Piles, also known as 'haemorrhoids', are small, bluish swellings, comprising of enlarged blood vessels situated either just inside or just outside the anus commonly called internal piles and external piles. In case of bleeding, they are termed as bleeding piles.

What causes Piles:

There are several factors which increase your risk of developing piles. Some of the common factors that might lead to piles are:

• Genetic tendency (due to weak rectal veins, and walls).
• Poor tone of muscle in the rectal region.
• Constipation (hard stool).
• Obesity
• Inactive or sedentary lifestyle.
• Chronic or prolonged cough.
• Pregnancy
• Excessive use of laxatives or enemas.
• Habitual weight lifting.

Because of all these factors, straining is needed to pass the small hard stools, which causes congestion in the network of blood vessels located inside the anal cushions. Gradually, these vessels enlarge and form piles. If the constipation further continues, they become large enough to be called second or third degree piles.

Internal or First-degree Piles:

Many people have these without even being aware of them. These are located just inside the anus, ocassionally causing some discomfort when a motion is passed. Rarely, slight bleeding may also occur during evacuation.

Second-degree Piles:

They usually appear as peasized swellings outside the anus after a bowel motion has been passed. They are usually retained inside the anus and may bleed and cause discomfort during passing stool with some degree of itching.

Third-degree Piles:

The swollen blood vessels are so enlarged that they remain outside the anus permanently. These are known as external piles, and are more troublesome. Soreness and persistent irritation are the common features.

Physicians of Swasti Ayurveda Clinic have treated the patients by two following principals

• Reduce the constipation (the commonest predisposing factor for piles).
  
• Relieve pain associated with piles and reduce the piles.

Doctors are providing best herbs and medicines and different life style measures to reduce the constipations. Along with medicines doctors prescribing asafoetida, fennel and cumin. Ghee, buttermilk and green leafy vegetables in diet which also reduce constipation. 

Physicians are prescribing very good quality medicines to relive pain and for reducing piles along with following herbs to combat this diseases effectively.

• Carrot (Daucus carota): It is effective in reducing the bleeding from piles (can be taken raw or cooked).
• Garlic (Allium sativum): It is effective in reducing the bleeding from piles and is helpful to stop the growth of bleeding piles. Insert the garlic high up in the rectum so that it remains inside the rectum overnight.

Other herbs prescribed for treatment of piles are trikatu, cassia fistula, mimosa pudica, ailanthus excels, blumea balsamifera,and  semicarpus anacardium

What is Fistula?

A fistula is an abnormal connection that forms between two organs or vessels that are lined with epithelial cells. Fistulas are generally the result of a disease condition but artificial fistulas may also be surgically created for therapy.

Examples of naturally occurring fistulas are those that form between the anus and an opening in the skin (anal fistula) or between the intestine and the vagina (enterovaginal fistula). An artificial fistula may be created, for example, between an artery and vein (arteriovenous fistula) when a person needs renal dialysis.

• Anal Rectal abscess is a collection of pus in the area of the anus or/and rectum.
  
• Fistula in ano is a tunnel like pipe, an infected track, abnormal connection between two different points in intestines, often deep within the body, to the skins surface, i.e. between rectum internally and peri anal skin externally.
  
• Definitive KSHARA-SUTRA / VARTI THERAPY to eradicate the fistula is required at a later date for complete healing.

Anal fistula is an abnormal connection or a tunnel between the anus and the other organs like urethra.  Anal fistula originates from anal glands situated between two layers of anal sphincter and into the anal canal. These glands can get infected and form abscess. This may burst and form abnormal to exit pus known as fistula. Ayurveda has a better solution for anal fistula.

Causes :

1. Complication of medical conditions such as crohn ’ s disease, irritable bowel syndrome, ulcerative
2. Anal fissures, hemorrhoids (piles)  
3. Complication from surgery
4. Low immunity
5. Injury or trauma to anal canal

Signs and symptoms :

1. Purulent or bloody discharge
2. Pain at the anal region
3. Local swelling
4. Itching and irritation around anus
5. Fever
6. Generalized weakness
   

Ayurvedic classification and specific symptoms :

1. Vataj (shataponaka) -
   
   
   • Foam like discharge
     
   • With many openings
     
     
2. Pittaj (ushtragriva) -
   
   
   • Offensive and hot discharge
   • With long curved tract
     
     
3. Kaphaj (parisravi) -
   
   
   • Continuous dense whitish discharge
   • Mild pain
     
   • Itching
     
     
4. Sannipataj (shambukavarta)-
   
   
   • Multiple type of discharge
   • Various types of pain
     
   • Circular tract in horse shoe shaped fistula
     
     
5. Aagantuj (unmargi)-
   
   
   • Due to trauma or injury
   • If untreated then form multiple openings
     
     
6. Diagnosis -
   
   
   • Diagnosis of anal fistula can be confirmed by following procedures.
   • Physical examination
   • Digital rectal examination
   • Anal ultrasound
   • MRI scan
   • CT scan
     

Body has its own linings all over the internal as well as on external parts. This lining is skin, on the external level and on the internal level this is mucosal lining. Skin is harder and capable of handling the rashes and scars but not the mucosal lining of the body. Mucosal linings, which are exposed to the external environment, are two- mucosal lining in mouth and second one is in anus. These two causes problems with the body. Buccal cavity mucosal membrane might face the problems like ulcers and mucosal membrane in the colon and anal region can cause colitis and once these scars appear on anal ring this is known as Anal Fissure!

