Study of Cause and Position of Fissure in Ano in Post Partum Females

of in cross-sectional all-female patients more than 18 of with complaints of a (cid:976)is-sure in ano and associated were studied detail history taken in the form of the framed questioner. The diagnosis of enrolled patients was based on clinical (cid:976)indings of anorectal evaluation by digital rectal examination and proctoscopy. Overall, 50 patients were enrolled in the study. Mixed dietary habits and history of constipation were found to be associated with the prevalence of (cid:976)issure. Similarly, patients with no exercise or physical had more prevalence of (cid:976)issure than patients who regularly (19.87% 11.54%). The of and (n=326); out of these patients, an anal After an assessment of subjects, the chi-square is (p<0.05), of a in The study conducted to (cid:976)ind out the position and the cause of postpartum (cid:976)issure in married women. The result suggested that the incidence of postpartum (cid:976)issure in women is signi(cid:976)icant. The factors associated with this high incidence include the age, parity, sleeping and dietary habits.

Anorectal diseases, issure in ano, Questionnaires, postpartum issure A Lifestyle has a signi icant collision with anorectal diseases and poor dietary habits. Therefore to ind out any relation between pregnancy and issurein-ano, the present study was conducted. There is no literature available for the prevalence of issure in ano In terms of cause and position of the issure in postpartum females. This was a cross-sectional observational study conducted from January to December 2017, all-female patients visiting OPD were screened. Female patients more than 18 years of age with complaints of a issure in ano and associated complaints were studied detail history taken in the form of the framed questioner. The diagnosis of enrolled patients was based on clinical indings of anorectal evaluation by digital rectal examination and proctoscopy. Overall, 50 patients were enrolled in the study. Mixed dietary habits and history of constipation were found to be associated with the prevalence of issure. Similarly, patients with no exercise or physical activity had more prevalence of issure than patients who exercised regularly (19.87% versus 11.54%). The majority of patients had bleeding and pain (n=326); out of these patients, 89 (27.30%) had an anal issure. After an assessment of 50 subjects, the chi-square test value is 4.20 (p<0.05), which indicates that the incidence of a issure in ano among the postpartum women is signi icant. The observational study was conducted to ind out the position and the cause of postpartum issure in married women. The result suggested that the incidence of postpartum issure in women is signi icant. The factors associated with this high incidence include the age, parity, sleeping and dietary habits.

INTRODUCTION
An anal issure is a longitudinal split in the anoderm of the distal anal canal, which extends from the anal verge proximally towards, but not beyond, the dentate line (Williams et al., 2008). Spasm of the anal sphincter has been noted in association with anal issure. It causes severe pain and bleeding with bowel movements, and is associated with spasm of the internal anal sphincter, which may lead to a reduction of blood low and delayed healing. In modern science, issure-in-ano has been classiied into two groups viz. acute and chronic, most anal issure is minor and thought to heal spontaneously. However, those that are still symptomatic after 4 to 6 weeks are often referred to as chronic issure (Mapel et al., 2014).
Fissure-in-ano was irst recognised as a disease in 1934; it is a common condition affecting a sizeable majority of the population, including all age groups but is mainly seen in young and healthy adults (Sharma and Sharma, 2015). It is observed that anal issure is commonly seen in today's era. The incidence of the anal issure is 10% of total cases attending proctology clinics (Rehman et al., 2009). According to Ayurveda, it is termed as parikartika and caused by apathy improper diet and dilatory habits (Garde and Vagbhata, 2018). Lifestyle has an important impact on anorectal diseases, along with improper dietary habits. So, to see whether there is any relation between pregnancy and issure-in-ano or not, the present study has been taken.

Aim
"Study of cause and position of a issure in ano in Postpartum females." Objectives 1. To assess the different surgical and Nonsurgical problems in Pregnant Female.
2. To analyse the Cause of Fissure in ano in pregnant Female who doesn't having complaints before.
3. To study the ef icacy of daily regimens of Garbhini (pregnant Female) with ayurvedic medicines.

MATERIALS AND METHODS
The study was conducted at Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod (Hirapur) and Acharya Vinoba Bhave Rural Hospital and Research Centre, Sawangi (Meghe) under Datta Meghe Institute of Medical Sciences. One hundred subjects who were having issure in ano since minimal six months were approached.
A structured and validated questionnaire on the incidence of issure-in-ano among night duty workers was distributed and illed by the participants. Permission of the hospital's authorities in university was obtained from where the participants were recruited. Based on the questionnaire, clinical assessment and statistical analysis were done.

