Dr Arnab Ray 
MS (Ayurveda), PhD
Ayurvedic Proctologist

External haemorrhoids originate below the dentate line. They are bulging around the anal verge, very painful when inflamed, sometimes itchy.

Internal hemorrhoids originate above the dentate line. They often cause painless bleeding and sometimes come out of anal orifice during defecation.

No.

First and second degree hemorrhoids are mostly treated with Ayurvedic medicines. Ksharakarma (local application of alkaline herbal paste) is often advised to shrink the internal pile masses.

The third and fourth degree haemorrhoids are treated with surgery.

Ksharasutra ligation is a minimal invasive Ayurvedic surgical procedure.

Yes.

Any type of surgical intervention causing anal dilation requires suitable anaesthesia. Commonly, these surgeries are performed under saddle block anaesthesia. External skin tags can be removed under local anaesthesia.

No, anesthesia is not required for Ksharakarma. The procedure involves inserting a slit proctoscope and applying the herbal paste.

Ksharasutra ligation in case of hemorrhoids is performed under saddle block and requires hospitalisation. The period of hospitalisation may vary from 24 hours to 72 hours.

Ksharakarma is performed on day-care basis

It depends on the condition of the disease.

Procedures done under local anaesthesia are mostly discharged on the same day. But the operation done under spinal or general anaesthesia in large piles requires hospitalisation for 24 to 72 hours.

Strangulation of hemorrhoidal mass causes ischemic necrosis. The kshara in the thread causes sclerosis of local tissue.

Ksharakarma involves applying a paste of kshara (medicine with alkaline property) on the internal hemorrhoids. It hardens and shrinks the piles mass.

No such guarantee, but the incidence of recurrence is less as it cuts the swollen mass as well as scleroses the local tissue.