Lateral Fissure-In-Ano - A Case Study

[Find the meaning and references behind the names: Dosha, Code, Class, India, Vata, Scholar, Cutting, Key, Date, Male, Males, Final, Jha, Hospital, Shailesh, Mash, Present, Pain, Hegde, Show, Acharya, Nov, Main, Daha, Head, Data, Under, Rasa, Blood, Pari, Year, Age, Patient, Days, Sneha, Pallavi, Mass, Ano, Dec, Post, Arunkumar, Quick, Severe, Hard, Basti, Case, Karthika, Pitta, Lower, Study, Strong, Canal, Bright, Common]

CASE REPORT Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 291 Lateral Fissure-In-Ano - A Case Study Jha Shailesh Arunkumar 1 , Pallavi A. Hegde 2 , M. M. Salimath 3 1 Final year Post Graduate Scholar, Department of PG Studies in Shalya Tantra, BVVS Ayurved Medical College and Hospital, Bagalkot, Karnataka, India. 2 Professor, Department of PG Studies in Shalya Tantra, BVVS Ayurved Medical College and Hospital, Bagalkot, Karnataka, India. 3 Principal, Head of Department, of PG Studies in Shalya Tantra, BVVS Ayurved Medical College and Hospital, Bagalkot, Karnataka, India. I NTRODUCTION Paikartika is one of the most painful and commonest condition in Gudagata Vikaraa affecting majority of population in morden world [1] The word Parikartika comprises of two words, Pari (around) and Karthika (cutting pain), Kartanaavat Peeda is the main symptoms of Parikartika . Acharya’s have explained it as a one among the Vamana, Virechana [2,3] and Bastivuapata [4] Address for correspondence: Dr. Jha Shailesh Arunkumar Final year Post Graduate Scholar, Department of PG Studies in Shalya Tantra, BVVS Ayurved Medical College and Hospital, Bagalkot, Karnataka, India. E-mail: mahishaileshjha@gmail.com Submission Date: 09/11/2021 Accepted Date: 19/12/2021 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA It is caused by Sthana Samshraya of vitiated Vata and Pitta Dosha’s in Gudapradesh , leading to Kartanavat Vedana and Daha [1] It can be equated with fissure in ano based on signs and symptoms [5] Fissure in ano is an elongated ulcer in longitudinal axis of lower anal canal associated with constipation, severe pain, burning sensation during defecation and passage of bright steaks of blood along with stool or will be seen on tissue paper [6] Fissure in ano occurs most commonly in midline posteriorly. In males usually posteriorly 95%, anteriorly 5% and in females posteriorly 80% and anteriorly 20% [7] About 30-40% of population suffers from proctologic pathologies at least once in their lives, while anal fissure comprises of 10-15% [8] It occurs in both men and women and is common in all age groups especially adults of 15 -40 years [9] In Chikitsa of Parikartika , Acharya’s have mentioned Madhura , Kashaya Rasa Sneha Yukta Dravyas in the form of Piccha Basti , Anuvasana Basti, [11] Pichu , Varti and Lepa which pacifies Vata and Pitta Dosha’s . A B S T R A C T The word Parikartika comprises of two words, Pari (around) and Karthika (cutting pain), Kartanaavat Peeda is the main symptoms of Parikartika . Acharya’s have explained it as a one among the Vamana , Virechana and Bastivyapata . It can be equated with Fissure-In-Ano based on signs and symptoms About 30-40% of population suffers from proctologic pathologies at least once in their lives, and anal fissure comprises of 10-15%. A 38 years male patient, who was businessman by profession came to Shalyatantra OPD with complaints of Pain at anal region with burning sensation after defecation since 20 days, bleeding during defecation since 20 days, feeling of mass per anal region since 20 days, hard stool since 25 days. In Chikitsa of Parikartika , Acharya’s have mentioned Madhura , Kashaya Rasa Sneha Yukta Dravyas in the form of Piccha Basti , Anuvasana Basti, Pichu, Varti and Lepa which pacifies Vata and Pitta Dosha’s . Hence present case study is planned with above said principle. Key words: Parikartika, Lateral Fissure-In-Ano, Matra Basti, Pichu, Jatyadi Taila.