Fissure is a furrow or a cut and anal is for anal ring- so anal fissure is a cut like condition in the anal ring!

Anus is an important part as it controls the movements of the excreta from the body. Once the stool is excessively hard, this leaves a scar on the ring and it causes this painful condition of anal fissure. Anal fissure is confused with the piles for a laymen and the main difference in piles and anal fissure is- the pain initiates just after passing the stool and if the cut is fresh there you can see a lining of the blood on the stool.

According ayurveda ihis is a condition of Vata aggravation. Once Vata is aggravated, it brings dryness in the body and due to this dryness is increased in the body it dries up the stool. Once this stool is passed forcefully through the anus, this stool cuts the linings of the mucosal membrane on the anal ring. Passing the stool there will be immense irritation on the anal ring and this irritation can increase to sever pain too.

There is one other condition in which Anal fissure can occur in the body and this is the shrinkage of the anal ring. Once this ring is tight to pass the stool, body exerts the maximum pressure on the ring to pass the stool and in this process there will be damage to this ring.

In this second condition, if we check the Dosha, it will be Vata again because this is the Vata Dosha which causes and brings constriction in the muscles.

Anal fissures are cracks or tears in the anus and anal canal. They may be acute or chronic. Anal fissures are caused primarily by trauma, but several non-traumatic diseases are associated with anal fissures and should be suspected if fissures occur in unusual locations. The primary symptom of anal fissures is pain during and following bowel movements. Bleeding, itching, and a malodorous discharge also may occur. Anal fissures are diagnosed and evaluated by visual inspection of the anus and anal canal. Endoscopy and, less commonly, gastrointestinal x-rays may be necessary.They affect men and women equally and both the young and the old. Fissures usually cause pain during bowel movements that often is severe. Anal fissure is the most common cause of rectal bleeding in infancy.

Anal fissures occur in the specialized tissue that lines the anus and anal canal, called anoderm. At a line just inside the anus; the skin (dermis) of the inner buttocks changes to anoderm. Unlike skin, anoderm has no hairs, sweat glands, or sebaceous (oil) glands and contains a larger number of somatic sensory nerves that sense light touch and pain. (The abundance of nerves explains why anal fissures are so painful.)

Symptoms:

• Patients with anal fissures almost always experience anal pain that worsens with bowel movements.
  
• The pain following a bowel movement may be brief or long lasting; the pain usually subsides between bowel movements.
  
• The pain can be so severe that patients are unwilling to have a bowel movement, resulting in constipation and even fecal impaction. Constipation can result in the passage of a larger, harder stool that causes further trauma and makes the fissure worse.
  
• The pain can also affect urination by causing discomfort during urinating, frequent urination, or the inability to urinate.
  
• If acute they may cause severe periodic pain after defecation but with chronic fissures pain intensity is often less.
  
• Bleeding in small amounts, itching, and a malodorous discharge may occur due to the discharge of pus from the fissure. This blood is separate from the stool. Blood mixed with the stool indicates some other conditions (like colon cancer and inflammatory bowel disease).
  
• Anal fissures commonly bleed in infants.
  

In modern concept the physicians treated this disease through :

• Anesthetics / steroids
• Nitroglycerine
• Calcium channel blocker
• Surgical intervention

Where none of the above method of treatment neither address the root cause of the problem nor is completely safe. Ayurveda is more promising with the treatment of Anal Fissure and that too in a safe manner, without any side effect and along with this Ayurvedic Treatment for Anal Fissure is completely is a cure and there will be minimal chances of recurrences.

Physicians of Swasti Herbal Clinic apply the unique ness of ayurveda to the patients for permanent recovery from this problem in following manner :

1. Healing of the wound: Pain, itching and uneasiness in the anal region are the main manifestations of the Anal fissure and these create a lot of uneasiness to a patient, so the first step is to relive someone from all these symptoms of the Anal fissure so that a patient can manage his life properly. For this main important thing is to heal the wound- the fissure- which is moreover a cut in the skin of the anal ring. Quick healing of this wound is hard because during defecation (passing of stool) it is again injured and it causes a lot of problems with a patient. This is the reason Ayurveda recommends to heal it with the best antibiotic, which is friendly to your body and never leaves any side effect on the body.
   
   
2. Softening of the Stool : This is the second step, because improper bowel movements are the basic cause of the Anal Fissure. This might be frequent defecation or constipation, whenever there are problems with the digestive system, it causes a lot of problems with the anus and can cause anal fissure. In this the main part is the softening of the stool in this step, so that hard stool will stop hurting the anus skin and will not complicate the condition of the Anal Fissure.
   
   
3. Proper Bowel Movements: These are the toxins in the system, which cause a lot of problems with the digestive system and until unless these toxins stay in the body these will keep on creating problems with the body- either anal fissure or some other conditions.