal hemorrhoidal dearterialization (THD) may be necessary. For these and other surgical options, an evaluation with a gastroenterologist is essential. For external hemorrhoids, mild to moderate sized ones will usually reabsorb within a couple months, but the more repeated the condition, the more likely they are to reoccur and persist. Here, the surgical measures mentioned above or others such as hemorrhoidectomy might need to be considered along with alternative care through Ayurveda or other holistic approaches.

Good Hygiene for Managing and Preventing Hemorrhoids

  • Hydrating well (at least 64 oz of water per day)
  • Increasing fiber in the diet.
  • Wiping with moistened toilet paper.
  • Applying a small amount of castor oil on and just inside the anal canal after cleaning the area.
  • Regular application of Witch Hazel after having a bowel movement or several times daily. (best for external use).
  • Drinking a tall glass of warm water 1st things in the morning.
  • Proper daily exercise and avoiding prolonged periods of sitting.
  • Regular Yoga and Pranayama practice is beneficial. https://www.youtube.com/watch?v=5JM1gloOyb4&t=3s

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