Fistula-in-ano

Fistula-in-ano is an inflammatory track which has an internal opening in the anal canal or rectum, and an external opening in the perianal skin. It is more likely to occur in people with a history of anal abscess. Females are more commonly affected than males. Incidence rate is higher in the age group of 20-60.

Ayurvedic View

Due to the factors which cause aggravation of vata, pitta, kapha or all the three doshas or due to some external causes, there occurs a tear in the area of rectum or anal region. The disease is manifested as papules developing within a specific area around the anus, accompanied with pain and exudation. It commences with an eruption which later form channels. This channel opens up to the exterior. The disease is accompanied with severe pain and exudation.

Causes

  • History of perianal abscess
  • Crohn’s disease
  • Tuberculosis
  • Ulcerative colitis

Signs & Symptoms

  • Anal itching
  • Pain and tenderness
  • Swelling
  • Skin maceration
  • Serous fluid or/and pus discharge

Diagnosis

  • Rectal examination
    • Digital
    • Probing
  • Proctoscopy
  • Fistulogram

Hemorrhoids

Hemorrhoids are enlarged or dilated veins within the anal canal. It can manifest in two ways: - internal or external. The signs and symptoms depend on the type of hemorrhoid manifested. Internal hemorrhoids are usually painless and bleed on defecation. Whereas, in external hemorrhoids, there occurs pain and swelling in the anal region. A skin tag (sentinel pile mass) may persist after the healing of external hemorrhoids.

Both genders are equally affected. It is found more commonly among the age group of 40 to 60. The disease is very common, and it’s said that above half the population may have experienced hemorrhoids by the age of 45-50.

Ayurvedic View

The doshas vitiate the skin, muscles and fat, and produce the formation of sprouts of muscles of different shapes in the rectum and anal canal. This can be Shushka (dry and non-exudative) or Sraavi (exudative).

It will be rough and painful if Vata dosha is predominately vitiated; discolored and with an opening in case of Pitta dosha predominance; knotty and smooth if Kapha dosha is predominant.

Causes

The exact cause is unknown. The following causes may contribute to the disease formation :-

  • Irregular bowels (diarrrhoea or constipation)
  • Aging
  • Prolonged episodes of strained defecation
  • Low-fiber diet
  • Ascites
  • Genetic causes

Risk Factors

  • Prolonged sitting posture
  • Obesity
  • Chronic cough
  • Pregnancy (cause temporary hemorrhoids)

Signs & Symptoms

  • Pain during bowel movements
  • Rectal bleeding while defecating – painless, bright-red in colour. Its typically called as the “splash in the pan” bleeding
  • Rectal prolapse
  • Mucous discharge – due to prolonged hemorrhoids. This results in itching
  • Anal itching
  • Usually painless, unless associated with anal fissure

Diagnosis

  • External hemorrhoids
    • Visual examination
    • Digital examination
  • Internal hemorrhoids
    • Anoscopy
    • Proctoscopy