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I J R H
CLINICAL PAPER
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A case of haemorrhoids in a 12‑year‑old DOI:

10.4103/0974-7168.129677

boy Quick Response Code:

Padmalaya Rath, Harleen Kaur1

ABSTRACT
Research Officer, Central Research
Haemorrhoids is a very common condition that a physician would encounter in day Institute for Homoeopathy, 1Senior
to day practice. However, haemorrhoids in children is not as common. The only Research Fellow, Central Research
Institute for Homoeopathy, Noida,
known treatment for the condition in conventional medicine is surgical excision, which Uttar Pradesh, India
is generally not favoured at this age. The case reported here is that of an internal
Address for correspondence:
haemorrhoids in a 12‑year‑old child, who was treated successfully with homoeopathic Dr. Padmalaya Rath,
medicine. The patient has been observed for more than 2 years without recurrence. A 1/1, Sector 24, Noida, India.
E-mail: [email protected]
Photographs were taken before and after treatment to record changes in the condition.
Non‑recurrence of complaint in the past two and half years suggests that a ‘near Received: 05‑08‑2013
Accepted: 17‑02‑2014
permanent’ cure is achievable through individualised homoeopathic treatment.

Keywords: Haemorrhoids, Dentate line, Individualized homoeopathy, Polyps,

Phosphorus

INTRODUCTION Hypertrophied anal papilla, composed of a smooth

mass located near the anal verge, is also considered
Haemorrhoids are enlarged veins located in the a differential diagnosis especially in a patient with a
lower part of the rectum and the anus. External history of chronic anal irritation or infection.[4]
haemorrhoids originate below the dentate line,
About 75% of people will have haemorrhoids at
while internal haemorrhoids are above the line and
some point in their lives.[5] Haemorrhoids is most
are classified according to their degree of prolapse
common among adults aged 45-65.[6] About 80% of
from the anal canal.[1] Haemorrhoids Grade I - are
people in India develop haemorrhoids. and about
visualised on anoscopy, bulge into the lumen but do
80% aged over 50 have some form of symptomatic
not extend below the dentate line, Grade II- prolapse
haemorrhoidal disease.[7]
out of the anal canal with defecation or with straining
but reduce spontaneously, Grade III - prolapse out However, haemorrhoids in children are not as
of the anal canal with defecation or straining, and common.[8,9] Some common symptoms include
require reduction, Grade IV haemorrhoids - are bleeding from the rectum, anal itching, general
irreducible and may strangulate.[2,3] It is important discomfort and an external anal protrusion. Children
to differentiate a haemorrhoids from other growths who are suffering from this condition should be
like anal papillae or polyps. Polyps are usually treated quickly and monitored carefully in order to
asymptomatic but occasionally grow large enough prevent the development of infections associated
to be felt by the patient or are likely to prolapse. with the condition. Typically, when treated quickly

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Rath and Kaur: A cured case of haemorrhoids in a 12‑year old boy

