Bawaseer

Dr. MSM Shiffa

Definition
A submucosal swelling in the anal canal
consisting of a dilated venous plexus, a small
artery and areolar tissue.
Further, Hemorrhoids are vascular and
connective tissue cushions that exist in three
columns in the anal canal: right anterolateral,
right posterolateral, and left lateral.
Types
Internal:
only involves tissue of upper anal canal
Internal hemorrhoids are above the dentate
line and thus covered with mucosa
These may bleed and prolapsed, but they do
not cause pain.
External
Involves tissue of lower anal canal.
External hemorrhoids are below the dentate
line and covered with anoderm. These do not
bleed but may thrombose, which causes pain
and itching, and secondary scarring may lead
to skin tag formation
Aetiology
Hard stools, prolonged straining, increased
abdominal pressure, and prolonged lack of
support to the pelvic floor all contribute to the
abnormal enlargement of hemorrhoidal tissue.
Increased venous pressure from straining
(low-fibre diet) or altered haemodynamics
(e.g. during pregnancy) causes chronic
dilation of submucosal venous plexus.
Found at the 3, 7 and 11 oclock positions in
the anal canal.
Clinical features
First degree (1): bleeding/itching only.
Second degree (2): prolapsed during
defecation.
Third degree (3): constantly prolapsed.
 Classification and Treatment of
Symptomatic Internal Hemorrhoids
Grad Description Treatments
e
I Palpable, nonprolapsing Dietary fiber, stool
enlarged venous softeners
cushions
II Prolapse with straining Dietary fiber, stool
and defecation, softeners, elastic ligation
spontaneously reduce
III Protrude spontaneously Dietary fiber, stool
or with straining, softeners, elastic ligation,
require manual excisional
reduction hemorrhoidectomy,
stapled
hemorrhoidectomy
IV Chronically prolapsed Dietary fiber, stool
and cannot be reduced, softeners, excisional
Treatment
Simple treatment bulk laxatives and high-fibre
diet.
Bleeding internal piles injection sclerotherapy,
Barrons bands, cryosurgery.
Prolapsing external haemorrhoidectomy
(complications: bleeding, anal stenosis).
A. Medical treatment
Medical treatment for first-degree and most second-
degree hemorrhoids includes increased dietary fiber and
water, stool softeners, and avoidance of straining during
defecation
Refractory second- and third-degree hemorrhoids may
be treated in the office by elastic ligation. The ligation
must be 1 to 2 cm above the dentate line to avoid pain
and infection. One quadrant is ligated every 2 weeks in
the office, and the patient is warned that the necrotic
hemorrhoid may slough in 7 to 10 days with bleeding
occurring at that time.
Patients on anticoagulation should be treated with
excisional hemorrhoidectomy instead of elastic ligation.
Severe sepsis may occur after banding in
immunocompromised patients or those who have had
full-thickness rectal prolapse ligated by mistake
B. Excisional hemorrhoidectomy
Excisional hemorrhoidectomy is reserved for
large third- and fourth-degree hemorrhoids,
mixed internal and external hemorrhoids, and
thrombosed, incarcerated hemorrhoids with
impending gangrene
The procedure is performed with the patient
in the prone flexed position, and the resulting
elliptical defects are completely closed with
chromic suture (Ferguson hemorrhoidectomy).
Complications include a 10% to 50% incidence
of urinary retention, bleeding, infection,
sphincter injury, and anal stenosis from taking
too much mucosa at the dentate line.
C. Stapled hemorrhoidectomy
Stapled hemorrhoidectomy is an alternative to
traditional excisional hemorrhoidectomy for
large prolapsing, bleeding third-degree
hemorrhoids with minimal external disease.
This procedure is performed by a
circumferential excision of redundant rectal
mucosa approximately 5 cm superior to the
dentate line using a specially designed
circular stapler
The authors concluded that excisional
hemorrhoidectomy remains the gold
standard.
D. Acutely thrombosed external hemorrhoids
Acutely thrombosed external hemorrhoids are
treated by excision of the thrombosed vein
outside the mucocutaneous junction, which
can be done in the office or emergency room
with the wound left open
If the thrombosis is more than 48 hours old,
the patient is treated with nonsurgical
management.
Unani concept
According to Samarkandi
Bawasir is a type of excessiveness produced in
the vessels of anus due to ghaleez sauda

Classification
1. Shape
I. Sololi masoor like
II. Anabi Angoor like
III. Tooti mulberry like
2. Bleeding
I. Bawasir e umya/ andhi
II. Bawasir-e-damya/ khooni

3. Site
III. Bawasir e- berooni (out side the anal ring,
covered with skin)
IV. Bawasir-e- andarooni (inside the anal ring)
Asbab
Sauda
Saudavi galeez khoon
Rarely balgham
Safravi muhtaraq
Qabz
Garam advia/ ghiza
Irritation in the anus
Asbab-e-muidda
Hard stool habitual Karamkela, masoor,
constipation brinjal, oil
Laziness Purgatives
Lack of physical exercise Zoaf-e-jigar
Sedentary life Pregnancy
Alcoholism Prostatic enlargement
Unhealthy eating habits Renal calculi
Less water Sitting on cold & wet place
Intestinal worms Benign & malignant
tumour
Excessive meat
Ch colonic diseases
Hot spices
Hot climate
Rectal or anal injury
Above 40 yrs
Alamat
Asymptomatic
Itching
Heaviness & irritation
Inflamed pile mass local irritation & cold
Prevents walking and sitting
Andarooni asymptomatic, feeling of foreign
body in the rectum, bleeding, if ch anaemia,
Mucus discharge, Prolapsed pile mass
Usool
Eliminate the cause
Relieve qabz
Clean the affected part
Apply oil
Musaffiyat
Istifragh e sauda
Correct tihal & jigar
If warm muhallilat
If thrombosed pile mass bed rest, clean the intestine with enema,
hot fomentation, hot enema
Muwallid-e- khoon
Incision and drainage
Abzan habis, mudammil, mufattih, musakkin, muhallil
Amal bil yad ligation, excision, kai
Ilaj
Zood hazm ghiza
Mooli, Gajar, Shaljam
Nafakh advia, gosht stop
Prevent qabz
Advia mufradah
Muqil, raswat, gandna, mgz-e-tkhm-e-neem, m t
bakayin, barg-e-hena
Advia murakkaba
Ith. Muqil, hab-e muqil, h. raswat, h. bawseer
damawi,
H. muqil jadeed, ith mulayyin, jawarish-e mastagi
Ilaj
Mgz tkm neem, mgz tkm bakayin, raswat
khalis,
Zimad- raswat, muqil, abe gandna,
Jiryanud dam
Geru, sangejarahat, kaharuba, sh. Anjubar (4 T)
Geru, sangejarahat, kaharuba, busud, Sh. anar
Sh. Folad
R. bedanjir + a. badiyan prev of qabz
Fasad- basaleeq or safun
Alaq close to bawaseer
Ilaj
Poste anar khushk pasted with curd and take
internally
Marham safaid kaafoori paste externally
Murdar sing, kafoor, raswat equal quantity
make paste and apply externally
barg-e-bang is boiled in milk. Take the
sediments and apply on pile mass
Thank you