Pain is a most terrible lord of
mankind than even death himself
-
Albert schweitzer
Anal fissure is
one of most painful condition among the anorectal disorder. In classical
Āyurveda literature, Anal fissure is termed as Parikartika. It is a common
anorectal condition in terms of prevalence it ranks third after chronic
constipation and hemorrhoids, but exact data of its prevalence is rare. The
true prevalence of anal fissure though is not known but it is estimated that
they account for 6% to 15% proctology diseases.
On the basis of symptoms, the disease
fissure-in-ano can be compared to the disease Parikartika according to Āyurveda.
Ācārya Dalhana has described the term Parikartika as a condition of Gudā in
which there is cutting and tearing pain. Similarly, Jejjāta and Todara have
clearly described Parikartika as a condition which causes cutting pain in
anorectum. The factors responsible for causation of Parikartika as found in
various texts are Vamana-Virecana-Vyāpada , Bastikarma Vyāpada , Atisāra,
Grahani, Arśa, Udāvarta etc. In the similar manner, it has been described of
three types viz. Vātaja, Pittaja and Kaphaja. Suśruta while describing the
symptoms of the disease speaks of the features like, cutting or burning pain in
anus, penis, umbilical region and neck of urinary bladder with cessation of
flatus. Whereas Caraka has described the features like, pricking pain in groins
and sacral area, scanty constipated stools and frothy bleed per anus.
An alarming
rise in the incidence of the disease fissure-in-ano and no known satisfactory
remedies evolved so far has given an impetus to find out a suitable solution,
with altogether better effects from among the treatments advocated by the
ancient Āyurvedacāryas.
An anal fissure is a painful linear tear or crack in the
distal anal canal. In Ayurveda anal fissure termed as Parikartika.
Fissure-in-ano is very
common and painful condition fissure occur most commonly in the midline
posterior. In males fissures usually occur in the midline posterior- 90%, and
much less commonly anterior 10%. In females fissures on the midline posterior
are slightly commoner than anterior (60:40).
On the basis of the clinical symptoms the disease
fissure-in-ano has been classified into two varieties, viz. acute
fissure-in-ano and chronic fissure-in ano. Either acute or chronic, pain or
bleeding are the two main symptoms of this condition, pain is sometimes
intolerable. In long standing cases it may be associated with hemorrhoids or a
sentinel tag. Pruritis ani may be another symptom of this condition. So, to
restrict the progress of the disease and emergence of complications, so this
disease should be treated early.
The present
trend in the treatment of fissure-in-ano depends on the type of the disease,
e.g. in cases of acute variety with short history of the problem can be treated
on the conservative lines, which include oral pain killing medication to be
taken before anticipated bowel movement. Stool softener may be used to make the
stool soft enough, weak bulk laxative or cathartics are the use. Soothing
ointment, self dilatation etc. are considered to be effective. Sometime fissure
does not heal by conservative treatment, this could be happens due to scarring
or muscle spasm of the internal anal sphincter muscle. Those which continue to
cause pain or bleeding.
Whereas in
chronic ulcer Anal dilatation, posterior sphincterotomy and fissurectomy and
excision of the anal ulcer are the gold standard treatment modalities but still
recurrence have been recorded in the long due course.
Keeping the above disadvantages of various
treatment modalities, A comparative study of ksārasūtra application to fissure
in ano with standard sphincterotomy procedure is selected in management of Parikartika.
The well accepted sphincterotomy procedure not only relieve the spasm of anal
canal instantly but also minimize the pain during defecation. But in long due
course recurrence have been recorded, even with the sphincterotomy procedure. BY.Dr.Manoj Dubey
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