Pilex Therapy in the Treatment of Haemorroids

Transcription

1 [Indian Medical Gazette (1977): (XVI), 9, p ] Pilex Therapy in the Treatment of Haemorroids Mohd. Shafi Misger, M.S., Assistant Medical Officer, Mushtag Ahmad Mir, M.B.,B.S., Resident House Officer, Nazir Ahmad Wani, M.S. Registrar, and Rashid, P.A., F.R.C.S. (Eng.), Associate Professor, Department of Surgery, Government Medical College, Srinagar, Kashmir. INTRODUCTION Haemorrhoids is a condition known and described since the origin of writings itself. The common people call them piles (Latin Pila = a ball), the aristocracy call them haemorrhoids (Greek, Haima=blood; rhoos=flowing), the French call them figs (from figer=to clot), what does it matter as long as you can cure them? (Jhon Andrene, 1370). It is usually stated that haemorrhoids are varicosities of the terminal parts of either superior or the inferior haemorroidal plexus or both, situated in the upper half of the anal canal. The incidence in the population is unknown since many patients with few symptoms do not seek medical advice, indeed they are so common as to be regarded by many as almost a natural attribute, affecting young and old, rich and poor alike. The correct treatment of piles can only be found upon sound actiological concepts. Many explanations have been suggested that they are a natural consequence of the adoption of an erect posture by mankind. The absence of valves in the portal venous system allowing back pressure to fill the haemorroidal plexuses. Occlusion of the veins as they pass through the rectal musculature 10 cm above the anus would produce a similar effect. Many predisposing factors, such as heredity, temperament, climate, age, sex pregnancy puerperal state and suppression of haemorrhages in other areas, have been incriminated in their aetiology. The various exciting factors mentioned include the chronic constipation, enemata, irritation of the anal canal, tight lacing and spasm, atony of anal sphincters, carcinoma rectum, obesity, portal hypertension and use of pessaries and suppositories. Burkitt (1972) has recently thrown light upon the aetiology of haemorrhoids in his epidemiological studies. Piles are rare throughout rural Africa and almost unknown in the more primitive communities. He states that communities exposed to western influences have a significantly higher incidence of piles. He attributes this rarity due to dieting habits of the traditional high residue diet in the Africans. Haemorrhoids can be either wholly internal where there is involvement of the internal haemorroidal plexus or combined due to involvement of internal and external haemorroidal plexuses. Internal haemorroids in associated with the terminal divisions of the superior rectal artery are arranged in three group at 3, 7 and 11 O clock positions when the patient is seen in the lithotomy position. Depending upon the severity of symptoms, the haemorroids are classified into three degrees, bleeding is a prominent feature but many patients find the discomfort of persistent discharge the main symptom, this results in the soreness of the adjacent skin and irritation. There is always considerable confusion and much difference of opinion in the treatment of any disease of obscure origin and aetiology. The range of patent medicine, suppositories, conservative and operative measures for controlling the symptoms of haemorroids bears a testimony to this confusion (Hawley, 1973). For many centuries a number of indigenous drugs and herbs have been used in India for oral treatment of piles.