Inclusion criteria
Female patients with an age group of 18 to 50 years, having complaints of a issure in ano.

Exclusion criteria
Female patients presenting with features of other anorectal disorders are excluded.

RESULTS
Total 100 subjects where enrollred for the study,80 subjects are having issure in ano after delivery and 76 subjects having the issure in ano in position of 6 o' clock were diagnosed.
The majority of subjects were having the age of 41-50yrs in group A (58%)and group B(58%) are having issure in ano. The subjects were having the maximum no. of the para 3 having groupA(32%) and group B(32%). According the position of issure in ano at 6 o' clock are having The maximum no. of subjects in the group A (74%) and group B (78%).
According to occupation the maximum number of subjects are found to be housewife group A (56%) and group B (58%). The maximum number of subjects are having disturbed sleep group A (42%) and group B (70%).
The participants are showing the mixed diet as group A (46%) and group B (58%).The subjects were complaining about the issure in ano after the delivery which shows about group A (78%) and group B (82%).

DISCUSSION
In the present study, total hundred subjects having problems of a issure in ano for more than six months, irrespective of religion were approached. They were distributed with the questionnaire. 80 subjects were found to have some of the complaints listed in questionnaire among these 80 subjects are having issure in ano after delivery and 76 subjects having the issure in ano in position of 6 o' clock. were diagnosed.

Age
The subjects were having the age of 41-50yrs in group A (58%)and group B(58%) are having issure in ano

Pariety
The subjects were having the maximum no. of the para 3 having group A(32%) and group B(32%) having the maximum no. of pariety due to recurrent pressure on the posterior wall of the anus during the delivery causes issure in ano.

Position
The maximum no. of subjects are having the position of a issure in ano at six o'clock in the group A (74%), and group B (78%) during delivery the weight of the baby puts pressure on the posterior wall of the rectum which causes the longitudinal tear on the posterior wall results in the issure in ano.

Occupation
The maximum number of subjects are found to be housewife group A (56%) and group B (58%) the irregular dietary habits leads to the improper digestion which leads to constipation and causes issure in ano.

Sleep
The maximum number of subjects are having disturbed sleep group A (42%) and group B (70%) the irregular sleep or late night sleeping causes the disturbances in abdomen leads to the improper digestion which leads to constipation and causes issure in ano.

Diet
The participants are showing the mixed diet as group A (46%) and group B (58%) the intake the nonveg food which requires a lot of time for proper digestion and improper timing of the eating habits leads to constipation and hard stools leads to the issure in ano.

H/o of issure in ano
The subjects were complaining about the issure in ano after the delivery, which shows about group A (78%) and group B (82%).

Limitation
The author also acknowledges the following limitations of the study. This study was conducted at a single site, and the indings may not be generalised. This study aimed to study the prevalence of anal issure and did not collect information on other anorectal disorders.

CONCLUSIONS
The study reveals that the women had improper dietary habits during their anc period of 9 months irrespective of age, religion, is responsible for causing a issure in ano after delivery. During the duration of their antenatal care, the women should take care of their dietary habits and lifestyle, and improper dietary habits cause abdominal disturbances which lead to constipation. Sometimes due to heavyweight of the baby exerts pressure on the posterior wall of the anus that leads to the issure in ano in postpartum women, the maximum women experience vacuum delivery due to bigger head the pressure exerts on the posterior wall of the anus. Looking at the signi icant incidence revealed from this study, the issure, which is a cause in the postpartum period is called as postpartum issure, the most common position seen is at six o'clock. So the dietary habits of the women during the pregnancy should be maintained. If the Garbhini perikarya are followed as per Samhita, then postpartum issure can be prevented. Many pregnant women are worried about their symptoms like constipation which can be aggravated at any time. Abdominal pressure due to fetus cannot be minimised, but we can practice some small exercises lifestyle modi ications to avoid anorectal diseases. Bowel and diet habits play a crucial role in consideration of issure in ano. Precautions should be taken from the irst day of pregnancy; even a lady should start Ayurveda regimens from the day of conceiving. This small study has paved a big avenue in the postpartum issure in ano.