Ayurveda for Hemorrhoids and Anorectal Conditions: Evidence and Cautions

Urgent guidance first

Bleeding from the bottom should not be assumed to be piles. The NHS (UK) says to seek urgent help for painless bleeding, pus from piles, a very high temperature or feeling generally unwell, and to go to A&E or call 999 for non-stop bleeding, a lot of blood or large clots, or severe pain. [1] In the US, call 911 for heavy bleeding. Please do not treat bleeding with an Ayurvedic product before a clinician has examined you.

What piles are, and how Ayurveda names them

Piles (haemorrhoids) are swollen blood vessels in and around the anus; the NHS says it is not clear what causes them, and constipation, straining, heavy lifting, pregnancy, older age and being overweight make them more likely. [1] Ayurveda describes these conditions as arshas in its classical texts, within a framework of the doshas and digestion. That is a traditional framework, not a biomedical explanation. For the framework see Ayurvedic traditional concepts.

Everyday care that is not specific to Ayurveda

The NHS suggests drinking plenty of fluid, eating plenty of fiber, not straining, keeping the area clean and dry, and asking a pharmacist about creams and laxatives. [1] For constipation see constipation.

What Ayurvedic practitioners offer

Kshara sutra is a medicated thread (seton) used by Ayurvedic surgeons and anorectal specialists; for piles it is used as a ligature. It is a procedure performed by a trained practitioner, not something to try at home. We give no instructions.

1. Kshar sutra ligation versus rubber band ligation, grade II and III piles

   Unclear

   A trial in 20 adults (10 per group) followed for 30 days: rubber band ligation caused less pain and recovery time; kshar sutra patients reported higher satisfaction and 100% versus 80% resolution of prolapse, a difference that was not statistically significant [2]

   Insufficient evidence (very small trial)

2. Kshara sutra versus open fistulotomy, anal fistula (a different condition)

   Unclear

   A randomized trial in Kolkata (50 patients): less severe pain and fewer days off work with kshara sutra, but longer healing time (53 versus 35.7 days) and more wound discharge [3]

   Promising but limited for fistula

3. Oral Ayurvedic medicines or ointments for piles

   Unclear

   Proper evidence not found. We searched PubMed for trials of Ayurvedic oral formulations and ointments for hemorrhoids and found nothing usable

   Insufficient evidence; traditional use only

The piles trial had 20 people; it cannot show how kshara sutra compares in safety or recurrence. Compare this with standard options listed by the NHS: rubber band ligation, sclerotherapy, infrared coagulation and surgery. [1] The NHS also notes that treatment does not always stop piles coming back. [1]