Fissure-in-Ano (Ano-Rectal Disease): Treatment with Diet & Lifestyle Management 

Author:

Dr. Imlikumba  
B.A.M.S, M.D (Panchakarma), KRTC (Jamnagar)  
MO (Ayur) Bokajan PHC
Chief Consultant @Health Naturally Clinic  
Kevijau Colony Dimapur  
imlikumba@gmail.com  
Ph: 09483328411

This article was published in the leading newspaper of Nagaland, the Nagaland Post, on May 14, 2017.

"When the diet is wrong, medicine is of no use. When diet is correct, medicine is of no need."

Anal fissure or fissure-in-ano is a longitudinal cut (linear ulcer) at the outer anterior and posterior margins of the anal canal (skin-lined part), which forms when a person suffering from constipation passes a hard stool with strain. Occasionally, a fissure will heal without difficulty, but often a cycle of pain and muscular spasm of the anus develops. The combination of anal pain and spasm makes it difficult to open your bowels well, creating a vicious cycle of worsening constipation and harder stools leading to more pain and damage when you do open your bowels. This muscular spasm is also thought to reduce blood flow to the area, contributing to poor healing of the fissure. It is extremely painful. Ano-rectal conditions lead sufferers into stress and anxiety. The person is so distressed that he or she develops fear of passing stool. This tendency, however, adds to the problem as it further aggravates constipation. Anal fissures commonly occur at the midline posteriorly but are sometimes seen at the midline anteriorly and rarely seen anywhere else in the anal circumference. The ulcer of an anal fissure doesn’t heal easily because the anal canal is always full of microorganisms, i.e., it is always infected. The passage of hard stool during defecation prevents easy healing.

Typical symptoms of a fissure include stinging, tearing, or burning pain when passing a bowel motion (stool), often with a small amount of bright bleeding on the stool. The pain may be very severe and throbbing, preventing sleep. Constipation often precedes the development of a fissure, and the presence of pain with a fissure often compounds the problem of constipation. Anal tags may develop next to long-standing anal fissures, and these may predispose to moisture and irritation of the skin outside the anus. In the acute stage, the fissure is extremely painful and may bleed frequently, but if ignored for more than 7-8 months, it partially heals, and a skin growth known as a sentinel tag or sentinel pile surrounds it. This sentinel tag further hinders the complete healing of the underlying fissure or cut.

Clinical Appearance:  

Often, the anal region is too painful to allow the doctor to examine the area properly or conduct an internal examination. If an examination is possible, the split in the bowel lining at the anus may be visible by parting the buttocks, with the presence of a sentinel tag. Internal examination by sigmoidoscopy or colonoscopy (depending on your age and the external appearance of the anal area) is recommended to exclude other causes of pain and bleeding from the bowel, such as Crohn’s disease.

Causative Factors of Fissure-In-Ano: 

People who have a habit of eating junk and fast foods with less dietary fiber, people who drink less fluids and water, people who do not exercise or walk and have a sedentary lifestyle. Women during pregnancy generally develop constipation, and thus anal fissure is seen more in women than in men.

Prevention of Fissure-In-Ano: 

The primary cause of anal fissures is constipation. So, one has to develop habits by which constipation can be prevented. A few measures can be; Taking adequate dietary fibers. Eat more vegetables, fruits, and salad. Drink plenty of water and fluids but avoid excessive coffee and tea. Avoid straining during defecation. Avoid excessive chilies and spices in food items. Avoid excessive non-veg. food. Try to be vegetarian. The use of buttermilk with a pinch of cumin powder and black salt keeps digestion correct.

Treatment for Fissure-In-Ano:

In acute conditions, medicines to relieve constipation along with Ayurvedic healing oils for local application are prescribed. Dilation using anal dilators of appropriate diameters or using the index finger is done along with Ayurvedic healing oils. However, if the condition becomes chronic and a sentinel tag has formed, surgical intervention is necessary.

Kshar-Sutra Ligation:

In Ayurveda, the sentinel tag is cut using a specialized medicated alkaline thread ligation technique, known as Kshara-Sutra ligation, which offers a better way to treat chronic fissure-in-ano than conventional surgery. Kshara-Sutra method is the least invasive para-surgical procedure for cutting benign tissues like sentinel tag, Piles Masses, Warts, Condyloma, etc. In this technique, a highly specialized medicated thread is ligated tightly around the sentinel tag, which strangulates the tissue and causes necrosis; thus, the tag falls off in 3 to 5 days. The underlying fissure heals up in the next 5-15 days. Ayurvedic medicines for constipation and Ayurvedic healing promotion oils like Jatyadi Oil or Panchguna Oil, etc., along with Finger dilation of the anal canal (Ganesh Kriya), are used until the fissure gets healed completely.

Sitz Bath:  

In acute as well as chronic cases of Fissure-In-Ano, a sitz bath with lukewarm Triphala or Panchvalkal Kwath is quite helpful in relieving the pain. The patient should use a plastic tub of appropriate diameter and fill it with lukewarm Panchvalkal/Triphala Kwath or simply tap water with some antiseptic solution, and should sit in such a way that his anus and buttocks get submerged inside the warm medicated water. It greatly helps in relieving the pain in ano-rectal diseases and gives a soothing effect. Sitz bath is advised in all patients suffering from Fissure-In-Ano, Piles, or Fistula-In-Ano, and also it is an important part of post-operative treatment in Ano-Rectal cases.

