200 BEST PILES TREATMENT IN KOLKATA,INDIA,DR.NIRMAL ROY(DR.N.ROY)VISIT:WWW.DRNROY.COM
PILES
PILES (HAEMORRHOIDS) Hemorrhoids, emerods, or piles are swelling and inflammation of veins in the rectum and anus. The anatomical term "hemorrhoids" technically refers to "'Cushions of tissue filled with blood vessels at the junction of the rectum and the anus." However, the term is popularly used to refer to varicosities of the hemorrhoid tissue. Perianal hematoma are sometimes misdiagnosed and mislabeled as hemorrhoids, when in fact they have different causes and treatments. External hemorrhoids are those that occur outside the anal verge (the distal end of the anal canal). Specifically they are varicosities of the veins draining the territory of the inferior rectal arteries, which are branches of the pudendal artery. They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom of external hemorrhoids, is more commonly due to skin irritation. External hemorrhoids are prone to thrombosis: if the vein ruptures and/or a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid. Internal hemorrhoids are those that occur inside the rectum. Specifically they are varicosities of veins draining the territory of branches of the superior rectal arteries. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated, usually due to constipation. Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids: Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside the anus. If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid. Classification by degree of prolapse : The most common grading system was developed by Banov: Grading of Internal Hemorrhoids Grade I: The hemorrhoids do not prolapse. Grade II: The hemorrhoids prolapse upon defecation but spontaneously reduce. Grade III: The hemorrhoids prolapse upon defecation, but must be manually reduced. Grade IV: The hemorrhoids are prolapsed and cannot be manually reduced. Symptoms : Many anorectal problems, including fissures, fistulae, abscesses, anal melanoma or irritation and itching, also called pruritus ani, have similar symptoms and are incorrectly referred to as hemorrhoids. Hemorrhoids are usually not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days. Although many people have hemorrhoids, and hemorrhoidal radiation, not all experience symptoms. The most common symptom of internal hemorrhoidal radiation is bright red blood covering the feces (hematochezia), on toilet paper, and/or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding hemorrhoid. Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid. In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious circle of symptoms. Draining anal mucus, produced by the dentate line may also cause itching. Causes : Sitting for long periods of time can start the hemorrhoidic process. Increased straining during bowel movements caused by constipation or diarrhea may lead to hemorrhoids. It is thus a common condition due to constipation caused by water retention in women experiencing premenstrual syndrome or menstruation. Hypertension, particularly portal hypertension, can also cause hemorrhoids because of the connections between the portal vein and the vena cava which occur in the rectal wall - known as portocaval anastomoses. Obesity can be a factor by increasing rectal vein pressure. Poor muscle tone or poor posture can result in too much pressure on the rectal veins. Pregnancy may lead to hypertension and increase strain during bowel movements, so hemorrhoids are often associated with pregnancy. Insufficient liquid can cause a hard stool, or even chronic constipation, which can lead to hemorrhoidal radiation. An excess of lactic acid in the stool, a product of excessive consumption of dairy products, such as yogurt, can cause radiation; reducing such consumption can bring relief. Vitamin E deficiency is also a common cause. Eating spicy food does not cause hemorrhoids, though spicy foods may aggravate the condition. ksksksks Prevention : Prevention of hemorrhoids includes drinking more fluids, eating more dietary fiber (such as fruits, vegetables and cereals high in fiber), exercising, practicing better posture, and reducing bowel movement strain and time. Wearing tight clothing and underwear may also contribute to irritation and poor muscle tone in the region and promote hemorrhoid development. Women who notice they have painful stools around the time of menstruation would be well-advised to begin taking extra dietary fiber and fluids a couple days prior to that time. Fluids emitted by the intestinal tract may contain irritants that may increase the fissures associated with hemorrhoids. Washing the anus with cool water and soap may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluid. Many people do