A contemporary treatment approach for issure in ano: A case report of 38 year old patient

Anal Fissure is one of the major causes for pain at anal region. We are presenting case report of 38 year oldmale patient came to Shalyatantra OPDwith chief complains of pain during and after defecation, bleeding per rectum, itching since 30 days. Intervention-In this case report patient is treated by using chakramarda ghrita for the management of acute issure in ano chakramarda ghrita was used for local application along with sitz bath. The effectiveness of Charamarda was assessed by pain bleeding itching and healing. The patient has found effective relief from pain, bleeding, itching at perianal region using chakramarda ghrita which has anti-in lammatory activity, antibacterial, antifungal scavenging activity, antiulcer, anti-proliferative activity, antioxidant activity. The outcome of this management is that Chakramarda is effective in the management of Fissure in ano. Patients who take all follow-up after treatment will have less chance of symptom reoccurrence.


Fissure in ano, Chakramarda Ghrita, Ayurveda, Antifungal
A Anal Fissure is one of the major causes for pain at anal region. We are presenting case report of 38 year old male patient came to Shalyatantra OPD with chief complains of pain during and after defecation, bleeding per rectum, itching since 30 days. Intervention-In this case report patient is treated by using chakramarda ghrita for the management of acute issure in ano chakramarda ghrita was used for local application along with sitz bath. The effectiveness of Charamarda was assessed by pain bleeding itching and healing. The patient has found effective relief from pain, bleeding, itching at perianal region using chakramarda ghrita which has anti-in lammatory activity, antibacterial, antifungal scavenging activity, antiulcer, anti-proliferative activity, antioxidant activity. The outcome of this management is that Chakramarda is effective in the management of Fissure in ano. Patients who take all follow-up after treatment will have less chance of symptom reoccurrence.

INTRODUCTION
In the age of fast food, there is a shift in the habit of taking food and its timings as well as in the lifestyle that has become sedentary. Both of these causes produce disturbance in the digestive system that leads to many diseases including anorectal disorders such as piles, issure, istula, prolapsed etc.
Anal Fissure is one of the major causes for pain at anal region (Shashidharan and Beaty, 2016). The issure-in-ano is categorized into two types depending on the clinical symptoms & durations of the disease; viz. Acute and Chronic (Zaghiyan and Fleshner, 2011). The two primary signs of this disorder are, bleeding and pain; pain is often unbearable (Villalba, 2007). In long-standing instances, sentinel tag and haemorrhoids can be associated with this. Pruritus ani can be another symptom of this disorder (Siddiqi et al., 2008). In males anal issure typically occurs in the midline posterior-90 percent and 10 percent much less frequently. Subsequently, female issures on the anterior midline are somewhat more common than before (Jonas and Schole ield, 2001 Parikartika also has symptoms such as pain in the, penis, anus, neck of the urinary bladder and umbilical region with latus cessation . In Kashyap Samhita, in the chapter Garbhini Chikitsa, we receive doshik classi ication, aetiology, symptomatology and treatment of Parikartika . Acharya Charaka further mentioned issure in ano as a Vataj Atisara complication. In ayurveda chakramarda is used for the treatment of kandu, pamma, kusta, vrana.latin name of chakramarda is cassia tora

CASE REPORT
We are presenting case report of 38 year old male patient came to shalya tantra OPD with chief complains of pain during and after defecation, bleeding per rectum, itching since 30 days. The patient has previous history of hypertension for which he went to local practitioner and he was prescribed with Amlodipine 5 mg once a day till next consultation. Presently, the patient vitals were as follows pulse was 76/min, Blood pressure 130/70 mm hg, respiratory rate 18/min, temperature 96.5F. His cardiovascular examination and Respiratory examination was normal. On per rectum examination Fissure in ano was present at 6 and 12 o clocks, spasm Grade 1, with no active bleeding was present (Figure 1).
Intervention-In this case report patient is treated by using chakramarda ghrita for the management of acute issure in ano chakramarda ghrita was used for local application along with sitz bath. The effectiveness of Charamarda was assessed by pain bleeding itching and healing. Assessment was done on 1 st day ,7 th day.14 thday follow up was taken on 45 th day.

DISCUSSION
In Ayurveda Chakramarda is used for the treatment of Pama, Jwara, Kasa, Kandu, Dadru. Rasapanchak of Chakramarda is Rasa-Katu, Guna-Laghu, Ushna, Virya-Ushan, Vipaka-Katu, Karma -Vata-Kaphasamak. It is known for Vranaropak properties. Fissure in ano is longitudinal tear in the anoderm distal of anal canal. In contemporary sciences surgical treatment available for issure in ano are sphincterotomy, lord's dilatation, issurectomy, but these surgical procedure having adverse effects such as bleeding, infection, incontinence. (Gupta, 2004) The methanolic extract of cassia tora having antioxidant activaity. (Yen et al., 1998) Chakramarda is effective  (Rakinic, 2007) To sort out these problem we need treatment which is easily applicable and non surgical

CONCLUSIONS
The patient has found effective relief from pain, bleeding, itching at perianal region using chakramarda ghrita which has anti-in lammatory activity, antibacterial, antifungal scavenging activity, antiulcer, anti-proliferative activity, antioxidant activity. The outcome of this management is that Chakramarda is effective in the management of Fissure in ano. Patients who take all follow-up after treatment will have less chance of symptom reoccurrence.

Con lict of Interest
The authors declare that they have no con lict of interest for this study.