Management of internal bleeding piles by ligation and plication followed by Matra Basti - A case report

Arsha (hemorrhoids) is engorgement of the hemorrhoidal venous plexus, characterized by bleeding per rectum, constipation, pain in ano, prolapse and discharge per anum. It is a primary disease, with impaired digestion as the underlying pathogenesis. It is manifested due to improper diet, prolonged standing and faulty habits of defecation causing derangement of Tridosha, mainly Vata Dosha. Vitiated Dosha localizes in Houstan's Valve, rectal arteries, fascia and vitiates Skin, muscles, adipose tissue and blood due to Annavaha Srotodushti (vitiation of gastrointestinal tract). A 45-year-old male patient came to the OPD of Dr. Sarvepalli Radhakrishnan Rajasthan Ayurved University hospital, Jodhpur, Rajasthan, with complaints of prolapsing pile mass during defecation, pain per anum with erosion and bleeding per anum while passing stool. On proctoscopy, pile masses were seen at 11 and 3 O’clock positions and few erosions were seen near the 3 O’clock pile mass. The case was diagnosed as “Raktarsha”- later stage of 2(nd) degree internal hemorrhoids at 11 and 3 O’clock positions, deeply situated, projecting one and caused by Pitta and Rakta Dosha; with bleeding tendency. Ligation of pile mass by surgical linen barbour thread number 20 on 11 O’clock positions and plication by absorbable chromic catgut on 3 O’clock positions of internal hemorrhoid were done under local anesthesia followed by Matra Basti (therapeutic oil enema) with Jatyadi oil. The pile mass and per rectal bleeding resolved in 10 days and the patient got relief from all the symptoms within 4 weeks. No complications were reported after the procedure. The patient was followed up regularly from the registered date onward till 3 months and proctoscopic examination did not revealed any evidence of recurrence of the hemorrhoids.