not get a sufficient supply of dietary fiber (20 to 25 grams daily), and small changes in a person's daily diet can help tremendously in both prevention and treatment of hemorrhoids. Examination : Endoscopic image of internal hemorrhoids seen on retro flexion of the flexible sigmoidoscope at the ano-rectal junction After visual examination of the anus and surrounding area for external or prolapsed hemorrhoids, a doctor may conduct a digital examination. In addition to probing for hemorrhoidal bulges, a doctor may also look for indications of rectal tumor or polyp, enlarged prostate and abscesses. Visual confirmation of hemorrhoids can be done by doing an anoscopy, using a medical device called an anoscope. This device is basically a hollow tube with a light attached at one end that allows the doctor to see the internal hemorrhoids, as well as polyps in the rectum. If warranted, more detailed examinations, such as sigmoidoscopy and colonoscopy can be performed. In sigmoidoscopy, the last 60 cm of the colon and rectum are examined whereas in colonoscopy the entire large bowel (colon) is examined. Treatments : Treatments for hemorrhoids vary in their cost, risk, and effectiveness. Different cultures and individuals approach treatment differently. Some of the treatments used are listed here in increasing order of intrusiveness and cost. Home treatments : For many people, hemorrhoids are mild and temporary conditions that heal spontaneously or by the same measures recommended for prevention. Temporary relief from symptoms can be provided by: Hydrotherapy with a bathtub, bidet, or extend-able shower head. Especially in the case of external hemorrhoids with a visible lump of small size, the condition can be improved with warm bath causing the vessels around the rectal region to be relaxed. Cold compress. Topical analgesic (pain reliever), such as xylocaine or pramocaine. Systemic (pill-form) analgesic (pain reliever). Topical corticosteroid such as hydrocortisone. (May weaken the skin and may contribute to further flare-ups). Topical vasoconstrictor such as phenylephrine. Topical moisturizer. Topical medicines may be delivered as an ointment or suppository. Some hemorrhoid-specific medications contain a mixture of multiple ingredients, such as Preparation H, Proctosedyl, and Faktu. Ayurvedic Kshar-sutra application : These days Ayurvedic Kshar-sutra treatment is in trends. This is the method of treatment of hemorrhoids which is described in ancient Ayurvedic grantha. It is showing high successful rate and negligible reoccurrence. This is non surgical treatment and can be done by experienced physician. In this treatment Kshar-sutra is applied in the hemorrhoids under local anesthesia/general anesthesia and the pile mass sheds off within seven to ten days with stool. Indian Council of Medical Research (ICMR) has tried this technique in Hospitals in Metro Cities for ten years and then declared this technique the most successful procedure for treatment of hemorrhoids. In fistula in ano Kshar-sutra is showing tremendous results. Most surgeons are also treating fistula in ano with Kshar-sutra because surgery can cause incontinence and some chances of reoccurrence are always there after surgery. Surgical and Non-medicinal Treatments : Rubber band ligation, sometimes called Baron ligation. Elastic bands are applied onto an internal hemorrhoid to cut off its blood supply. Within several days, the withered hemorrhoid is sloughed off during normal bowel movement. Hemorrhoidolysis, desiccation of the hemorrhoid by electrical current. Sclerotherapy, sclerosant or another hardening agent is injected into hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up. Cryosurgery, a frozen tip of a cryoprobe is used to destroy hemorrhoidal tissues. Rarely used anymore because of side effects. Hemorrhoidectomy, a surgical excision of the hemorrhoid. Has possible correlation with incontinence issues later in life; in addition, many patients complain that pain during recovery is severe. For this reason it is often now recommended only for severe (grade IV) hemorrhoids. Doppler guided hemorrhoidal artery ligation, which cuts the artery that delivers blood to the hemorrhoid. It is the best treatment for bleeding piles, as the bleeding stops immediately. ksksks Natural Treatments : Eating fiber-rich diets, including water, helps create a softer stool that is easier to pass, to lessen the irritation of existing hemorrhoids. Using the squatting position for bowel movements. Dietary supplements can help treat and prevent many complications of hemorrhoids. Diseases with Similar Symptoms : Symptoms associated with rectal cancer, anal fissure, anal abscess, anal fistula, perianal hematoma, and other diseases may be similar to those produced by hemorrhoids and may be reduced by the topical analgesic methods described above. For this reason, it is a good idea to consult with a physician when these symptoms are encountered, particularly for the first time, and periodically should the problem continue. Colonoscopy is recommended as a general diagnostic for those over age 50 (40 with family history of bowel cancers. ABOUT KSHAR-SUTRA The fact that so many of us, from far & wide have gathered here is in itself evidence of the coming back of the age old science of life. 