Fissure and Dosha: What's the connection?

Gastrointestinal disorders are increasingly common, but often remain underdiagnosed and poorly treated because of our squeamishness with the subject. No matter how uncomfortable it may be to talk about bowel movements and problems with passing stools, it’s important that you get help and address these problems swiftly. After all, there’s scarcely any discomfort worse than having to deal with anal fissures. Anal fissures can be incredibly painful, making regular passage of stools a nightmare. An anal fissure is basically a tear in the anus or to be more specific in the mucosa or soft tissue that lines the anal opening.  

The Ayurvedic Perspective of Anal Fissures

In Ayurvedic literature, anal fissures are not described as a separate or independent disease, but as a symptom or complication that develops as a result of certain procedures. As you will find out, this classification is completely justified, but we’ll get to that later. Referred to as parikartika by all acharyas, an anal fissure is described as a complication of virechana or purgation procedures by Charaka, while Sushruta also echoes this sentiment. In fact, this is a common observation from most classical sources, wherein the condition is associated with complications from therapeutic procedures like Bastivyapad or enema and surgical interventions. The term parikartika in fact derives from the words ‘pari’ referring to all around, and ‘kartanam’, which refers to the act of cutting. This also reflects symptoms recorded in classical texts of a cutting and tearing pain that may be localized or radiating from the anus. This sharp shooting pain also matches modern medical descriptions of anal fissures.

Anal fissure is rightfully classified as a symptom or complication, rather than an independent disease as its origins can be attributed to specific procedures as well as to other factors like severe and chronic constipation or diarrhea, pregnancy, and certain diseases. Anal fissures do not develop independently without some other underlying condition. In our modern times, the condition has become increasingly common not as a complication, but as a result of disorders and imbalances that arise from our faulty modern diets. This is why there have been attempts to classify anal fissures as a disease in itself. To effectively deal with the condition let’s take a closer look at the role of dosha imbalances and the main underlying causes of anal fissures.

Anal Fissure and Dosha Imbalances

Treatments are well described by sages like Sushruta, with great attention to the influence of the doshas. From these texts we know that both vata and pitta doshas can play a role, with vitiated vata being the primary contributing factor. The anal fissure symptom of sharp cutting pain is associated with vata, while the burning sensation and inflammation is linked to pitta. Parikartika or anal fissure is also described as a wound that forms because of trauma to the rectal passage or anus by hard stools. This type of trauma caused by hardened feces is now the most common cause of anal fissures because of our poor dietary and lifestyle choices.

Although largely regarded as a complication from therapeutic procedures, there are many sources that also point to the roe of diet in the development of anal fissures. According to Vagbhata and Kashyapa, a diet dominated by high or excessive intake of pulses like Chanaka (bengal gram), Adhaki (toor dal), and Mudga (green gram) could give rise to severe constipation because of their water absorbent nature. This could lead to the aggravation of apanavayu or vata in its own seat – Pakwashaya, which referred to part of the large intestine and rectal canal. This results in obstruction of the adhovaha srotas (channel for elimination of wastes), by depleting it of moisture and impeding the movement of feces. As vata in the form of apanavayu governs downward movements, including evacuation of the bowels, this ultimately results in hardening of stools and delayed evacuation. 

Any vata disturbance in the body can contribute to the problem as vata disturbances are associated with any kind of increase in dryness, including hardening of feces. However, vata disturbances can also cause vitiation of other doshas, causing them to exacerbate the problem. This is where pitta dosha comes into play. Blockage of the channels and buildup of hardened wastes can lead to aggravation of pitta, which may also be caused by other factors. What is important to note that this excess vata in combination with vitiated vata increases the drying out effect. In some situations, the aggravation and accumulation of kapha can also obstruct the downward flow of apanavayu, causing a buildup of ama and delayed bowel movements. However, kapha dosha associated constipation is generally not linked to anal fissures.

The use of Ayurved for fissure treatment derives from this fundamental understanding of the underlying causes of the condition. It therefore requires a combination of natural remedies and best ayurvedic medicine for piles and fissure to provide relief and promote healing, as well as diet therapy, lifestyle changes, and herbal medications to treat the underlying dosha imbalances. Accordingly, there are a few recommendations that you should keep in mind:

• Fomentation or sudation therapy with hot sitz baths, described as avagaha sweda is highly recommended as a natural anal fissure treatment to provide quick relief and promote healing. Similarly, colloidal oats baths can also help relieve anal fissures. These treatments are also backed by study findings.
• Triphala powder made into a paste can also be used as a topical application to reduce pain and promote healing. It has a cleaning and antiseptic effect, reducing any chances of infection of the anal fissure. Similarly healing oils like nirgundi and jatyadi are regarded as some of the best Ayurvedic medicines for piles and fissures because of proven anti-inflammatory and analgesic effects.
• When using herbs or Ayurvedic medicines for fissures and piles, look for ingredients like guggulu, sonamukhi, haritaki, and nagkesar. These herbs are known to exhibit analgesic, anti-inflammatory, and wound healing properties with sonamukhi specifically supporting peristaltic movement of the intestines.
• Dietary changes are vital to avoid vata aggravation. This includes not only cutting back on processed food intake, but also avoiding vata-aggravating choices like raw and cold foods, including raw salads, cold drinks, ice creams, and so on. The diet should also strengthen agni, with warm, light, and slightly oily foods. 

In addition to these recommendations, make sure to follow a disciplined routine with fixed meal and sleep timings. Similarly, follow regular bowel movements and never suppress the urge to pass stools. Excessive fasting and improper chewing of foods can also contribute to constipation and ultimately anal fissures and should be avoided. Try to take up a daily yoga routine as certain yoga asanas are known to promote digestion, reducing the risk of anal fissures. Moreover, physical activity can provide relief as chronic constipation and complications like fissures are more associated with a sedentary lifestyle.

References:

• Sarkar, Dr. Suman. “Critical Review of Parikartika as a Disease.” Journal of Ayurved and Integrated Medical Sciences (JAIMS), vol. 1, no. 2, 2016, pp. 154–157., doi:10.21760/jaims.v1i2.3671
• Hiremath, Geetanjali et al. “COMPREHENSIVE REVIEW ON PARIKARTIKA (FISSURE-IN-ANO).” International Journal of Ayurved and Pharma Research vol. 4,9 (2016): Retrieved from https://ijapr.in/index.php/ijapr/article/view/428
• Tripathi, Raakhi K et al. “Efficacy and safety of a polyherbal formulation in hemorrhoids.” Journal of Ayurved and integrative medicine vol. 6,4 (2015): 225-32. doi:10.4103/0975-9476.172382
• Jensen, S L. “Treatment of first episodes of acute anal fissure: prospective randomised study of lignocaine ointment versus hydrocortisone ointment or warm sitz baths plus bran.” British medical journal (Clinical research ed.) vol. 292,6529 (1986): 1167-9. doi:10.1136/bmj.292.6529.1167
• Bag, Anwesa et al. “The development of Terminalia chebula Retz. (Combretaceae) in clinical research.” Asian Pacific journal of tropical biomedicine vol. 3,3 (2013): 244-52. doi:10.1016/S2221-1691(13)60059-3

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