NAVIGATING PARIKARTIKA (ACUTE FISSURE-IN-ANO) IN AYURVEDIC PERSPECTIVES – A LITERATURE ANALYSIS
Abstract
Parikartika is a common painful condition among anorectal diseases that resembles a fissure in ano. In the present era, due to changing lifestyles such as sedentary work patterns, increased stress, and improper dietary and sleep habits, various lifestyle disorders are increasing continuously. An anal fissure or rectal fissure, commonly known as Parikartika in Ayurveda, is a split in the skin of the distal anal canal due to stretching of the anal mucosa beyond its capability. The acute fissure is a superficial splitting of the anoderm and may heal with conservative management. In adults, fissures may be caused by constipation, or by prolonged diarrhea. In older adults, it may be caused by decreased blood flow to the area. Fissures may also be caused by tuberculosis, occult abscesses, leukemic infiltrates, carcinoma, Acquired Immunodeficiency Syndrome (AIDS) or Inflammatory Bowel Disease, Sexually Transmitted Infections (Syphilis, Herpes, Chlamydia and Human Papilloma Virus). Other common causes of anal fissures include Childbirth trauma in women, Crohn's disease, Ulcerative colitis, and Poor toileting practices in young children. Practice parameters from the American College of Gastroenterology (2014) recommended that acute anal fissure should be treated conservatively initially. The first line of management to reduce anal trauma is conservative treatment modalities like a high-fibre diet, stool softeners, and oral and topical use of Ca channel blockers or nitrates. It is the need of the hour to opt for a conservative line of management to avoid unnecessary surgical burden and morbidity among patients suffering from an acute fissure in ano. Parikartika (acute fissure in ano) is being managed conservatively as a traumatic wound (agantuja vrana) only by giving Vata pitta hara Chikitsa and Avagahan (sitz bath). None of Samhitas described surgical management, so it indicates that conservative treatment is sufficient for the treatment of Parikartika.