and properly, haemorrhoids cause no lasting effects • Thirst for large quantity
on the children.[10] In this case report we describe • Haemorrhoids protruding
one such patient. • Haemorrhoids protruding, stool during
• Haemorrhoids bleeding.
CASE REPORT The repertorial result that followed using Hompath
Repertory (Classic M.D.) is shown in Table 1.
A 12-year-old boy presented with bleeding from anus
since 3 years. Patient complained of some projection A detailed account of the treatment is given below.
from anus, accompanied with bleeding during First Prescription (31.12.09)
passage of stool. The patient reported of pushing Phosphorus 200/2 doses‑OD *2 days
up the protrusion by hand after daefecation. There
Placebo 30/BD *15 days
was no history of pain. The patient did not take any
prior treatment before reporting for homoeopathic Advice: Sitz bath; restrict spicy and oily food.
medication. He had been advised surgery and the
Basis of Prescription
usual fear of surgery prompted his parents to seek
In terms of repertorial scoring, both Phosphorous and
homoeopathic treatment. Subsequently, the patient
Sulphur scored 23/10 and Calcarea carb. scored 21/9.
was brought to the OPD of CRI (H), Noida. On
In this case, Phosphorous was preferred as it is a
physical examination, position of haemorrhoids was
known anti-haemorrhagic medicine. It is prescribed
found to be 11’O clock [Figure 1]. for discharge of blood from rectum during stool,
The patient was non-vegetarian and of tall, lean bleeding haemorrhoids[11] and also known to cover
built. His parents reported of his irritable nature and the symptom ‘painless stool’ well. Further, to
marked anxiety before examination at school. The confirm the prescription of Phoshorus over other
patient was also observed to be anxious in general, a drugs, a detailed cross-reference study was done. It
fact that was verified by his parents. His appetite was was found that the rubric, ‘Haemorrhoids protrude
good and he desired both sweet and salty food items. stool during’ is an important one but not covered
He would also drink water frequently, about two by Sulphur in Kent and Synthesis repertories and
glasses of water at a time. The boy was hot thermally, is covered only in 1 grade in Complete repertory.
but also had a tendency to catch cold easily. Another rubric, ‘Haemorrhage from anus stool
during’ has three marks in Phosphorus and only
Family history: Mother - heavy menstrual flow
one mark in Sulphur as per Synthesis repertory,
The following symptoms were considered for while the same doesn’t find a mention in any other
repertorisation: repertory that was consulted. Calcarea carb. on the
• Anxiety other hand, though scored 21/9 and two marks in
• Hot patient ‘haemorrhoids protrude during stool’, the patient’s
• Tendency to catch cold physical appearance was not in consonance with
• Desire for sweet and salted things the drug.
The follow up is mentioned in detail in Table 2.

RESULT

After prescription of Phosphorus in various potencies,

the bleeding from haemorrhoids eventually stopped.
However, there were a few intermittent episodes
of bleeding before final cessation. Even the size of
the protrusion reduced [Figure 2]. Later, in the due
course of treatment, the haemorrhoids disappeared,
as observed on 23rd March 2011 and confirmed by
surgeon on 27th July 2011 [Figure 3]. Even after two
years of stopping treatment, the patient has not
Figure 1: Internal hemorrhoid (Grade III) as observed on first visit (31.12.09) reported of any recurrence.

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Rath and Kaur: A cured case of haemorrhoids in a 12‑year old boy

Table 1: Hompath repertory (classic M.D.)

Table 2: Follow ups

Date Symptoms Medicine Potency Repetition Days
01.02.10 Bleeding during stool-sometimes Phos. 200 O.D. 2
Size of protrusion during stool-no change Placebo 30 B.D. 15
15.02.10 No bleeding during stool Placebo 30 B.D.* 10
Protrusion of mass: same as before
08.03.10 Bleeding during stool: At times Phos. 1M O.D. 2
Size of protruding mass: same as before Placebo 30 B.D. 30
29.03.10 No bleeding during stool Placebo 30 B.D. 15
Size of protruding mass: same as before
28.06.10 No bleeding during stool Phos. 1M O.D. 2
Size of protruding mass: same as before Placebo 30 B.D 30
18.10.10 No bleeding during stool Aloe socotrina 30 T.D.S. 3
Size of protruding mass: same as before
Diarrhoea mucoid<morning (5-6 times in morning) since 2 days
24.01.11 Heavy bleeding during stool in the morning Phos. 1M O.D. 2
Advice: Sitz bath 30 B.D. 7
Placebo
02.02.11 No bleeding during stool Placebo 30 B.D. 30
Size of protruding mass: Reduced; No need to push the mass
inside after stool; it goes in automatically (Figure 2)
23.03.11 No bleeding during stool Sulphur 1M O.D. 2
No protrusion of mass during passage of stool (Figure 3) Placebo 30 B.D. 20
No other complaints
27.07.11 Proctoscopy done by surgeon reported no demonstrable
pathology
27.05.13 No demonstrable pathology still
Phos: Phosphorus; O.D.: Once Daily; B.D.: Twice Daily; T.D.S: Thrice Daily

