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PILES, FISSURE, FISTULA-AYURVEDIC VIEW

PILES, FISSURE, FISTULA-AYURVEDIC VIEW
By Nagaland Post | Publish Date: 7/28/2019 5:06:48 AM IST

 Any Problem During Defecation Or Toilet Related Problem Is Not Piles

Due to indulgence in unwholesome diet and regimen eg: excessive non vegetarian diet, unhygienic and improperly cooked foods, consumption of alcohol, smoking, changing lifestyle, increased stress, improper sleep habits, obesity etc, leads to agnimandya which is the root cause of most of the ano-rectal diseases. Ano-rectal disorders are very common and painful. 

Their prevalence in general population are probably much higher than seen in clinical practice as most of patients do not seek medical attention. Ano-rectal symptoms are a consequence of disorder bowel habits.  The common Ano-rectal diseases are Arsha (Piles), Parikartika (Fissure in-ano), Guda arbuda (Rectal Carcinoma, Codyloma acuminate, Rectalpolyps) Pidaka (Perianal abscess), Bhagandar (fistula in-ano), Gudabhramsha (Rectal prolapse), Vibandha (constipation), Thrombosed haemorrhoid, Fecal impaction, Pruritis-ani, Proctitis, Rectal foreign bodies etc. 

Most of the diseases can be diagnosed clinically with proper history, some leading features like pain, bleeding, swelling, bowel habit, discharge etc. assisted with digital per- rectal examination and proctoscopy. Only a few diseases may require sophisticated investigation.

PILES/ HAEMORRHOIDS (ARSHA):  Arsha is defined as the fleshy projection which creates obstruction in anal passage, killing the life of the person whom it effects like enemy. The term ‘haemorrhoid’ is derived from the Greek adjective haemorrhoid, meaning bleeding (haima = blood, rhoos = flowing). The haemorrhoids are dilated veins within the anal canal.

Classification:Piles are classified as internal and external piles 

Internal haemorrhoids: Symptoms: There are two cardinal symptoms of internal haemorrhoids.

• Bleeding

• Prolapsed.

• Particularly severe pain may occur if the piles become prolapsed and thrombosed. 

• Other symptoms are mucoid discharge and anal irritation.

• Symptoms of a secondary anaemia may develop.

Bleeding: Initially slight streak of blood on the motion or toilet paper. There is a steady drip of blood for a few minutes after the motion has been passed. At a still later stage bleeding may occur apart from defaecation at any time when the piles prolapsed and become congested. 

Prolapse: Prolapse of the haemorrhoids is a later development as a rule. The pile appearing at the anal orifice at the height of the expulsive efforts and slipping back immediately afterwards. Finally a stage is reached when the piles are more or less permanently prolapsed, with anal mucosa exposed and in contact with the underclothing.

Classification by degree of prolapsed: The most common grading system was developed by Banov: Grading of Internal Hemorrhoids

• Grade I: The hemorrhoids do not prolapse.

• Grade II: The hemorrhoids prolapse upon defecation but spontaneously reduce.

• Grade III: The hemorrhoids prolapse upon defecation, but must be manually reduced.

• Grade IV: The hemorrhoids are prolapsed and cannot be manually reduced.

Thrombosed heamorrhoid: Thrombosis is almost always a complication of large prolapsing second – or third-degree haemorrhoids and is believed to be due to their becoming nipped by the sphincter muscles while in the prolapsed position so that congestion and thrombosis result.

Home treatments :For many people, Piles are mild and temporary conditions that heal spontaneously or by the same measures recommended for prevention. Temporary relief from symptoms can be provided by:

•Sthanika Sweda(Sitz bath/Hydrotherapy) with a bathtub with Panchvalakal Kwatha. Especially in the case of external hemorrhoids with a visible lump of small size, the condition can be improved with warm bath causing the vessels around the rectal region to be relaxed.

• Matra-Basti: 5ml per rectal application with Kasisadi Taila for Piles Cold compress.

• Topical moisturizer.

Natural treatments:

• Eating fiber-rich diets, including water, helps create a softer stool that is easier to pass, to lessen the irritation of existing piles.

• Using the squatting position for bowel movements and taking less time for defecation maximum 2 minutes.

• Dietary supplements can help treat and• prevent many complications of piles.

FISSURE-IN-ANO (PARIKARTIKA)- The word Parikartika means Parikartanavat Vedana in Guda and can be correlated with fissure in- ano. It is commonly seen in children, adult age, pregnant women and during puerperium period. Parikartika means cutting and tearing type of pain in Guda (Anal Region) during defecation. An anal fissure (synonym: fissure-in-ano) is a longitudinal split in the anoderm of the distal anal canal.