'Ayurveda' is picking up momentum not only in India but also in other countries. Globalization of Ayurveda brings with it increased requirement of all types of Ayurvedic preparations and even standardization of these preparations. Availability of standard Ayurvedic drugs, even those which are widely used, is a problem at many places even in India. Where rare, expensive or sparingly used drugs are considered, this problem rises still higher. Kshar-Sutra is one such preparation. Treatment of anorectal diseases through Ayurveda is slowly becoming popular in India. People have started realizing that Ayurveda has a lot to offer in this field like in many others. Kshar Sutra is undoubtedly the preparation of prime importance in this field. However manufacturing and marketing of Kshar-sutra has not been given due importance till date and almost all Ayurvedic proctologist have to prepare their own Kshar-Sutra which makes it more difficult to work in this field. ksksksks Treatment of anorectal diseases through Ksharsutra - Ayurveda We shall have to accept that there is not a single reference in the Brihattrayee or even in the Laghutrayee, of the method of preparation of Kshar Sutra as it is used today. Though there are some references indicating the use of medicated thread in the treatment of Arshas and Bhagandara in Sushruta and Bhavprakasha. In the recent past, the late Dr. P. J. Deshpande had done extensive research and had come forward with a scientific and standard method of preparing the Kshar Sutra. This method of preparation of Kshar Sutra has been adopted widely by institutes of Ayurveda and by ayurvedists in general. Not only the clinical efficacy but many other aspects are also considered in the standardization of the Ksharsutra. The tensile strength of the thread, the PH of the drugs used and the PH of the Ksharsutra itself, the dispersal pattern of different Ksharas, its chromatographic studies, the alkalinity, the method of sterilization and the packing and preserving methods of the prepared Ksharsutras were studied before the Ksharsutras could be standardized. The Ksharsutra here are prepared in strict accordance to the standards set by the CCRAS. (Ref.: Management of Bhagandara with Ksharsutra by Dr P. J. Deshpande, Dr K. R. Sharma, Dr S. K. Sharma). PREPARATION OF KSHARSUTRA AND THE DRUGS REQUIRED : ks Apamarg Achyranthus aspera ks Apamarg Achyranthus aspera ks Apamarg Achyranthus aspera ks Burning of Apamarg Plant ks Ashes of Achyranthus aspera ks Dissolving the ashes in water (4 times) ks Decantation and straining of Apamarg Solution ks Filtration ks Boiling the solution to get the Kshar ks Apamarg Kshar ks Snuhi Euphorbia Netriifolia ks Snuhi Euphorbia Netriifolia ks Collection of latex by slitting open the Snuhi plant vertically ks Straining of the latex of Snuhi ks Rhizomes of Haridra ks Haridra Plants Curcuma Lonnga PREPARATION OF KSHARSUTRA : ks Dissected Rhizomes of Haridra showing the orange inner portion ks Powder of dry Haridra Rhizomes ks Thread used for preparing Kshar Sutra ks Tying the thread on the frame ks Coating the thread with latex / Ksheer of Snuhi ks Coating the thread with Snuhi Ksheer prior to Apamarg Kshar Coat ks Coating the thread with Apamarg Kshar ks Coating the thread with Snuhi Ksheer prior to Haridra powder coat ks Coating the thread with powder of Haridra ks Prepared Ksharsutra on the frame ks Packing the Ksharsutra in a glass tube ks Packed and Sealed Ksharsutra Preparation of Kshar-Sutra is no doubt, a lengthy and difficult task and the collection and preparation of required drugs is still more cumbersome. A number of different drugs are used in various combinations for the preparation of the Kshar-Sutra. The ksheer (latex) generally used are of Snuhi, Ark, Arendakarkataki, Udumbar etc. The Ksharas used are Apamarg Kshar, Ark Kshar, Kadali Kshar etc. We have here used the following drugs. DRUGS REQUIRED : Snuhi Ksheer Apamarg Kshar Haridra powder Thread,-Linen Barbour No.