JALAASHA - Department Of Anorectal Disorders
"Healing Touch Of A Caring Heart"
Jalaasha deals with management of Anorectal diseases to avoid complications and recurrence . So in order to achieve complete cure one should consider Ayurvedic treatment along with operative methods describes by modern science in order to achieve holistic approach.
INTRODUCTION :
Anorectal diseases like Piles, fissure, fistula are common in human being due to his erect posture as well as habitat. So these are the conditions to be treated with much care in order to cure the patient. So there are various treatment modalities described by Ayurveda as well as modern science. But while treating various conditions in these diseases one should consider a particular modality in particular situation. Considering anorectal diseases mainly three-four conditions are elaborated in Samhitas like Arsha, Parikartika and Bhagandara. While in modern science also same pathologies are describe at anorectal region like - Piles - resembling Arsha, Fissure in Ano-resembling Parikartika and Fistula in Ano resembling Bhagandara. All these are different entities and require different modalities for treatment. But lack of this awareness misconcepts, patients go for wrong treatment and face many complications.
Ayurveda clearly indicates the most effective corrective techniques and medicines for these disorders with complete control and healthy life Without Surgery.
Ano-rectal disorders can affect people of all ages from young infants to seniors. Among all ano-rectal disorders, Piles, Fissure and Fistula are the most common. Piles is characterised by bleeding and prolapsing of the rectum during defecation. Fissures are tears in the anal tract caused due to passing hard stool. Fistula is a pus-filled cavity in the anal tract. In all ano-rectal disorders digestion is a major concern along with sluggish digestion. Other common causes include excessive indulgence in sexual activities, physical strain, consuming non-vegetarian and drinking alcohol.
SASH Provides Ayurveda treatment for ano-rectal disorder offers good results with personalized medicines, diet and lifestyle recommendations.Mainly the Ayurveda treatments are the recovery is faster, less painful and reoccurrence rate is very low. Ano-rectal complaints are usually benign in origin. Most of the patients suffering with these disorders do not seek medical advice at an early stage due to embarrassment. It results in advancement of the disease and significant disturbance in the quality of life. Among the available treatment modalities of ano-rectal disorders (ARDs), Ksharasutra (medicated thread) appears to be the best in terms of relief and nonrecurrence.
Main treatment line for fistula is ksharasutra a special medicated thread processed in different types of strong alkali and herbal powders and is having the power to pierce the skin and cut through the channels and heal the tract.The wonderful property of cutting and healing is the main advantage of this procedure. This will remove the unhealthy granulation while healing.
The treatment modalities includes panchakarma, kshara Sutra, kshara karma, and agni karma external therapies, internal medications, Activities, Advice of food and life style changes.
SASH Department Of Anorectal Disorder
1] Hemorrhoids [Arsas]
Hemorrhoids also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). Nearly three out of four adults will have hemorrhoids from time to time. Hemorrhoids have a number of causes, but often the cause is unknown.
External hemorrhoids
These are under the skin around your anus. Signs and symptoms might include:
- Itching or irritation in your anal region.
- Pain or discomfort.
- Swelling around your anus.
- Bleeding.
Internal hemorrhoids
Internal hemorrhoids lie inside the rectum. You usually can't see or feel them, and they rarely cause discomfort. But straining or irritation when passing stool can cause:
- Painless bleeding during bowel movements. You might notice small amounts of bright red blood on your toilet tissue or in the toilet.
- A hemorrhoid to push through the anal opening (prolapsed or protruding hemorrhoid), resulting in pain and irritation.
Fortunately, effective options are available to treat hemorrhoids. Many people get relief with home treatments and lifestyle changes.
TREATMENT
Arsha is a problem related to life style, age, occupation and dietary factors. Therapeutic treatment of hemorrhoids ranges from dietary and lifestyle modification to radical surgery, depending on degree and severity of symptoms.
Conservative Management
- Prevention of constipation- Laxatives like Triphala churna, Haritaki churna, Abhayaarista etc.
- Deepan pachana and Arshoghna medicines, Rakta stambhaka , Vrana ropak-[Jatyadi tail, Nirgundi tail], Vednahara-[Madhuyastyadi tail, Triphala guggulu] medicines can be given.
- Hot sitz bath
Procedures
- Kshara Sutra Ligation.
- Chedana Karma [Excision].
- After Chedana Karma, if needed, Agnikarma[cauterization] should be immediately applied in case of any remnant or to arrest the active bleeding or secondary oozing of the blood vessels.
- Ksharkarma Involves the applying of a sclerosing agent, such as Apamarg Kshar, Snuhi Kshar, into the hemorrhoid. This causes the vein walls to collapse and the hemorrhoids to shrivel up.
2 ] Fistula [Bhagandara]
Fistula in Ano is inflammatory track which has external opening (secondary) in the perennial skin and internal opening (primary) in the anal canal or rectum this track is lined by unhealthy tissue. Is an abnormal channel from the anus or rectum usually to the skin near the anus but occasionally to another organ such as Vagina. Fistulas are usually caused by injury or surgery, but they can also result from an infection or inflammation.
- Frequent anal abscesses.
- Pain and swelling around the anus.
- Bloody or foul-smelling drainage (pus) from an opening around the anus. The pain may decrease after the fistula drains.
- Irritation of the skin around the anus from drainage.
- Pain with bowel movements.
- Bleeding.