Types of Fissure: Fissure is of two types Acute Fissure & Chronic Fissure. Acute Anal Fissures look much like a paper cut, and may be hard to detect upon visual inspection, they will generally self-heal within a couple of weeks. However, some anal fissures become chronic and deep and will not heal. The most common cause of non-healing is spasming of the internal anal sphincter muscle which results in impaired blood supply to the anal mucosa. The result is a non-healing ulcer, which may become infected by fecal bacteria

 Lakshna(Signs & Symptoms) of Parikartia/ Fissure:

• Cutting type of pain in rectum, umbilicus, penis, and head of urinary bladder during defecation.

• Burning sensation in the rectum.

• Obstruction of flatus.

• Anorexia.

• An ulcer present in the posterior and anterior

Treatment: 

• Non-surgical treatment is recommended as first-line treatment of acute and chronic anal fissures. Customary treatments include warm Sthanika Sweda(Sitz bath/Hydrotherapy) with a bathtub with Panchvalakal Kwatha, topical anesthetics, high-fiber diet and stool softeners. 

• Matra-Basti : 5ml per rectal application with Jatyadi Taila for Fissure. 

• Kshar-sutra application at fissure region along with sentinel pile shows dramatic results. Sentinel pile sheds off like pile mass and the wound heals within a week. 

FISTULA-IN-ANO (BHAGANDAR) : The formation of inflammatory swelling in Bhaga, Guda, Vasti pradesha (i.e. perianal area) is called Pidaka & when they suppurates and burst out it cause severe pain and called as Bhagandara. The fistula in ano is a chronic granulating track connecting two epithelial lined surfaces. It is a single track with an external opening in the skin of the perianal region and internal opening in the modified skin or mucosa of the anal canal or rectum

Purvarupa of Bhagandara:

• Pain in the waist.

• Itching at the anus.

• Burning sensation at the anus.

• Swelling at the anus.

Symptoms: Anal fistulae can present with many different symptoms:

• Pain.

• Discharge - either bloody or purulent.

• Pruritus ani - itching•  Systemic symptoms if abscess becomes infected

Kshar-sutra Treatment – This method is most effective non surgical method. This treatment can be done by an Ayurvedic physician. In this method medicated Kshar-sutra is applied through the fistula tract with the help of special probe and it is changed weekly. Within few weeks the fistula tract is cured. Successful rate in this treatment are tremendous.

PERIANAL ABSCESS (PIDAKA/VIDHRADHI): The swelling presence in the  Guda Pradesh (anal region)  which is not burst out is called as Pidaka. Due to indulgence of virudha ahara and vihara(incompatible diets & regims) it produce a swelling which is slowly bulging up, deep rooted, painful, round or wide is called as vidhradhi. The collection of pus in the perianal region is called as Perianal abscess.

Clinical features: 

• Thrombing type of pain in the anal region.

• If occasionally the abscess has burst and pain was much relieve due to discharge of pus.

• Presence of moderate fever.

• The swelling shows as reddish, tender localized rounded or ovoid and close to the anus. At the later stage obvious fluctuation may be elicited in the swelling.

Treatment: Anal abscesses, unfortunately, cannot be treated by a simple course of antibiotics or other medications. Generally speaking, a fairly small but deep incision is performed close to the root of the abscess, and Kshar-varti is applied to the wound which curates the internal wall of abscess and heals the wound in the course of time. The incision is not closed (stitched), as the damaged tissues must heal from the inside toward the skin over a period of time.

CONCLUSION: The important clinical features of the anorectal diseases and the diagnosis and treatment of anorectal disorders such as Arshas (Piles/Haemorrhoids), Pariartika (Fissure-in-ano), Bhagandar(Fistula-in-ano),Vidradhi (Perianal Abscess). are approach to staging and management of diseases. Despite advances in diagnostic tests, a clinical interview is essential for characterizing the presence and severity of symptoms, establishing rapport with patients, selecting diagnostic tests, and plan for therapy.

BENEFITS OF TREATMENT WITH KSHAR SUTRA:

• There is no need of operation.

• There is no need of hospitalisation.

• Patient can do mild word during the course of treatment.

• There is no need of costly antibiotics.

• There is no threat of side effects like incontinence.

• Chances of reoccurrence are negligible.

• Cost of treatment is very less as comparative to surgery.

NOTE: Ayurvedic medicines and treatments should be taken under Qualified Ayurvedic Doctor/Physician. contact 9483328411. The drugs described in this article are for general information/educational purpose only. Anyone should not use these without consulting a qualified Ayurveda doctor/physician.

Dr. Imlikumba, B.A.M.S, MD(Panchakarma), PG Dip Yoga, Dip in Accupunture., Health Naturally Clinic, Mercy Building: Kevijau colony,                  Dimapur: Nagaland, +919483328411, imlikumba@gmail.com

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