[Find the meaning and references behind the names: Local, Verge, Day, Normal, Tender, Time, Aimed, Diet, Ase, Sleep, Get, Habit, Vrana, Back, Tag, Manual, Non, Past, Black, General, Heard, Min, Pass, None, Stretch]

Jha Shailesh Arunkumar et al. Lateral Fissure-In-Ano - A Case Study ISSN: 2456-3110 CASE REPORT Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 292 Acharya Sushruta has mentioned Anuvasana Basti with Grithamanda and Yastimadhu Taila in Parikartika [12] He has mentioned Pichu Prayoga in context of Shashti Upakrama , [13] in management of Vrana . Hence present case study is aimed to evaluate the combined effect of Avagaha Sweda with Panchavalkala Kwath , Matra basti and Pichu with Jatyadi Taila, Jaloukavacharana and anal dilatation in the management of lateral fissure-in-Ano. C ASE R EPORT A 38 years male patient, who was businessman by profession came to Shalya Tantra OPD of BVVS Ayurved Medical College and Hospital, Bagalkot, with complaints of Pain at anal region with burning sensation after defecation since 20 days, bleeding during defecation since 20 days, feeling of mass per anal region since 20 days, hard stool since 25 days. Associated Complaints Difficulty in micturition since 15 days. Lower abdominal discomfort since 15 days. History of Present Illness Patient was apparently normal 20 days back. Suddenly he started itching around the anal verge and he was unable to pass stool since 1-2 days. For which he did manual evacuation of stool. This was black and hard in consistency. Then he started pain with burning sensation which was lasted for 30 to 45 min, streak along stool, per rectal bleed after defecation since 25 days, for this patient approached his family doctor and he advised him some ointment for local application, but he didn’t get complete relief. Later on he started complaints like difficulty in maturation and lower abdominal discomfort since 10 days. He had same complaints 6 years back and since that time he is having mass peranal region which is asymptomatic, so for which he had taken Ayurvedic treatment in our hospital by which patient got complete relief but now again same complaints reoccurred, so he approached our hospital for further management. Past History No H/O DM. HTN etc. Patient had suffered from fissure-in-Ano 6 years back Past Treatment History Nothing Specific. Family History No relevant family history found. Personal History ▪ Appetite - Decreased ▪ Diet - Vegetarian ▪ Bowel - Irregular, Hard stool ▪ Micturition - 5 to 6 times / day ▪ Sleep - Disturbed ▪ Habit - None General Examination ▪ BP - 120/80 mmHg ▪ PR - 100/ min ▪ RR - 20/min ▪ Temperature - 98.6 ᵒ F ▪ Pallor, Icterus, Cyanosis - Absent ▪ CNS - Conscious and Oriented ▪ CVS - S 1 S 2 Heard ▪ RS - AEBE, Clear ▪ PA - Soft, non-tender Local Examination Inspection - Lateral fissure with Tag at 3 o’clock position. Lateral fissure at 9 o’clock position Bleed noted stretch of ulcer edges. Palpation Tenderness on lateral side of anal verge Digital examination Not done.

[Find the meaning and references behind the names: Rbs, Sec]

Jha Shailesh Arunkumar et al. Lateral Fissure-In-Ano - A Case Study ISSN: 2456-3110 CASE REPORT Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 293 Investigation CBC – Hb - 12.4 gm%, WBC - 9100 cells/ cu mm, RBS - 153 mg/dl BT - 3.40 sec, CT - 4.10 sec, RVD and HBsAg - Non reactive. Urine routine - Pus cells - 2 to 4 /hpf, Epithelial cells- 2 to 3 Treatment Protocol Avagaha Sweda with Panchavalkala Kwath twice a day for 7 days Matra basti - Jatyadi Taila (30 ml) for 7 days Pichu with Jatyadi Taila twice a day for 7 days. Jaloukavacharana - one sitting Anal dilatation with anal dilator for 4 days Procedure Matra Basti and Pichu with Jatyadi Taila Jaloukavacharana Procedure ▪ No of Jalouka - 01 ▪ Siteanal verge - 3 o’clock position ▪ Starting time - 4 pm ▪ Ending time - 4:25 pm ▪ Quantity of blood - 15 ml Anal Dilatation with Anal Dilator

