Fissure – in – Ano (Parikartika, Guda Vranam)

An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

Signs and Symptoms —

• Pain, sometimes severe, during bowel movements
• Pain after bowel movements that can last up to several hours
• Bright red blood on the stool or toilet paper after a bowel movement
• A visible crack in the skin around the anus
• A small lump or skin tag on the skin near the anal fissure

Causes —

Common causes of anal fissure include:

• Passing large or hard stools 
• Constipation and straining during bowel movements 
• Chronic diarrhea 
• Anal intercourse 
• Childbirth

Risk factors —

Factors that may increase your risk of developing an anal fissure include:

• Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing.
• Childbirth. Anal fissures are more common in women after they give birth.
• Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing.
• Anal intercourse.
• Age. Anal fissures can occur at any age, but are more common in infants and middle-aged adults.

Treatment Principle —

• Treated like Vrana
• Ice Pack can be kept.

External Administration —

• Shatadhouta Ghrita should be applied with an applicator before and after evacuation.
• Mahatiktaka Ghritam can be applied externally.
• Murivenna is kept in the refrigerator and cooled and administered 30ml for retention enema as a regular injection at bedtime.

Internal Administration —

Kashayam —

• Tiktakam Kashaya
• Maha Tiktakam Kashaya
• Drakshadi Kashayam
• Chandanadi Kashayam
• Mrdvikadi Kashayam
• Nyagrodhadi Kashayam
• Shinotamrta Kashayam

Churnam —

• Shaddharana Churna
• Triphala Churnam
• Guggulu Panchapala Churnam
• Yashti Triphala churna
• Haritaki Churnam

Gulika —

• Guggulu panchapala Tablet
• Triphala Guggulu
• Kaishora Guggulu

Lehyam —

• Kalyanaka Gudam
• Bahushala Gudam
• Dashamula Haritaki
• Trivrit lehyam
• Madhusnuhi Rasayanam
• Sukumara Lehyam

Treatment Modalities —

Avagaha Swedam —

• Nirgundi patra Kashayam or Luke warm water

Pichu —

• Murivenna
• Maha Tiktaka Ghrita
• Shatadhouta ghrita

Matra Vasti —

• Shatadhouta Ghrita
• Murivenna

Ksara Sutram —

• Sometimes surgery may be needed for unremitting chronic conditions.

Do’s —

• If the patient is a known DM, it has to be controlled.
• Suranam, onions and butter milk can be recommended as food supplements.
• Warm sitz bath 10 to 15 minutes after bowel movements.
• Less spicy and less oily food is very useful.

Reference —

• Anal Fissure
• Principles & practice of Ayurvedic Clinical Medicine by Dr L Mahadevan