-20. Aluminium or steel frames are drilled with small hooks for holding threads in place at an interval of about 1 1/2'. The size of the frame may vary to suit specific needs. Any cotton / linen thread of good strength can be used for Kshar-Sutra. In our practice, we generally use Barbour Linen No. 30 and 20. No. 30 is finer compared to No. 20. The tensile strength of No. 20 is reduced to the least extent in comparison to other threads after the complete procedure and hence it is this thread which is usually preferred in the manufacture of Kshar-sutras. The thread is tightly wound around opposite hooks to form rows. The thread is given 21 coatings out of which the first 10 coating are given only the fresh Snuhi Ksheer. The next 7 with Snuhi Ksheer and Apamarg Kshar and the last 4 with Snuhi Ksheer and Haridra. A piece of gauze is taken and folded into a small square. It is then dipped in the fresh Snuhi Ksheer (latex of Euphorbia neriifolia) and the thread is coated (i.e. a Bhavna is given) with the ksheer from down upwards. When all the threads are coated in this manner, the frame is kept to dry in a specially made chamber. The second coating (Bhavna) is given only when the first one dries. The thread is coated 10 times in this way; one after the other after the previous coating of the ksheer dries completely. The frames are placed in a special chamber for drying. The temperature inside the chamber may be increased by passing hot dry air with the help of a fan. The air inside the chamber should be kept circulating to facilitate quicker drying of the threads. The process of drying is best performed when the level of Humidity is lower. After completing the first 10 coatings of Snuhi ksheer, we now proceed to coat the thread with both Snuhi ksheer and Apamarg Kshar. The thread is coated with fresh Snuhi ksheer in the way described above. Apamarg Kshar is coated on it immediately (i. e. when the thread is still wet) so that it sticks to the thread properly. Different practitioners have developed different ways in which to do this. With experience we have found that the best way to do it is to coat only 3 or 4 threads at a time with Snuhi ksheer and then pass them through a pile of Apamarg Kshar on a flat plate. This is done by sliding the frame over the pile of Kshar in such a way that the threads pass through the pile of Kshar and the Kshar sticks on the wet thread. When all threads of a frame are coated in this way, the frame is again kept for drying in the chamber. The thread is coated in this way 7 times. The thread is coated only when the previous coat is completely dry. Hence 10+7= 17 coats are completed. The last four coats are to be given with Snuhi ksheer and Haridra. This is done in the same way as the previous 7 coats substituting Haridra powder in place of Apamarg Kshar. While applying every coat, care should be taken that the drug spreads evenly on all the sides of the thread and does not aggregate at one spot to make a knot like appearance. The thread should be smooth and even, having the same thickness through out the length. Care should be taken to carry out the procedure in a dry atmosphere. A specially prepared chamber is used for drying the threads so that it can be dried in a dust free atmosphere. In the absence of a chamber the threads may be dried in the open under direct sun rays in a dry and dust free atmosphere. After we finish coating the threads 21 times and they are totally dry the threads are cut to size and then packed in capillary like glass test tubes. These tubes are cut to size, cleaned, dried, and sterilized. One or two threads are packed in each tube. The tube is packed/ sealed over a burner so that the Kshar-Sutra in it remains dry and sterile. These tubes are sent for Gama radiation after being packed & sealed. The tube is broken and the Kshar-Sutra removed for use when required. Before going into the details of the collection and preparation the drugs required, I would like to mention here that though the most widely used Kshar-Sutra are prepared from Snuhi ksheer and Apamarg Kshar and Haridra, we can make a variety of different Kshar-sutra from a combination of ksheer from different ksheeri vrikshas i.e. latex of different trees like Udumber ksheer, Arka ksheer, Aerandkarkati ksheer and Ksharas like Ark Kshar, Kadli Kshar, Nimb Kshar etc. COLLECTION AND PREPARATION OF THE DRUGS REQUIRED IN THE PREPARATION OF KSHAR SUTRA : Collection of Snuhi Ksheer : - Latex of Euphorbia neriifolia The ksheer from Snuhi is collected best, early in the morning, before sunrise. If collection of ksheer is tried after sunrise, we can get just a few drops of ksheer from a Snuhi branch. With the help of a scalpel, we slit the Snuhi branch vertically from down upwards (5mm deep) keeping a collection jar under the slit. As soon as the cut is made, a milky substance (ksheer) starts dripping down. This ksheer is collected in the jar. The amount to be collected depends upon the threads to be coated. After collection