[Find the meaning and references behind the names: Paka, Plan, Level, Dosa, Act, Goes, Bed, Cleaning, Cap, Size, Oral, Smooth, Neema, Reason, Due, Role, Tab, Samana, Good]

Jha Shailesh Arunkumar et al. Lateral Fissure-In-Ano - A Case Study ISSN: 2456-3110 CASE REPORT Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 294 Oral Medication TB. Anuloma DS 1 Tab HS Cap. Arshohita 1 Tab TID Tb. Triphala Guggulu 1 Tab TID Shatadhautaghrita for Local application. Yestimadhu Kasheera Paka (50 ml) in morning. Chikitsa Parinama - After Jalaukavcharana Before Treatment After Treatment Complaints Before Treatment After Treatment Pain at anal region Present Reduced Bleeding during defecation Present Absent Burning sensation at anal region after defecation Present Reduced Ulcer Size 0.9 cm 0.2 cm Tag Size 1 cm 0.3 cm DISCUSSION This treatment was advised for 7 days, it was found that there is significant relief in subjective and objective parameters for lateral fissure-in-ano. The Avaghasweda with Panchavalkala Kwath played important role in maintaining local hygiene, Shodhana (cleaning) as well as Ropana (healing) of ulcer. Matrabasti with Jatyadi Taila – It is good Shodhana and Ropana drug, it acts as a soothing agent for smooth evacuation of feaces and protects fissure bed. Pichu with Jatyadi Taila - as we know most of the ingredients used in Jatyadi Taila are Shothahara , Vedanasthapana and Ropana , which are helpful of healing a wound. Ingredients like Neema and Daruharidra are antibacterial and promote wound healing. Jaloukavacharana - As patient was continued to experience pain and tenderness around anal verge, for which inflamed tag could be the reason. Application of Jalauka result in reduction in symptoms by antiinflammatory substances present in its saliva. It goes to deeper level and acts as Thrombolytic, Vasodilation etc. So, there was significant reduction in size of swelling. Jalauka should be applied in the disease where there is Avagadha Dosha Dusti . Due to fissure, the hypertonic sphincter was relaxed by above procedure. After assessing the healing ratio of ulcer dilator was introduced for further enhancing the lumen diameter. CONCLUSION In this patient lateral fissure-in-Ano occurred due to constipation, which was caused by Vitiated Apana Vata . Here, disease is caused due to Vata and Pitta dosa. Avagaha Sweda with Panchavalkala Kwath, Matra basti – Jatyadi Taila (30 ml), Pichu with Jatyadi Taila etc all together will act on Vataanulomana, Pitta Samana, Vrana- Shodhana and Ropana etc. This shows that if plan of treatment is selected according to principle of Ayurveda along with proper drug, doses

[Find the meaning and references behind the names: Williams, Shukla, Christopher, Sriram, Work, Srb, Cite, Mamatha, Meda, Ravi, Panda, Delhi, Sutra, Shastri, Lord, Int, Single, Kumar, Sci, Hemantha, Works, Love, Tripathi, February, London, Original, Brothers, Bhat, Dutt, Success, Vaidya, Vis, Member, Open, Nil, Bailey, Hodder, Rao, Med, Hindi, Russell, Author, Siddi, Srinivas, Medas, Short]

