Anal fissure refers to a minor or a small breach in the continuity of skin of the anal opening. Commonly this happens because of hard stools during bowel evacuation. Generally, anal fissures are known to cause pain and bleeding associated with itching sensation, during defecation. In many people it may also lead to muscular spasms in the anus.
Though, anal fissure is very commonly found in infants but can be seen in any age group. Mostly, they resolve with simple measures, like increasing intake of fiber intake, adequate hygiene or sitz baths (immersing lower body in warm water). If these do not help, there may be need for oral medications.
Ayurveda describes fissure as Parikartika. This word refers to the cutting or burning nature of pain. In addition to this, bleeding is another vital sign of the disease
COMMON CAUSES OF ANAL FISSURE
Anal fissures can be caused by trauma to the anus and anal canal. The cause of the trauma can be one or more of the following:
- Excessive straining to have a bowel movement, especially if the stool is large, hard, and/or dry
- Anal stretching
- Decreased blood flow to the anal area
- Chronic disease conditions (diarrhea, tuberculosis, HIV)
- Pregnancy and childbirth
- Sedentary lifestyle
- Unhealthy food habits(Eating hot, spicy, junk food in large amounts regularly)
- Excess smoking and alcohol consumption
- Longstanding poor bowel habits
- Overly tight or spastic anal sphincter muscles (muscles that control the closing of the anus)
- Scarring in the anorectal area
- Presence of an underlying medical problem: such as Crohn's disease and ulcerative colitis; anal cancer; leukemia; infectious diseases (such as tuberculosis); and sexually transmitted diseases (such as syphilis, gonorrhea, Chlamydia, chancroid, HIV)
SYMPTOMS OF ANAL FISSURE
- Pain during, and even hours after, a bowel movement
- Constipation
- Blood stained stool
- A visible crack or tear in the anus or anal canal
- Burning and itching that may be associated with pain
- Discomfort when urinating, frequent urination
- Foul-smelling discharge/pus discharge from the affected area
- Sharp pain during and also after the bowel movement
- Irritation or burning sensation around the anus
- Feeling a small lump or skin tag in anal region
DO'S AND DONT'S
- Do not hold back your natural urges
- Avoid sitting in toilets for too long
- Keep anal area dry and clean
- Use warm water and mild soup to cleanse your anal area
- Eat fibre rich diet like fruits, vegetables, wheat, oats
- Drink atleast 4-5 litres water a day, to avoid the hard stools
- Do regular exercises, Practice yoga regularly.
- Avoid spicy, salty and sour foods as they aggravate the condition
- Use natural laxatives if you have constipation.
- Add Cow ghee to your diet, it balances aggravated doshas and also lubricates your GIT.
- Avoid juices, eat the complete fruit, eat Amla regularly.
TREATMENT
Anal fissure can be compared to PARIKARTIKA explained in Ayurveda, and it is caused by aggravation of Vata and Pitta Dosha. So, treatment is done according to dosha involved.
We can divide treatment into two main categories according to the type of fissure
TREATMENT OF ACUTE FISSURE IN ANO
Matra basti is a type of Anuvasana basti. It acts as a retention enema and it helps in easy passage of stools, it promotes Vatanulomana and it cures the diseases, which are caused by aggravated Vata. As Parikartika is Vata dominate Vyadhi, Matrabasti does the local Snehana. Spasm will also be relieved and thus it brings down the pain. It softens the stools, lubricates the anal canal and provides an easy evacuation of stools.
Per rectal administration of 15-20 ml oil (having Vranaropana property) will reduce the spasm of the sphincter muscles and gives relief from pain and helps in healing the ulcer.
Tail or ghrit forms protective layer over fissure wound, it s ooths the anal canal, so, relieves pain by decreasing sphincter tone and it cleanses the wound thus helps in healing of ulcer. Some of the oils and ghrita used for this purpose are - Jatyadi oil, Shatadhaut ghritam, Jatyadi ghritam, Durva ghritam, Triphala ghritam
It has antimicrobial, antiseptic, antipruritic and wound healing properties and reduces itching, burning and irritation around the anal region.
Add half tablespoon of Sphatika powder in a tub of warm water and soak your bottom in it for 10-20mins, few times a day. Sitting in the warm/hot water tub after each bowel movement soothes pain and relaxes spasm of internal sphincter for some time. It also helps in cleaning of fissure wound. Sitz bath is highly effective in treatment of fissure. You can use any tub you have at home.
The rate of intestinal passage of food depends on the nature of the diet and its fluidity(ability to flow easily). The greater the water content, the more rapidly it will reach the rectum and produce its distension and there after evacuation. Therefore patients should take daily fibre rich food and plenty of fluids to improve digestion and regularize bowels Fibres are a complex carbohydrate, they bind with water in the colon and create a larger, softer stool. Larger, softer, stools stretch and relax the sphincter muscles and helps the blood to flow and also require a little pressure to pass.
TREATMENT OF CHRONIC FISSURE IN ANO
Treatment of chronic fissure can be divided in 4 parts
KSHARA SUTRA THERAPY
Ligation of Kshara sutra to sentinel pile masses, by this they may fall within few days by themselves.
KSHARA LEPAM
Lepa of Apamarga Pratisaraneeya kshara is done over the (Chronic fissure-in-ano) ulcer surface, by scraping action (Lekhan karma) of Kshara, this reduces the excess fibrous tissue present over the ulcer by scrapping it and the ulcer heals & sphincter relaxation occurs simultaneously.
AGNIKARMA
Para surgical procedure like Agnikarma has been widely advised by our Acharya Sushruta. Agnikarma treatment provides marked relief & no recurrence. Excision of sentinel piles by Agnikarma i.e. by electro thermal cautery reduces the chances of recurrence to zero.
ORAL MEDICATIONS FOR FISSURE IN ANO
Keeping all the aggravated doshas, and symptoms in mind CHANDIGARH AYURVEDA CENTRE has prepared "ANAL FISSURE CARE KIT"
It contains : Detox premium powder, Arshcare tabl, Triphala syrup, Pile soft tab, Stop bleeding tablet, Panchskar tab and Shatadhaut ghrutam
ANAL FISSURE CARE KIT
OTHER SINGLE HERBS
- Triphala : Helps in improving digestion and regulates bowel movements(Laxative) to cure constipation. You can have it with lukewarm water before bed
- HARIDRA : Acts as an anti oxidant, helps in inflammation and itching. Drink milk boiled with Turmeric.
- GUGGULU : Acts as an analgesic, anti inflammatory, relieves gas and pain
