Anorectal Disorders Research Articles

Lower Gastrointestinal Bleeding

Of patients who present with major gastrointestinal (GI) bleeding, 20 to 30% will ultimately be diagnosed with bleeding originating from a lower GI source. Lower GI bleeding has traditionally been defined as bleeding originating from a source distal to the ligament of Treitz; however, with the advent of capsule endoscopy and deep enteroscopy allowing for visualization of the entire small bowel, the definition has been updated to GI bleeding originating from a source distal to the ileocecal valve. Lower GI bleeding can range from occult blood loss to massive bleeding with hemodynamic instability and predominantly affects older individuals, with a mean age at presentation of 63 to 77 years. Comorbid illness, which is a risk factor for mortality from GI bleeding, is also more common with increasing age. Most deaths related to GI bleeding are not due to uncontrolled hemorrhage but exacerbation of underlying comorbidities or nosocomial complications. This review covers the following areas: evaluation of lower GI bleeding (including physical examination and diagnostic tests), initial management, and differential diagnosis. Disorders addressed in the differential diagnosis include diverticulosis, arteriovenous malformations (AVMs), ischemic colitis, anorectal disorders, radiation proctitis, postpolypectomy bleeding, and colorectal neoplasms. Figures show an algorithm for management of patients with suspected lower GI bleeding, tagged red blood cell scans, diverticular bleeding, colonic AVM, ischemic colitis, bleeding hemorrhoid, chronic radiation proctitis, and ileocolonic valve polyp. Tables list descriptive terms for rectal bleeding and suggested location of bleeding, imaging modalities and differential diagnosis for lower GI bleeding, endoscopic techniques for hemostasis, and an internal hemorrhoids grading system. This review contains 8 highly rendered figures, 5 tables, and 100 references.

Comparison of Anorectal Function as Measured with High-Resolution and High-Definition Anorectal Manometry

Introduction: Anorectal manometry (ARM) provides comprehensive assessment of pressure activity in the rectum and anal canal. Absolute pressure values might depend on the catheter used. Objective: Our aim was to compare the results obtained by different anorectal catheters in children with functional anorectal disorders. Methods: Children diagnosed with functional defecation disorders based on the Rome IV criteria were prospectively enrolled. ARM was performed in the supine position successively using 2 different probes in each patient in random order. Resting, squeeze pressures, and bear-down maneuver variables obtained by high-resolution (2-dimensional [2D]) and high-definition (3-dimensional [3D]) catheters were compared. Results: We prospectively included 100 children {mean age 7.5 [standard deviation (SD) ± 4.3] years; 62 boys}. Mean resting pressures were significantly higher when measured with the 3D than with the 2D catheter (71 [SD ± 19.4] vs. 65 [SD ± 20.1] mm Hg, respectively; p = 0.000). Intrarectal pressure measured by 3D and 2D catheters was similar (35 vs. 39 mm Hg, respectively; p = 0.761), but the percent of anal relaxation appeared to be higher for the 3D than for the 2D probe (12 vs. 5%, respectively; p = 0.002). Dyssynergic defecation (DD) was diagnosed in 41/71 patients (57.7%) using the 3D probe and in 51/71 children (71.8%) using the 2D probe (p = 0.044). Cohen’s kappa showed only fair agreement between the catheters (κ = 0.40) in diagnosis of DD. Conclusions: Our study demonstrated significantly different values of pressures obtained with different types of catheters. Normal ranges for conventional manometry cannot be applied to high-resolution systems, and results obtained by different types of manometry cannot be compared without adjustments (NCT02812823).

Functional Gastrointestinal Disorders and Associated Health Impairment in Individuals with Celiac Disease

