Anal fissure is a tear in the skin around the opening of the anal canal.
This is an extremely painful anorectal condition which may lead to stress and anxiety.
Fissures are generally caused by frequent straining to pass hard or dry stools in constipation. It can also occur in case of chronic Diarrhea.
Other causes include anal trauma due to delivery or any other reason, insertion of objects through Anal region, anal intercourse, sexually transmitted diseases or any other chronic bowel disease.
People who eat low fiber diet or junk food, consume less amount of water, take excessive tea or coffee, do not exercise and have prolonged sitting habits are at high risk of suffering from fissure in ano.
1. A tear in the anal region.
2. Severe pain around the anal region especially during defecation, sometimes burning sensation or itching may also be present.
3. Small amount of bright red blood may be passed mixed with stool or can be detected in the toilet paper.
4. Anal fissure is extremely painful during examination by doctor.
5. In long standing cases Anal fissure is covered by a thin fold of skin which is called as a sentinel tag. This tag hinders the complete healing of fissure.
Ayurvedic Acharyas have mentioned it in various places as “Parikartika”. Pari – All around; Kartan – Cutting pain. In anal fissure the pain in ano rectal region resembles like a cutting type of pain therefore it is called as Parikartika.
This is Vata and Pitta Dosha predominant disease caused due to Mandagni (Low digestive fire).
1. As a complication of Virechana therapy - Virechana is a Panchkarma therapy in which a controlled purgation is done in order to expel excessive pitta dosha and toxins from the body. If virechana becomes uncontrolled then the skin around the anal region may break leading to formation of fissure.
2. As a complication of Vasti treatment – Vasti is again a type of Panchkarma therapy in which the medicines are given through anal route. It is very beneficial in vata dosha predominant diseases. If medicines given through Vasti are very harsh or dry then it may lead to fissure formation in anal route.
3. As a complication of Vasti Netra – The nozzle which is inserted in anal route for giving the Vasti is Vasti Netra. If not inserted properly, may damage the anorectal region leading to formation of Anal fissure.
4. After frequent passage of hard stools
According to Acharya Sushruta, The clinical features include excessive cutting like pain in ano rectal region, pelvic region and umbilical region, Obstruction in passage of flatus(May be due to spasm of anal sphincters) and loss of appetite.
The line of treatment for anal fissure is to improve the Jatharagni (Metabolic rate), Vata Pitta balancing treatment and to locally heal the wound.
Thus, Principle of treatment can be divided into two types.
1. Generalised Treatment – It includes orally given medicines to treat the root cause of disease. Single herbs – Neem(Azadirachta indica), Turmeric (Curcumin longum), Manjistha (Rubia cordifolia), Amla (Emblica officinalis),Bala(Sida cordifolia), Chopchini(Smilax china), Khadira (Acacia catechu), Amaltas (Garcinia pedunculata), Sariva (Hemidesmus indicus), Aloe vera
Examples of Medicines given to relieve from pain and speed up the healing process in wound include – chopchinyadi churna, saptvimshati guggulu, Mahamanjisthadi churna, Sarivadyasava, Khadirarishta, Kaishor guggulu, Sarivadi vati, Pancha Tikta Ghrita.
Examples of Medicines given to improve the digestive mechanism and relieve constipation- Panchsakar churna, Trifala churna, Aragwadhadi kwaath, Trifala guggulu
2. Localised Treatment -a) Hot sitz bath in luke warm water mixed with alum powder or betadine solution.
b) Local application of Jatyadi oil or jatyadi ghrit after sitz bath helps in speedy recovery of fissure and relieves from pain, it also provides lubrication in the ano rectal part.
C) Anuvasana Vasti or Matra Vasti consisting of drugs having lubricating, soothing and drug healing properties given through anal route is main treatment for relieving pain and fast healing of anal fissure
1. Every time after defecation wash the anal region with Betadine solution because the bacteria present in stool may infect and lead to pus formation in fissure which will delay its healing.
2. Regular application of Aloe vera pulp helps in healing of wound. Take 2 tablespoon of aloe vera and half teaspoon of curcumin powder. Mix it well and apply this paste on the fissure area regularly for 2 to 3 weeks or till the fissure heals.
3. Local administration of jatyadi oil 5 to 10 ml in the rectum through a syringe before going to defecate will help in reducing the pain and bleeding during passage of stools.
4. Regularly take 1 glass of luke warm milk mixed with 5 gms of cow’s ghee at night to soft stools.
5. Some Home remedies for improving constipation – 5to 6 milk soaked Raisins in the morning or 10 to 15 ml of castor oil mixed with oil at night or 5 to 10 gms Isaphghula husk with milk at night time.
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