Anal Fissure/ Parikarthika

Anal fissure, or Fissure in ano, is a painful condition that commonly occurs in the midline posteriorly, which is the least protected part of the anal canal. It is characterized by a small tear or cut in the lining of the anal canal, often resulting from trauma during bowel movements, constipation, or the passage of hard stools. Symptoms of an anal fissure typically include sharp pain during and after bowel movements, bleeding, and sometimes itching or irritation around the anus. The pain can be severe and may lead to a fear of defecation, which can exacerbate the problem by causing further constipation.There are two main types of anal fissures: acute and chronic. Acute fissures are recent tears that may heal on their own with conservative treatment, while chronic fissures are those that have persisted for more than several weeks and may require more intensive management, such as surgical intervention.Treatment options for anal fissures often include lifestyle modifications, such as increasing dietary fiber intake, staying hydrated, and using stool softeners to ensure regular and soft bowel movements. Topical treatments, including anesthetics and nitroglycerin ointment, can help reduce pain and promote healing. In more severe cases or when conservative treatments fail, surgical options like lateral internal sphincterotomy may be considered to relieve tension in the anal sphincter and promote healing.Proper hygiene is also essential in managing anal fissures, and patients are typically advised to gently clean the area after bowel movements and avoid excessive wiping. If symptoms persist or worsen, it is important to consult a healthcare professional for further evaluation and treatment.

WHAT IS ANAL FISSURE?

It is an elongated superficial ulcer/tear situated in the lining or long axis of the anal canal.

WHAT CAUSES ANAL FISSURE?

· Constipation

· Spasm of internal sphincter

· Anal stenosis

· Tearing of an anal valve due the passage of hard stool.

WHAT ARE THE TYPES OF ANAL FISSURE?

· Acute- Deep tear through the skin of anal margin extending into the anal canal

· Chronic- Characterized by inflamed indurated margin, presence of sentinel tag and an infection can result in abscess formation.

WHAT ARE THE SYMPTOMS OF ANAL FISSURE?

· More common in women

· Chronic constipation

· Sharp, agonizing pain during defecation

· Passage of bright streaks/drop of blood along with stool.

WHAT ARE THE TREATMENT METHODOLOGIES?

1. CONSERVATIVE MANAGEMENT-

· Increased fluid intake to help maintain hydration and support bowel function.

· Regular physical activity to promote healthy digestion and reduce constipation.

· Warm sitz baths to relieve discomfort and promote relaxation of the anal muscles.

· Topical treatments, such as hydrocortisone creams, to reduce inflammation and irritation in the anal area.

· Avoidance of straining during bowel movements to prevent further irritation or injury.

· Consultation with a healthcare provider for personalized recommendations and to rule out any underlying conditions.

· Potential use of probiotics to support gut health and improve stool consistency.

2. SURGICAL INTERVENTION-

It seems like you're looking for information related to surgical procedures concerning anal conditions. Here’s an overview of each procedure you mentioned:

1. Lord's Dilatation: This is a surgical procedure used primarily for the treatment of anal fissures. It involves the gentle stretching of the anal sphincter to relieve pressure and allow for healing. It's typically done under local anesthesia and can provide relief from pain associated with fissures.

2. Lateral Sphincterectomy and Fissurectomy: This procedure involves the surgical removal of a portion of the anal sphincter muscle along with the fissure itself. It is usually performed in cases where conservative treatments have failed and the fissure is chronic. The aim is to reduce anal spasm and promote healing.

3. Excision of Anal Ulcer: This procedure involves the surgical removal of an ulcer located in the anal region. It may be indicated for ulcers that are chronic, painful, or not healing with conservative treatment. The excision can help alleviate symptoms and promote healing.

WHAT IS ANAL FISSURE ACCORDING TO AYURVEDA?

In Ayurveda, Fissure in ano can be compared or correlated to Parikarthika, which is mentioned as a painful condition. It is mentioned in Atiyoga of Vamana.

DEFINITION OF PARIKARTHIKA?

The Vyaadi/Disease which produces cutting type of pain in Guda pradesha/Anal region is Parikarthika.