Jha Shailesh Arunkumar et al. Lateral Fissure-In-Ano - A Case Study ISSN: 2456-3110 CASE REPORT Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 295 and duration there is assurance of success in treatment a seen in this case. REFERENCES 1 Savadi B. S et al: A Comparative Clinical Study On The Efficacy Of Yastimadhu Ghrita Matra Basti And Kasisadi Ghrita Matra Basti In The Management Of Parikartika W.S.R To Acute Fissure-In-Ano. International Ayurvedic Medical Journal.2019;7(10). 2 Kaviraja Ambikadutta Shastri, Hindi commentary on Sushruta Samhita of sushruta. Chikitsa sthana ; Vamanavirechanavyapat: Chapter 34, Verse 3. Varanasi: Choukhambha Sanskrit Pratishthan, 2018: Pp 183. 3 Vaidya Vidyadhar Shukla, prof. Ravi Dutt Tripathi, Hindi commentary on Charaka Samhita of charaka Siddi Sthana; Vamanavirechana Vyapat : Chapter 6, Verse 29. Delhi: Choukhambha Sanskrit Pratishthan, 2017; Pp 923. 4 Vaidya Vidyadhar Shukla, Prof. Ravi Dutt Tripathi, Hindi commentary on Charaka Samhita of charaka. Siddi Sthana ; Basti Vyapat : Chapter 7, Verse 5. Delhi: Choukhambha Sanskrit Pratishthan, 2017; Pp 931. 5 Srinivas GP, Mamatha HM. Efficacy of gopyadi matra basti in Parikartika vis-a-vis fissure in ano; a randomized single group clinical study. Int J Health Sci Res.2020;10(8). 6 R.C.G Russell, N.S. Williams & Christopher J.K.Bulstrode, editors. Bailey & love’s Short Practice of Surgery. 2 4 th edition. The anus & anal canal, Chapter 72, London: a member of Hodder Headline Group; 2004. Pp 1253. 7 Sriram Bhat M,editor. SRB’s Manual of Surgery. 5 th edition. Rectum & Anal Canal, Chapter 25, Dehli: Japee Brothers Medical Publishers(P) Ltd; 2016. Pp 976. 8 Shravya Kanumalli & Narmada M G: Management of Parikartika wsr to Acute Fissure-In-Ano with Yashadamrita Malahara – A Single Case Study. International Ayurvedic Medical Journal (online)2021 (cited February,2021). 9 Meda Mruthyumjaya Rao, P.Hemantha Kumar, Purnendu Panda, Bikartan Das. Comparative Study of Efficacy of Jatyadi Ghrita Pichu and Yasthimadhu Ghrita Pichu in the Management of Parikartika (Fissure – In – Ano). International Journal of Ayurveda and Pharma Research. 2016; 4(2):1-9. 10 Comparative study on Kshara Sutra suturing and Lord’s anal dilatation in the management of Parikartika , 05/22/2021, 08:10 am. 11 Vaidya Vidyadhar Shukla, Prof. Ravi Dutt Tripathi, Hindi commentary on Charaka Samhita of charaka. Siddi Sthana ; Vamanavirechana Vyapat : Chapter 6, Verse 67. Delhi: Choukhambha Sanskrit Pratishthan, 2017; Pp 926. 12 Kaviraja Ambikadutta Shastri, Hindi commentary on Sushruta Samhita of sushruta. Chikitsa sthana ; Vamanavirechanavyapat : Chapter 34, Verse 16. Varanasi: Choukhambha Sanskrit Pratishthan, 2018; Pp 187. 13 Kaviraja Ambikadutta Shastri, Hindi commentary on Sushruta Samhita of sushruta. Chikitsa sthana ; Dwivraneeyachikitsa : Chapter 1, Verse 40. Varanasi: Choukhambha Sanskrit Pratishthan, 2018; Pp 9. ******************************* How to cite this article: Jha Shailesh Arunkumar, Pallavi A. Hegde, M. M. Salimath. Lateral Fissure-In-Ano - A Case Study. J Ayurveda Integr Med Sci 2021;6:291-295. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2021 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

Other Health Sciences Concepts:

[back to top]

Discover the significance of concepts within the article: ‘Lateral Fissure-In-Ano - A Case Study’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:

Matra-basti, Shalyatantra, Parikartika, Pichu, Pittashamana, Burning sensation, Anal canal, Cutting pain, Vata and Pitta, Personal history, E-Mail, Treatment Protocol, Case report, Acharya Sushruta, Case study, Jatyadi taila, Local examination, Jaloukavacharana, Objective parameter, Patient complaints, Fissure-in-ano, Oral medication, Anal dilatation, Avagaha sweda, Hard stool, Ulcer size, Quick Response Code, Key-word, Tag Size.