CONSERVATIVE MANAGEMENT OF FISSURE-IN-ANO VIA A COMBINED APPROACH OF ANAL DILATATION AND APPLICATION OF JATYADI TAIL: A CASE STUDY

Abstract

Fissure-in-ano is a painful longitudinal tear in the distal anoderm, frequently secondary to chronic constipation and subsequent internal anal sphincter hypertonicity. In Ayurveda, this condition is called as Parikartika, presenting as an acute, painful ulceration (Sadyo Vrana) driven primarily by Vata dushti. Modern standard protocols for chronic cases often involve surgical interventions like lateral internal sphincterotomy (LIS), which carry inherent risks of faecal or flatus incontinence. This case study evaluates a conservative, sphincter-preserving approach combining periodic anal dilatation (Sroto vivardhana karma1) and application of medicated oils through the ano-rectal route. Case Presentation - A 52-year-old female patient presented with a two-month history of severe pain and an intense burning sensation during and after defecation, secondary to chronic constipation. Local proctological examination revealed chronic anal fissures at both the anterior and posterior midlines, internal anal sphincter spasm, and secondary hypertrophied anal papillae at the 4, 7, and 8 o’clock positions. Management - The patient underwent a 7-day therapeutic protocol consisting of daily graduated periodic anal dilatation using clinical anal dilators, immediately followed by the administration of a 30 mL of Jatyadi taila. No oral laxatives or systemic analgesics were prescribed during the intervention. Results - A notable reduction in post-defecation pain and burning sensation was achieved by the 2nd day of treatment. By the 7th day, internal anal sphincter spasm was completely resolved, the fissure lines demonstrated advanced epithelialization, and bowel habits normalized with complete relief from constipation. Conclusion - The combination of Sroto vivardhana karma and application Jatyadi taila provides a safe, minimally invasive, and cost-effective conservative treatment for chronic fissure-in-ano. By addressing both the mechanical hypertonicity of the anal sphincter and the underlying Vata-induced constipation, this integrated regimen serves as a viable non-surgical alternative for managing Parikartika.