WHAT NIDANA/CAUSES OF PARIKARTHIKA?

The imbalance in Vata and Pitha dosha is the main causative factor of Parikarthika. Person who is Snigda (unctuous/oleated), has Mandagni (low disgestive fire), is kshina(weak), has association of Ama, takes tiksha virechana oushada (strong purgatives), it enters to guda pradesha(anal region) and quick explosion of dosha happens. The imbalance of Vata and Pitha dosha can lead to various digestive disturbances, resulting in the condition known as Parikarthika, commonly characterized by anal pain and discomfort. When a person exhibits Snigda qualities, it indicates a condition of excess moisture or oiliness in the body, which can further exacerbate the imbalance of the doshas. The presence of Mandagni signifies a weakened digestive capacity, leading to improper digestion and the accumulation of Ama, or toxic byproducts from undigested food. This Ama can aggravate both Vata and Pitha doshas, resulting in inflammation and irritation in the anal region. When a person with these predispositions consumes tiksha virechana oushada, which are strong purgatives, it can act too aggressively on the already sensitive digestive system. This sudden and intense action can cause a rapid shift of doshas into the guda pradesha, leading to a quick and often painful exacerbation of symptoms. The result is a vicious cycle where the imbalanced doshas lead to discomfort, and the treatment methods may further irritate the condition. Therefore, it's essential for individuals suffering from Parikarthika to seek a balanced approach to treatment that includes gentle purgatives, dietary modifications to strengthen Agni, and therapies aimed at restoring the equilibrium of Vata and Pitha doshas. This holistic approach will not only alleviate symptoms but also promote overall digestive health and well-being. In addition, incorporating lifestyle changes such as regular, moderate exercise, stress management techniques, and adequate hydration can support the body's natural balance and aid in recovery from Parikarthika.

SYMPTOMS/LAKSHANAS OF PARIKARTHIKA

· Theevra – Excruciating pain

· Shoola - Sawing type of pain

· Picha - Slimy discharge

· Asra – blood discharge

MANAGEMENT OF PARIKARTHIKA

· Piccha Basthi – Medicinal enemas

· Shithala jala snana – Cold water shower

· Anuvasana Vasthi - Lubricating enemas

· Pichu - Medicated cotton oil pads

· Varthi – Medicated Suppositories

· Kshira Bhojaja – Intake of food with milk

WHAT ARE THE PATHYA-APATHYAS?

PATHYA – BENEFICIAL/WHOLESOME DIETARY

· Vata pacifying food which are warm, easily digestible and light

· Include soups, whole grains like red rice, pulses like barley, horse gram etc.

· Avoid cold and dry foods which aggravates Vata

· Add more fibre rich food to diet to avoid constipation.

· Hydrate your body thoroughly by drinking plenty of water

· Stress management and regular exercise or physical activities plays a key role in management

· Avoid foods that are heavy and difficult to digest.

· Avoid too much straining while defecating.

· Avoid foods that are too salty, spicy and strong

· Incorporate healthy fats such as ghee or olive oil to help lubricate the digestive system.

· Favor cooked vegetables over raw ones, as cooking makes them easier to digest and reduces Vata.

· Include sweet, sour, and salty tastes in your meals, as they help to balance Vata.

· Use warming spices like ginger, cinnamon, and cumin in your cooking to aid digestion and enhance the flavor of foods.

· Practice mindfulness while eating, focusing on each bite to foster better digestion and satisfaction.

· Establish a regular meal schedule to help stabilize Vata and promote a sense of routine.

· Consider herbal teas that are soothing and balancing, such as chamomile or peppermint, to aid digestion.

· Engage in calming activities such as yoga, meditation, or deep breathing exercises to reduce stress and balance Vata energies.

· Ensure adequate rest and sleep to support overall health and well-being, as Vata is aggravated by fatigue.

· Consult with a healthcare professional or an Ayurvedic practitioner for personalized dietary recommendations tailored to your unique constitution and needs.

Effective Ayurvedic Treatment for Anal Fissure | Ayurveda Solutions