2 We have in report our experience of clinical study of Pilex therapy in the treatment of first and second degree of haemorroids and the relief obtained in third degree haemorroids. MATERIAL AND METHODS The present clinical study was undertaken on fifty outdoor patients in the surgical department of S.M.H.S. Hospital, Srinagar from 1st July, 1974 to 1st July, Patients of all the ages and both the sexes were selected for the study. A detailed history was taken regarding age, sex, occupation, family history of piles, diet, drugs, bowel habits and other symptoms like chronic cough and difficulty in micturation. A thorough general examination was done. Special attention to anaemia, hypertension, evidence of portal hypertension, heart failure, pelvic tumour and to exclude any other disease. A detailed ano-rectal examination was done for any other associated ano-rectal examination was done for any other associated ano-rectal condition such as fissure-in-ano, fistula-in-ano, prolapse rectum and perineal infection. Digital examination of rectum was done to exclude carcinoma rectum. Proctoscopic examination was done to see the position, size and degree of piles. The haemorroids were classified into 3 degrees. The first degree haemorroids, where the only symptom was bleeding and prolapse just sufficient for the anal sphincter to nip them for a moment at the time of defecation, the second degree haemorroids which prolapsed at the time of defecation and did not reduce themselves but had to be reduced digitally and the third degree haemorroids, where the haemorroids were permanently prolapsed. Each patient irrespective of degree of haemorroids was treated with Pilex tablets and Pilex ointment simultaneously. The Pilex tablets were given in the dosage of two tablets three times a day and Pilex ointment was applied twice a daily before and after defecation. The therapy was given over a period of eight weeks and each case was examined after every two weeks to see the improvement or otherwise of the various symptoms associated with haemorroids. Cases in the series who were severely constipated were given additional laxatives like Agarol or Cremaffin and Cremaffin Pink at bedtime. Each Pilex tablet contains:- Balsamodendron mukul Melia azadirachta seeds Shilajeet Ext. Phyllanthus emblica Terminalia chebula Berberis aristata Arisaema wallichianum Cassia fistula Bauhinia variegata 0.13 g 7 mg 32 mg 3 mg (Specially processed in the juices and decoctions of Commelina salicifolia, Mimosa pudica, Acorus calamus, Blumea, lacera, Caesulpinia bonducella, Amorphophailus companulatus). Pilex ointment is composed of:- Exts. Mimosa pudica 5%, Vitex negundo 3%, Calendula officinalis 2%, Eclipta alba 3%, Aesoulus hippocastanum 2%. Camphor 1.225%, Base q.s. ad. 100%. (Prepared in Melia azadirachta, Ailanthus excelsa, Blumea balsamifera, Eclipta alba, Allium ascalonicum, Acorus calamus, Solanum nigrum etc).

3 OBSERVATIONS Table 1: Age distribution Age group No. of patients Percentage years years years years years years 1 2 Over 70 years 1 2 Table 2: Sex distribution Sex No. of Patients Percentage Male Female Table 3: Showing degree of Haemorroids Degree of Pilex No. of patients Percentage 1st degree nd degree rd degree 5 10 Table 4: Showing presenting symptoms Presenting symptoms No. of patients Percentage Bleeding per rectum Constipation Mucous discharge Prolapse Perineal pain Perineal itching Table 5: Showing effect of Pilex tablets and Pilex ointment used simultaneously in first degree haemorroids (No. of cases 30) Bleeding per rectum (80%) 4 (13.3%) 2 (6.7%) Constipation (60%) 8 (32.0%) 2 (8.0%) Mucous discharge 5 3 (60%) 1 (20.0%) 1 (20.0%) Size of piles 30 3 (10%) 21 (70%) 6 (20.0%) Perineal pain 5 4 (80%) 1 (20%)

4 Table 6: Showing effect of Pilex tablets and Pilex ointment used simultaneously in second degree of haemorroids (No. of cases 15) Bleeding per rectum (66.6%) 3 (20%) 2 (13.4%) Constipation 13 9 (69.2%) 3 (23.1%) 1 (7.7%) Discharge 14 8 (57.1%) 4 (28.5%) 2 (14.4%) Prolapse 15 6 (40%) 6 (4%) 3 (20.0%) Size of piles 15 1 (6.6%) 9 (60%) 5 (33.4%) Perineal pain 5 3 (60%) 1 (20%) 1 (20.0%) Table 7: Showing effect of Pilex tablets and Pilex ointment used simultaneously in third degree haemorroids (No. of cases 5) Prolapse 5 3 (60%) 2 (40%) Bleeding per rectum 5 2 (40%) 2 (40%) 1 (20%) Mucous discharge 5 1 (20%) 2 (40%) 2 (40%) Perineal pain 5 2 (40%) 1 (20%) 2 (40%) Size of piles 5 2 (40%) 3 (60%) Fifty cases of haemorroids were treated in a clinical study with Pilex tablets and Pilex ointment used simultaneously during the period of two years from 1st July, 1974 to 1st July, The greatest incidence of symptoms was found between the ages of 21 and 40 years. This being the period of greatest physical activity. Seventy percent patients were males and 30 percent female cases. The age and sex incidence in this series is almost the same as recorded by other observers. Out of 50 cases, 30 cases were 1st degree haemorrids (60%) and 5 cases were 3rd degree haemorroids (10%). The most common presenting symptoms were bleeding per rectum during defecation (100%), constipation (76%), prolapse of pile mass (52%). Mucous discharge and perineal pain found in 48% and 30% of cases respectively. In the present clinical study of 30 cases of first degree of piles the response to Pilex therapy was very good. Twenty-four cases (80%) were completely relieved from bleeding, 4 cases (13.3%) showed improvement and only in 2 cases (6.7 percent) there was no improvement. Mucous discharge and perineal pain was completely relieved in 60 percent and 80 percent cases respectively. Three cases (10 percent) showed complete disappearance of piles and reduction in pile mass was observed in 21 cases (70%). However, in 6 cases (20%) there was no change at all. Relief in symptoms was noted from 2nd week after the start of therapy and was dramatic at the end of eight weeks. In the second degree of haemorroids, the response to Pilex therapy was also good. Bleeding completely stopped in 10 cases (66.6%), improved in 3 cases (20%) and in 2 cases (13.4%) the bleeding continued. Six cases (40%) out of total of 1 cases of 2nd degree of haemorroids showed complete relief of prolapse of the pile mass. Sixty per cent of cases showed reduction in the size of pile and one case (6.6%) had complete reduction of pile mass. The discharge and perineal pain also got relieved in 57.1 per cent and 60% of cases respectively. Relief in symptoms was observed from 3rd week after the start of therapy and was remarkable at the end of eight weeks. In a total of 5 cases of third degree haemorroids, the response to Pilex therapy was satisfactory and a notable change was found in the relief of symptoms. One case showed complete relief from prolapse and 3 cases showed improvement and only in one case there was no improvement. Forty percent of patients of 3rd degree of haemorroids showed complete relief from bleeding probably due to relief of congestion, reduction in prolapse and size of pile mass with Pilex therapy. Recurrence was noted in one patient who came after 6 months, but got relief after a further 30 days therapy with Pilex tablets and Pilex ointment.