Individuals with celiac disease (CD) can experience persisting gastrointestinal symptoms despite adhering to a gluten-free diet (GFD). This may be due to functional gastrointestinal disorders (FGIDs), although there is little data on its prevalence and associated factors. An online health questionnaire was completed by adult members of Celiac UK in October 2018. The survey included validated questions on Rome IV FGIDs, nongastrointestinal somatic symptoms, anxiety, depression, quality of life, health care use, GFD duration, and its adherence using the celiac dietary adherence test score (with a value ≤ 13 indicating optimal adherence). The prevalence of FGIDs and associated health impairment in the celiac cohort was compared against an age- and sex-matched population-based control group. Of the 863 individuals with CD (73% female; mean age, 61 years), all were taking a GFD for at least 1 year, with 96% declaring that they have been on the diet for 2 or more years (2-4 years, 20%; ≥5 years, 76%). The adherence to a GFD was deemed optimal in 61% (n= 523), with the remaining 39% (n= 340) nonadherent. Those adhering to a GFD fulfilled criteria for a FGID in approximately one-half of cases, although this was significantly lower than nonadherent subjects (51% vs 75%; odds ratio [OR], 2.0; P < .001). However, the prevalence of FGIDs in GFD-adherent subjects was significantly higher than in matched population-based controls (35%; OR, 2.0; P < .001). This was accounted for by functional bowel (46% vs 31%; OR, 1.9; P < .0001) and anorectal disorders (14.5% vs 9.3%; OR, 1.7; P= .02) but not functional esophageal (7.6% vs 6.1%; P= .36) or gastroduodenal disorders (8.7% vs 7.4%; P= .47). Finally, GFD-adherent subjects with FGIDs were significantly more likely than their counterparts without FGIDs to have abnormal levels of anxiety (5% vs 2%; OR, 2.8; P= .04), depression (7% vs 2%; OR, 3.6; P= .01), somatization (31% vs 8%; OR, 5.1; P < .0001), and reduced quality of life (P < .0001). One in 2 people with CD, despite having been on a GFD for a number of years and demonstrating optimal adherence, have ongoing symptoms compatible with a Rome IV FGID. This is 2-fold the odds of FGIDs seen in age- and sex-matched controls. The presence of FGIDs is associated with significant health impairment, including psychological comorbidity. Addressing disorders of gut-brain interaction might improve outcomes in this specific group of patients.

Better quality of life and reduced fecal incontinence in rectal cancer patients with the watch-and-wait follow-up strategy

IntroductionThe watch-and-wait (WW) strategy is an alternative to anterior resection in patients with rectal cancer (RC) that have had a complete clinical response to neoadjuvant treatment. Few reports describe the quality of life and functional anorectal disorders (FADs) in that population. AimTo analyze and compare the FADs and quality of life in patients with locally advanced adenocarcinoma of the rectum treated with neoadjuvant therapy, divided into two different strategy groups: group 1 (G1), WW; and group 2 (G2), anterior resection. Materials and methodsThirty patients (G1: n = 20 and G2: n = 10) that had finished neoadjuvant therapy at least 12 months prior were included. Mean patient age was 59.5 years (range: 41-79) and 15 of the patients were men. The FADs were evaluated through: a) clinical history, b) 21-day bowel diary, c) Jorge and Wexner fecal incontinence scale, d) anorectal manometry (ARM), and fecal incontinence quality of life scale (FIQL). ResultsBowel diary: fecal incontinence (40%) and urge to defecate (45%) in G1 vs. fecal incontinence (60%) and urge to defecate (30%) in G2, with no significant differences (p = NS). Fecal incontinence scale: fecal incontinence in G1 was significantly less severe than that in G2 (median 6.5 points vs. 13 points [p = 0.0142]). ARM: no differences between the two groups. Quality of life: significantly different between the two groups (FIQL/G1: 3.7 vs. FIQL/G2: 2.8; p < 0.03). ConclusionsThe WW follow-up strategy in patients with locally advanced rectal cancer was associated with better quality of life and reduced fecal incontinence.

Functional gastrointestinal disorders as predictors of suicidal ideation. An observational study.

Suicidal ideation (SI), a symptom of depression, is known to be associated with irritable bowel syndrome (IBS) but is not known to be associated with other functional gastrointestinal disorders (FGIDs). However, the source of this association is discussed. It could be related to a possible abnormal biochemical pathway implicating neurotransmitters common to both disorders like serotonin or pain and an ill-being associated with a chronic disorder of unknown etiology. The present study aims to search for the FGIDs associated with suicidal ideation. Observational study. A total of 1469 patients with FGIDs (71% of women) were included in the present study. They filled the Rome III questionnaire, Beck depression inventory, and state and trait anxiety questionnaires. Data were analyzed using analysis of variance with Bonferroni correction and logistic regression analysis. Suicidal ideation was reported by 15% of patients, associated with increased scales of depression (P < 0.001), state (P = 0.006), and trait anxiety (P = 0.021). Clinically, these patients reported a higher prevalence of IBS-diarrhea subtype (P = 0.045), fecal incontinence (P = 0.020), soiling (P = 0.016), and difficult defecation (P = 0.005), and higher perceived severity for constipation, diarrhea, bloating, and abdominal pain (P < 0.001 for all scales). This study shows that only functional bowel and functional anorectal disorders are associated with suicidal ideation. This result must be taken into account in the management of these patients.

