Haemorrhoids and Other Rectal Conditions
NATIONAL JOURNAL OF HOMOEOPATHY 2000 July / Aug VOL II NO 4.
Dr C H Asrani

Millions of people throughout the world attribute their strength or weakness, clear-headedness or sluggishness, good or bad spirits, to the particular state of their bowel movement that day. Every day they anticipate its character and a satisfactory elimination heralds the start of a bright and successful day! Is it any wonder then that these same people are so deeply affected by a disorder in this region? The majority of them anxiously seek advice when they have chronic constipation, persistent diarrhea, rectal itching, bleeding or the appearance of hemorrhoids (piles) designating the last inch of rectum - the most important part of the almost 40 feet of intestine.

The anus, the last inch of the rectum, is composed of a diaphragm of muscle, which surrounds the outlet: it expands and contracts at every passage. It is an extremely sensitive and delicate mechanism, which gets out of order easily, particularly in this modern world, where irregularity is more common than regularity. As a matter of fact, no area in the body is more susceptible to upset than rectum and anal canal.

It has been estimated that nearly one-third of all adults at one time or another suffer from hemorrhoids or some other local disease of the anus or rectum. In addition to hemorrhoids, this area is commonly the site for fissures (tear in the mucous membrane), fistulas (abnormal tracts or tunnels extending from the wall of lower rectum out to the skin) and polyps (non-malignant growths of the rectal and anal mucous membrane). Fortunately, rectal conditions are not always so severe and so persistent as to require surgery. Most patients can be relieved of their discomfort by judicious medical management.

1. Hemorrhoids are varicose dilatations of veins that drain the rectal and anal regions. It is felt that these veins break down and become incompetent because of the extraordinary strain of modern living habits. Irregularity of the bowel evacuation, prolonged sojourns upon the toilet (planning the day) and chronic constipation are contributors towards their formation. Plus some inherit weakness of these blood vessels so that even minor strain may cause piles to form. Others are engaged in occupations, which entail strenuous muscular activity, and this seems to make them more prone to develop hemorrhoids. Pregnancy, because of the pressure of the baby's head in the pelvis, predisposes to the same. And lastly, one cannot omit mention of the psychological aspects of the rectal and anal disease, for it has been observed by all physicians that emotionally unstable or neurotic people have extremely high incidence of trouble in this region - making it a goldmine for the Homoeopath.
   
   The mere existence of hemorrhoids does not indicate the need for surgery. However, many of these weakened blood vessels become involved in an inflammatory process or infection, which originates from the lining of the rectum. Also, the repeated contraction and expansion of the anus during bowel evacuation and the recurrent passage of stool over the hemorrhoidal area often produce marked irritation with accompanying ulceration and hemorrhage. Or infection of the walls of the rectal veins may result in phlebitis, with painful clot formation (thrombosed hemorrhoids). When haemorrhoids become inflamed and clotted, they enlarge and tend to be pushed out of the anus during defecation to appear externally as firm, extremely painful lumps. Any one of the above situations, repeated hemorrhage, severe infection, or thrombosis, may call for surgical removal.
   
   Hemorrhoids are classified as internal or external, but in most instances, both types are present. Those that originate from the rectal wall above the sphincter muscle are termed internal, whereas those that arise below this area in the region of the anal canal are termed External. The importance of this distinction is that in certain cases, the internal type can be treated by injection method, instead of surgery. On the other hand, external hemorrhoids do not lend themselves to injection treatment.
   
   
2. A Fissure (fissure-in-ano) is a slit like crack in the lining of the anal skin causing pain whenever there is an attempt to move the bowels. It usually starts as a superficial scratch but fails to heal because of the repeated contractions and stretching of the anal orifice. If this process continues for any length of time, the fissure gets deeper and its walls become inflamed and thickened. At this stage, it will require surgical removal, with cutting of the underlying circular sphincter muscle. By doing this, the anus is put to rest temporarily, spasmodic contractions are interrupted and the whole area heals in solidly.
   
   
3. A Fistula-in-ano may be described as an abnormal communication between the lining membranes of the rectum or anus and the skin surface near the anal opening. They are so common that they constitute about one-fourth of all conditions originating in and about the rectum and anus. Fistulas are almost always the end result of a previous infection, which started in the rectal or anal wall and tunneled its way out to the skin surface. The patient typically gives a history of having a painful "boil" or abscess alongside the rectum that opened and discharged pus for several days. The abscess opening would then heal and discharge alternately over a period of weeks or months. Because of this tendency, it is important that we warn the patient of possible future fistula formation whenever we treat a boil or abscess near the rectum. Often an interval of several months may elapse between the original infection and the establishment of a fistulous tract. In untreated, advanced cases, it is not at all uncommon to find multiple openings on the skin and a tunnel that extends in many directions for a distance of two to four inches from its origin. Every patient with a true fistula in the ano should be operated upon because these communications, once established, practically never heal spontaneously. To leave them untreated is to invite further abscess formation and extension of the tract. Occasionally a fistula in ano will surround the entire anal circumference and will have to be treated surgically in several stages. The function of the anal sphincter may be jeopardized, as the sphincter muscle must be cut in order to lay open the tract.
   
   
4. Non-Malignant Or Benign Polyps of the anus and rectum are extremely common and usually give rise to considerable concern to the patient. The first indication of the presence of a polyp may be a rather severe hemorrhage from the rectum. Or the patient may learn of his condition rather abruptly by the appearance, after bowel evacuation, of a protruding, painless, ball-shaped mass. These polyps or more accurately polypoid growths vary in size from a pea to a golf ball. They maybe located anywhere from the margin of the anal orifice itself up to several inches above. Many cause no symptoms whatever and are found only upon routine rectal examination.
   
   It is the feeling of most medical men that some polyps or polypoid growths can, in time become cancerous. It has therefore become common practice to advise their removal as a prophylactic measure. By this practice, many potential cancers can be eliminated!
   
   

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