- Fever, chills and a general feeling of fatigue.
TREATMENT
- Virechana-preparation of bowel.
- Eshana- Probing.
- Chedana/Patana (Laying open of the track).
- Margavisodhana- Cleaning of track.
- Dahana- Cauterization.
- Vranachikitsa- Wound managememt (postoperative).
- Ksharsutra therapy -It is indicate specially for those who are unsuitable for surgical procedures.
Preventive
- Avoidance of causative factor.
- Diet-Guru, Madhya, Asatmya food [unwholesome food].
- Life style - Strenuous execise, excessive coitus, riding or driving, Vegavarodha [suppersion of natural urges], Atisahas aatapa.
3] FISSURE-IN-ANO [ Parikartika ]
An anal fissure (synonym: fissure-in-ano) is a longitudinal split in the anoderm of the distal anal canal which extends from the anal verge proximally towards, but not beyond, the dentate line.
The cause of an anal fissure, and particularly the reason why the posterior midline is so frequently affected, is not completely understood. Classically, acute anal fissures arise from the trauma caused by the strained evacuation of a hard stool or, less commonly, from the repeated passage of diarrhea. Anterior anal fissure is much more common in women and may arise following vaginal delivery.
- 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.
TREATMENT
Parikartika is very common among ano rectal diseases due to improper diet and regimens.
Conservative treatment is sufficient for the treatment of Parikartika According to doshic vitiation.
Diet:
- Langhana- Deepana and Ruksha - Ushna - Laghu diet.
- Madhura and Brimhaniya diet, advised in thin & lean patient.
- In severe Vata Prakopa Avastha, Ghrit with Daadimarasa should be given.
- Devdaaru and Tila Kalka with Ushnodaka.
- Ashvattha, Udumbaar, Plaksha and Kadamba Siddha milk.
Local Treatment : Different type of Basti Karmas are described for local management. Basti's prepared in Ghrita and milk with the help of various other drugs are used for this. Most of the drugs, which are used in basti karma are VataShamak, Vrana Ropak and Pitta Shamak.
4] Rectal Prolapse : [Gudabhramsa]
Rectal prolapse is when the rectal walls have prolapsed to a degree where they protrude out the anus and are visible outside the body. Rectal prolapse may occur without any symptoms, but depending upon the nature of the prolapse there may be
- Mucous discharge (mucus coming from the anus).
- Rectal bleeding.
- Degrees of fecal incontinence.
- Obstructed defecation symptom.
TREATMENT
Rectal prolapse is generally more common in elderly women, although it may occur at any age and in either sex. It is very rarely life-threatening, but the symptoms can be debilitating if left untreated.
- The prolapsed portion of rectum should be anointed, given fomentation and pushed in (slowly), then a gophana type of bandage with a hole in its centre for expulsion of vayu (flatus) should be tied, and fomentation given frequently.
- Musika taila used for drinking and anointing externally cures Gudabhramsa, though difficult.
- Medicated ghee.
- Oil - enema.
- Mamsarasa (meat soup) is indicated in the condition of aggravated Vata.
- Ayurvedic management aims to correct the physiological impairment rather than a structural repair. For a successful intervention to treat the rectal prolapse, regulation of bowel habit should be carefully maintained by changing the food habits. To improve the anal sphincter function, exercises of pelvic floor will be beneficial.
5] FECAL INCONTINENCE
Fecal incontinence or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas) it is referred to as anal incontinence.
- FI is a sign or a symptom, not a diagnosis. Incontinence can result from different causes and might occur with either constipation or diarrhea.
- FI affects virtually all aspects of peoples' lives, greatly diminishing physical and mental health, and affect personal, social and professional life.
- Emotional effects may include stress, fearfulness, anxiety, exhaustion, fear of public humiliation, feeling dirty, poor body-image, reduced desire for sex, anger, humiliation, depression, isolation, secrecy, frustration and embarrassment. Some people may need to be in control of life outside of FI as means of compensation.
- The physical symptoms such as skin soreness, pain and odor may also affect quality of life. Physical activity such as shopping or exercise is often affected.
- Travel may be affected, requiring careful planning. Working is also affected for most. Relationships, social activities and self-image likewise often suffer. Symptoms may worsen over time.
TREATMENT
- Internal medicines like Dasamoolarishtam , kutajarishtam , different Rasa preparation like shankhavati , Sutasekhara rasa etc., are good for improving the digestive system.
- Panchkarma like Virechanam , Basti-Anuvasana and Niruha [Enema].
- Diet and exercise.
Preventive measures
- Reduce constipation.
- Avoid straining during defecation.
6] Anal Itching/ Pruritus ani
Pruritus ani is the irritation of the skin at the exit of the rectum, known as the anus, causing the desire to scratch.
- The intensity of anal itching increases from moisture, pressure, and rubbing caused by clothing and sitting.
- At worst, anal itching causes intolerable discomfort that often is accompanied by burning and soreness.
- The itching and irritation may be temporary or more persistent, depending on the cause.
TREATMENT
- Sits' bath in warm decoction of Triphala or Aragwadha etc.
- External application of pippalyadi talam is found to be useful.
- Ayurveda recommends the use of certain Ayurvedic medicines to increase the digestive power.
- Relief from anal itching can be achieved in several ways, Practice good hygiene and keep the area clean. Exercise regularly. Walking is the one of the best things.