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Rath and Kaur: A cured case of haemorrhoids in a 12‑year old boy

Figure 2: Non-bleeding haemorrhoids (02.02.11) Figure 3: No protrusion/bleeding (23.03.11)

DISCUSSION In this case, there was no history of repeated

diarrhoea or intestinal infections that could have
Haemorrhoids in children, however uncommon, can
precipitated the development of haemorrhoids. Since
result from unknown causes.
there is no known precipitant for the condition, we
The disease, once established, tends to get worse may conclude that the difficulty was constitutional in
over time. Medical application of creams and origin and hence speaks of disordered susceptibility.
suppositories can relieve irritation and pain but rarely A combination of lifestyle changes and homoeopathic
provide long‑term benefit. A high fibre diet and bulk treatment proved to be a great relief to this patient
laxatives prevent constipation and worsening of the and also eliminated the need for surgery. A thorough
disease without achieving a cure. The mainstay of homoeopathic treatment could remove the tendency
treatment is surgical. But unfortunately, operative and thereby prevent recurrence. Thus, the case
haemorrhoidectomy is usually associated with also verifies the superiority of Materia Medica over
significant postoperative complications, including repertory for correct choice of similimum. Phosphorus
pain, bleeding and anal strictures, which can result ultimately proved to be the correct choice as the first
in protracted period of convalescence. Since surgery prescription, going by the result of the case. The
does not target the root causes like individual dose 200 was selected in the beginning considering
tendencies, habitual constipation, etc., recurrence the severity of the case and the age of the child.
is also common. Homoeopathic medicines can However, it was increased to 1M when the bleeding
modify these tendencies, thus reducing chances of recurred after stoppage even after two doses in 200
recurrence significantly. Homoeopathic literature potency, which were allowed sufficient time to act.
mentions many medicines for the condition of 1M potency was given with the hope that it would
which a similimum can help a patient for keeping take the course of treatment further. Also, the size
the disease at bay for a longer period as evidenced of mass did not reduce with the 200 potency. 1M
in this case. Homeopathic remedies can offer gentle was again repeated in due course, which finally also
and safe relief. Patients have the highest satisfaction led to reduction and then final disappearance of the
after taking the treatment. Mental makeup, physical haemorrhoids. During the course of treatment, the
makeup, sensations experienced by the patient, patient once reported with diarrhoea, for which
characteristics of haemorrhoids (bleeding, protruding, Aloes was given as an acute remedy. Sulphur was
painful/painless), etc., also become a good tool later given as an anti-psoric medicine to clear up the
for prescription. Besides, in a study on 78 patients case at the conclusion. Proctoscopic examination by
between age group 25-60 years, homoeopathic surgeon did not reveal any haemorrhoids or growth
medicines in LM potencies was found to be effective after treatment.
(P=0.0001) in treatment of internal haemorrhoids.
This invites for further studies for evaluating the Although the case was successfully treated, a
efficacy of the medicines in LM potencies in treating better compliance from the patient’s side in terms
the condition.[14] of regular follow ups could have helped in quick

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Rath and Kaur: A cured case of haemorrhoids in a 12‑year old boy

recovery of patient. The patient was requested to A New Approach to a Gynecologic Dilemma; Supplement to OBG
management; August 2005; S3-7.
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Source of Support: Nil, Conflict of Interest: None declared.

EDITOR’S NOTE enunciated. For instance, when do we conclude that

a particular patient is hot? What sort of data would
While the results of Homoeopathic intervention justify such a conclusion? And which rubrics would
are miraculous, explanations for the choice of the accurately represent this thermal status? When do we
remedy are often complex and controversial. Also conclude that the action of a remedy is over and the
there are several alternative methods of posology patient needs a complementary follow up remedy?.
and the timing for the introduction of homoeopathic These aspects need to be researched to evolve a
remedies, the rules of which have not yet been clearly standardized homoeopathic treatment regime.

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Indian Journal of Research in Homoeopathy / Vol. 8 / Issue 1 / Jan-Mar 2014 41