Abstract / Summary
Fissure-in-ano is a common anorectal condition marked by pain, bleeding, and a longitudinal ulcer, affecting roughly 1.1 per 1000 people annually and present in about 18% of anorectal complaints. In Ayurveda, this condition is correlated with Parikartika, described as a complication of Virechana and Basti karma, and as a feature of several other conditions such as Vataja Atisaara and Sahaja Arsha. Conventional management includes conservative measures (laxatives, anesthetic ointments, anal dilators, local anesthetic injections) and surgical options (Lord's anal dilatation, lateral sphincterotomy, fissurectomy), though surgery carries risks like fecal incontinence and requires prolonged recovery. Jatyadi Taila Matrabasti has separately shown effectiveness in managing this condition across various Ayurvedic centers in India. This paper proposes combining graded anal dilatation using dilators of increasing diameter, 20mm and 23mm with Jatyadi Taila Matrabasti as an integrated approach to treating Parikartika/fissure-in-ano. The proposed protocol involves anal dilatation for ten minutes daily for 7 days (dilator size 20 for four days, then size 23 for three days) followed by administration of lukewarm Jatyadi Taila via catheter into the anal canal. The rationale is that dilatation reduces internal sphincter hypertonicity and improves local blood flow, while the medicated oil supports mucosal healing, together interrupting the pain–spasm–ischemia–constipation cycle that perpetuates the fissure.