the ksheer, jar is to be packed so that no air enters it because ksheer if kept in contact with air, starts to coagulate and turns into a chewing-gum like sticky semisolid substance. Before coating the threads, the ksheer is to be strained from a wire strainer or with the help of a double folded gauze piece. The ksheer is now ready for use. Snuhiksheer should be always used fresh. Method of preparing Apamarg Kshar : Water soluble extract of the ash of Achyranthus aspera. Well grown shrubs are collected in the month of November. These shrubs are dried. When dry, they are burned down to ash in a clean open space or in a big container. The ashes of the Panchang (whole plant) of the shrubs are collected on cooling. The ash itself can be preserved in airtight containers and may be used to prepare the Kshar at convenience. The ash is stirred in pure soft water 4 times the ash (Rastarangini). Here the ratio of ash to water is in reference to its volume and not weight. The water soluble constituents of the ash are dissolved in the water. The mixture is stirred for a few minutes and then allowed to stand for a few hours. This process is repeated 4 to 5 times. The mixture is then allowed to stand for a period of a few hours again. The ash settles down and we get a clear yellowish liquid solution on top which now contains all the water soluble constituents of the Apamarg ash. The solution is carefully decanted into another container and strained. The clear yellowish solution may still contain minute insoluble parts of the ash. To get pure Kshar it is advisable to further purify this solution by filtering so that the remaining minute insoluble particles are removed. The solution is now kept to boil in a thick preferably stainless steel container. As the water evaporates, we start getting crystals of Apamarg Kshar. They adhere to the sides of the container. Theses should be constantly removed by stirring the boiling solution. When almost all the water is evaporated we get a white substance which settles at the bottom. Minimizing the heat, the process should be continued till all the water evaporates and we get a thick layer of the Kshar at the bottom of the container. This thick layer can be removed on cooling. The substance which we now get is the pure extract of the ash of Apamarg Panchang. This is powdered and packed in air tight container for further use. The method of preparing the Kshar may be modified when mass production is desired. Preparation of Haridra Powder :- Curcuma Lonnga The third drug required for the last three coatings is Haridra powder. Haridra is known to most of us as turmeric. The well developed dry rhizomes of Curcuma longa are used to prepare the powder. The combination of the three above mentioned drugs does the work of cutting, curetting and healing the fistula. The multiple coats on the threads probably make the effect of the drugs gradual and continuous. The drugs keep on dissolving and being released gradually for a couple of days, after which the Ksharsootra is changed if and when required. The thread itself acts as a vehicle for the drugs to reach the sight and the coating on the thread probably renders a sort of a sustained release effect of the drugs in the track. With the picking up of the Kshar-sutra mode of treatment in Ano-rectal diseases, the requirement and demand for good quality standardized Kshar-sutra is inevitably going to increase and hence Kshar-sutra manufacturing and marketing on both large scale as well as small scale though quite difficult and cumbersome may be a rewarding project. Advantages of Kshar Sutra : The procedure does not require hospitalization for more than 3 to 4 hours. The patient requires no bed rest & can resume his/her daily routine within 6 to 12 hours. The procedure leaves just a pencil scar at the site. Freedom from painful dressings. There are on chances of incontinence and the recurrence rate which is usually found to be quite high after Fistulectomy is less than 2% with Kshar - Sutra treatment. This is because the medicines on the thread gradually and continuously curate the pyogenic membrane and fibrous tissue and thus leave no pus pockets undrained. Contact Details :Dr.Nirmal Roy(sexologist) Head Office : SODEPUR (EAST) Visiting Hours : Address : Dr.N.Roy's Chandsi & Herbal Clinic C46,Building , School Road ,Sodepur. Near Railway Station SODEPUR Opp. Police Fari Kolkata – 700110. West Bengal. Morning 10:00A.M to 1:00P.M Evening 5:30P.M to 9:00P.M Sunday Closed Help Line : +91 - 9831331555 +9133 – 65011474 drnirmalroy2015@gmail.com Website : www.drnroy.com Please call for more details. When you call, please don't forget to mention that you found this Ad on JustSold.in.
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