Diet for Constipation, Piles/Hemorrhoids, Anal fissure, and Fistula in ano (ano-rectal) patients as per Ayurveda:  

The cause of Anorectal disorders (Gudroga) mainly originates from irregular bowel habits (constipation). Due to a busy life schedule, most people suffer from constipation because of changes in diet, lifestyle, and sleep patterns. Constipation is an awkward problem that many men and women suffer from daily. Processed foods, baked goods, red meat, caffeine, oily food, and dairy products, as well as changes in daily lifestyles, are the main causes of indigestion leading to constipation. In Anorectal disorders, mainly external and internal hemorrhoids, fissure in ano, partial mucosal prolapse, and sentinel tag develop primarily due to constipation. In these cases, if we avoid constipation by improving a healthy fibrous diet, changing lifestyle, and proper sleep, then almost all patients will improve, and it will also prevent recurrence.

Causes Of Constipation:  

Improper eating habits, which include eating a lot of food that is difficult to digest (such as meat) and not eating enough vegetables and salads, also leads to constipation. Irregular sleeping habits or emotional disturbances (stress, grief, fear, or worry) are other causes of constipation due to the accumulation of toxins in the colon or excessive stimulation of the nervous system. Smoking, consuming too much tea and coffee, or intake of prescribed illicit drugs can also cause constipation.

Diet-(Aahar) In Anorectal Disorders:

Our diet is an essential factor for the formation of our body. Charak Says that consuming an improper diet in an improper way is the main cause of disease. As per the Ancient Ayurvedic Proverb by Vishesayatana Lolimbaraja “When diet is wrong, medicine is of no use. When diet is correct, medicine is of no need."

Importance Of Timely Food Consumption:

A person should take a meal only when he feels hungry. Lunch should be taken early before 12 and 1 PM. Ayurveda recommends that lunch should be the largest meal of the day. Dinner should be less and lighter than lunch.

Quantity Of Food:

Generally, half of the capacity of the stomach should be filled with solids, ¼th with liquids, and the rest should be kept empty for the free movements of body humors. The capacity of the stomach can be analyzed by the ingestion capacity of a person.

Method of Consuming Food:

Food should be taken after the complete digestion of the previous one. Chew your food until it is an even consistency before swallowing. Hard items should be consumed in the beginning followed by soft and liquids. Heavy substances are contraindicated after meals and should be avoided. Do not drink cold drinks just prior to or while eating; also, don't drink large quantities of liquid during meals. This weakens digestion of food, which leads to weakness. Also avoid cold and dry food as it leads to delayed digestion.

General Instructions About Meal – What Not to Do:

Do not eat while being engaged in some activity like watching television, excessive conversation, or reading. Don't eat fruits immediately after meals; eating fruits after meals will cause the stomach to be bloated with air. Therefore, take fruit one to two hours after a meal or one hour before a meal. Avoid meals after exertion. Don't suppress the appetite as it leads to body pain, anorexia, lassitude, vertigo, and general debility. Don't suppress thirst as it leads to general debility, giddiness. Avoid spicy food, fast food, junk food, cold drinks, chocolates, etc., because these foods disturb the digestive system & lead to constipation. Fried foods, beans, gas-forming vegetables like cabbage, cauliflower, and broccoli, nuts, and dried fruits should be avoided. Do not mix too many kinds of foods in one meal.

What To Do?

The diet taken during constipation must be easily digestible, and food should be chewed thoroughly. Include plenty of fruits, vegetables, salads, freshly cooked food, including probiotic foods like curd in your daily diet. Eating fruits like apples, oranges, cucumber, plums, pears, berries, and dried fruits. Intake plenty of water, about 3-4 liters in cold weather & 5-6 liters in hot seasons. During eating, keep yourself in the present mind and pay full attention to food.

Life Style- (Vihar) In Anorectal Disorders:

Drink one liter of warm water and walk around for a few minutes. Wake up early in the morning. Start the day with light exercises or a jog. Use an Indian toilet or squat when you poop. Avoid straining during defecation. Go for toilets when you feel pressure. Avoid long sitting time on the toilet; without pressure, don’t take time on the toilet. Drink hot green tea or hot water every morning. Walk a while (100 steps) after a meal to help digestion within one hour after the meal. Regular physical exercise is also important for maintaining proper bowel movements. Drinking a glass of warm milk before going to bed helps in easy evacuation in the morning. In case of severe constipation, mix two teaspoons of castor oil in the milk. Sleeping hours should be regulated, and efforts should be made to have a sound sleep.

Conclusion:

Diet, lifestyle, and physical activity in the case of Anorectal disorders are also part of the treatment of these diseases. Without the use of a healthy fibrous diet & change in lifestyle, the treatment of these diseases is difficult. So, for the prevention of these diseases, a healthy diet & lifestyle is compulsory. In our busy schedule, we have to remember the important instructions for a healthy life.

NOTE: Ayurvedic medicines and treatments should be taken under a Qualified Ayurvedic Doctor/Physician. The drugs described in this article are for general information/educational purposes only. Anyone should not use these without consulting a qualified Ayurveda doctor/physician.