5 SUMMARY A clinical study was conducted on 50 cases of 1st, 2nd and 3rd degree of haemorroids with Pilex tablets and Pilex ointment used simultaneously. The response to Pile therapy was very good in 1st degree of haemorroids good in 2nd degree of haemorroids and satisfactory in 3rd degree of haemorroids. In 1st degree of haemorroids the bleeding was stopped in 80% of cases and reduced in 13.3% percent of cases. An over all good result was obtained in 93.3 percent of cases. In 2nd degree of haemorroids 66.6% of cases showed complete relief from bleeding and 20 percent of cases there was no change. An over all good result was observed in 86.6% of cases. Forty percent of cases of 2nd degree of piles showed relief from prolapse of pile mass and improvement in 40% cases of 2nd degree of haemorroids. 60% of cases of 2nd degree of piles showed marked reduction in the size of pile mass, improvement in other symptoms like perineal pain and mucous discharge was also remarkable in both the 1st and 2nd degree of haemorroids. However, the response to Pilex therapy in 3rd degree of piles was satisfactory. Based on our clinical study we came to the conclusion that Pilex therapy is very good therapy for conservative treatment of haemorroids in 1st and 2nd degree. We believe that Pilex therapy should be tried in all cases of 1st and 2nd degree of haemorroids and only those patients who do not respond to this therapy should be subjected to surgical or other forms of treatment. In 3rd degree to haemorroids however improvement in the symptomatology is obtained to postpone the surgical treatment of piles. ACKNOWLEDGEMENT We are pleased to acknowledge the co-operation of The Himalaya Drug Co. for the supply of medicine and providing other facilities. REFERENCES 1. Baley and Love, Short practice of Surgery 15th Ed., pp , H.K. Leurs and Co. Ltd., London, (1971). 2. Burkitt, O.P. Varicosa Veins, Deep vein thrombosis and haemorroids, Epidemiology and suggested aetiology B.M.J. (1972): (11), Hawley, P.R., In Recent advances in surgery, Ed. Selwyn Taylor No. 8, 1973, Churchill Livingstone, Edinburgh and London 1973, Churchill Livingstone, Edinburgh and London 1973, pp Hughes, E.S.R. Surgery of the Anus, Anal canal and rectum, 1st Ed. 1957, pp E&S Livingstone Ltd., Edinburgh and London. 5. Parks, A.G. Brit. J. Surg. (1956): (43), Parks, A., Progress in Clinical Surgery, Ed Rodney Smith, No. III, Churchill Ltd., London, (1969): Rangnekar, G.V. and Arora, O.P. Treatment of piles with indigenous drugs Pilex tablets and ointment along with Styplon, Probe (1975): (XIV), 3, Apr.-June,