Introduction
In everyday life, people encounter with a number of smaller creatures may it be a germ or a parasite. Man’s life on earth is greatly influenced by the surrounding system including these organisms. Some of they live inside us in a friendly way but some of them cause potential harm to us, in the form of diseases. Pin worms are tiny, narrow worms white in colour and less than 2cm long. They are small parasites that live in the colon and rectum. Usually, people get affected when they swallow the worm eggs which hatch inside the human intestine. Female worms travel out of the infected person’s anus to lay eggs, mostly at night, causing severe itching on the area. Along with symptoms in digestive system, pin worms can cause chronic anaemia and other disorders. Strict personal hygiene measures are needed along with medications for complete cure.
Signs & symptoms
Itching around the anus, especially at night
Difficulty to fall asleep or disturbed sleep
Irritability
Teeth grinding
Restlessness
Occasional stomach pain, nausea & vomiting
In girls, itching in the vaginal area and rarely vaginal discharge
Causes
Inadequate hygiene is the cause of pinworm infestation. Eggs are transferred from the anus of an infected person to either their own mouth, re-infecting themselves, or another surface. If somebody else touches that contaminated surface and then touches their mouth, they may have ingested the eggs and can become infected.
Pathophysiology
The primary symptoms of pinworm (Enterobius vermicularis) infection include pruritus or a prickling sensation in the perianal area, which is produced when a gravid female pinworm migrates to the anal area and inserts her pin shaped tail into the mucosa for depositing ova, usually at night time. E vermicularis lives in the small intestines, primarily the ileocecal region.
The movement of the female and the ova cause intense local itching. Ova may survive for up to 3 weeks before hatching. The hatched larvae can then migrate back into the anus and lower intestine, causing retro infection. Embryonated eggs may be released into the anus, air or onto fomites (e.g., bedding, clothing, toys, paper) or onto hands and then placed directly into the mouth and swallowed (autoinfection), after which they settle in the small intestines.
Pinworms that inhabit the caecum and adjacent areas typically cause no symptoms. Diarrhoea due to inflammation of the bowel wall can occur during acute infection.
Risk factors for pinworms include living with a person who is egg-positive, eating before washing hands, and poor personal or group hygiene.
Identification of the worm or its eggs. Worms can sometimes be seen on the skin near the anus or on underwear or sheets about 2 to 3 hours after falling asleep. Pinworm eggs can be collected and examined using the “tape test” as soon as the person wakes up.
Treatments
The medications used for the treatment of pinworm are either mebendazole, pyrantel pamoate, or albendazole.
Prognosis
Pinworm infestation is very rarely fatal; death and morbidity are from secondary infection.
Complications
Although rare, other complications of a pinworm infection may include:
- Urinary tract infections
- Weight loss
- Infection of part of the abdomen (peritoneal cavity)
Disease & Ayurveda
Krimi
Nidana
Causative factors for krimi are the same as that of Kushtha.
Sparsa
Aahaara together – By touch and sharing food, bed etc.
Sayya
Amrijothbhava – Due to lack of proper personal hygiene
Purvaaroopa
Not mentioned separately
Samprapti
Due to contact with krimi (microbes or parasites) and due to lack of proper hygiene, the microbes enter the body through mouth and travel through the intestines. They enter the pakwaasaya, guda and produce the disease.
Lakshana
Vidbheda – Loose stools
Soola – Abdominal pain
Vishtambha – Distension of abdomen
Kaarsya – Emaciation/loss of weight
Paarushya – Roughness of body
Paanduta – Anaemia/ Pallor
Romaharsha – Horripilation
Agnisadana – Loss of appetite
Gudakandu – Itching of anus
Gudavinirgama – Rectal prolapse
Divisions
- Bahyam-external
- Aabhyantaram-internal
- Bahirmalaja-from external impurities
- Kaphaja-from kapha
- Rakthaja-from rakta
- Pureeshaja-from faecal matter
Prognosis
Kricchrasadhyam
Chikithsa
The Ayurvedic treatment of Krimi depends upon the type.
Here, the infestation is internal and it is aabhyantarakrimi but it can be seen outside the anus also. The main procedure is to physically remove the krimi from skin (if visible) and cleaning the Gastro-intestinal tract removing the krimis completely. Main Ayurvedic treatment for the disease pin worms include purificatory therapies called vamana(therapeutic emesis with medicated herbal drinks) and virechana(therapeutic purgation with herbal medicines administered orally). After cleaning the GIT with these procedures and vasti(medicated enemas) , diet & hygienic lifestyle to prevent worm infestation should be followed.
Samana
Apakarshana – extraction with hand or tool
Uthkharshana-powder massage
Lepana-external application of herbal pastes to reduce itching etc.
Parisheka-Pouring medicated herbal decoctions on the area
Sodhana
Vamana
Virechana
Aasthapanavasti
And after the krimi has expelled from the body, anuvasanavasti should be done to compensate the dryness and deterioration caused by aasthapanavasti.
Commonly used medicines
Vidangakrishnadi kashayam
Abhayarishtam
Avipattichoornam
Brands available
AVS Kottakal
Vaidyaratnam oushadhasala
SNA oushadhasala
Home remedies
Pinworm eggs can cling to surfaces, including toys, faucets, bedding and toilet seats, for two weeks. So besides regular cleaning of surfaces, methods to help prevent the spread of pinworm eggs or to prevent reinfection include:
- Because pinworms lay their eggs at night, washing the anal area in the morning can help reduce the number of pinworm eggs. Showering may help avoid possible re-contamination in bath water.
- Change underwear and bedding daily
- Wash bedsheets, pajamas, underwear, washcloths and towels in hot water to help kill pinworm eggs. Dry on high heat.
- Avoid scratching the anal area. Trim the fingernails so there’s less space for eggs to collect. Avoid biting nails.
- Wash hands well after using the toilet or changing a diaper and before eating.
- To be avoided
Red meat, fried non-veg items, and sea foods
Jaggery, sugar, sweet food items, Milk and milk products that cause obstruction in channels and a favourable condition for worms
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods and spicy food- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Raw papaya, pineapple etc.
Green gram, soups with black pepper, turmeric, ginger and curry leaves
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Maintain proper personal hygiene.
Avoid sedentary lifestyle. Be active.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid forcing or holding of natural urges like urine, faeces, vomiting, hiccups etc.
Avoid Stress and emotional imbalance as much as possible.
Yoga
Following a routine with regular exercises and specific yoga asanas like Ardhamathsyentra asanam, Halasanam, Vakrasanam, Dhanurasanam etc is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within and with surroundings.
Ardha mathsyentra asanam
Halasanam
Vakrasanam
Dhanurasanam
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522669/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
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