Therapeutics Aspects of Apamarga Kshara (Herbomineral Formulation) in Ayurveda - A Review

Kshara is one of the dosage forms utilizes in Ayurveda. Apamarga Kshara is prepared from alkaline ash of herbs used in Ayurveda as local and internal therapeutics. In local therapeutics, it is used in the form of Ksharasutra and as Pratisrniya Kashara. It can be also administered for internal use termed as Paniya Khara. Apamarga Kshara is a herbomineral formulation commonly used in anorectal disorders. It is used in various ailments such as warts, polyp, renal disorders calculus, nasal diseases, ear diseases, and leukoderma. The Apamarga Kshara having properties of Ksharana (debridation), Bhedana (incision), Chhedana (excision), Shodhana (purification), Stambhana (haemostatic), and Ropana (healing). Apamarga Ksharodaka is an aqueous solution of Apamarga Kshara useful in the management of warts. Apamargakshara Taila is medicated oil prepared from Acyranthes aspera and sesame oil is indicated in-ear disorder. Hence, a review of the therapeutics aspects of Apamarga Kshara is selected for the study. The present review study aimed to analyze available information from the different databases and published literature to provide information about clinical studies and case reports of Apamarga Kshara. The published clinical data suggest the safety and efficacy of Apamarga Kshara.

Observational study of the Mamsavaha Strotas Dushti according to Rachana Sharir w. s. r. to Bahya Arsha

Arsha is a gift of modern diets and busy lifestyles &amp; many people are suffering from some sort of Anorectal disorder. It may be simple constipation to complex carcinoma, in which prominent disorder is Arsha. Derangement of Jatharagni leading to vitiation of Tridosha, mainly vata dosha these vitiated Doshas get localized in Gudavali and Pradhana dhamani which further vitiates Twak, Mamsa, and Meda Dhatus leads to development of Arsha. The perianal skin is most pain sensitive, due to rich nerve endings. Hence even a mild form of disorder can produce great discomfort to the patient. On the basis of observation and statistics we got positive response for this parameters Malabaddhata 23 (71.88%), Abhishyandiahar 23 (71.88%), Guruahar 27 (84.38%), Diwaswap 18 (56.25%), Adhyashana 27 (84.38%), Prushtayana 29 (90.63%), Vegavidharana 32 (100%), Shavathu 24 (75%), Mamsashotha 19 (59.38%), Siragranthi 26 (81.25%), Amlika 21 (65.62%), Paridaha 18 (56.25%), Atop 28 (81.25%), Antrakujan 22 (68.76%), Gudaparikartan 32 (100%). In histopathology report we found fibromuscular tissue, stratified squamous epithelium, dilated and congested blood vessels which is the moolsthana of mamsavaha strotas. That means mamsavaha strotas dusti is co related with bahya arsha. This shows that there is significant correlation of origin of Bahya Arsha from Mamsavaha strotas dushti.&#x0D; Keywords- Arsha, mamsavaha srotas, dushti, malabaddhata, guda, histopathology

Nagasutra an effective and advance alternate of Ksharasutra for the treatment of Anorectal disorders: A hypothetical explication based on ancient ayurvedic treatise

Hypothesis and critical review are most essential part for any research work. It helps to know the subject in detail. In order to get the in depth knowledge of the subject, it is necessary to go through its ancient background. Ksharasutra is one of the unique preparation therapeutically used in Ayurveda and have been used as effective treatment method for decades without any observable side effects. Despite Kshatrasutra being very effective, Nagasutra can be used as an alternative. It can be an advance ayurvedic parasurgical treatment used to manage various anorectal disorders. Nagasutra is derived from two words, Nag (Lead) and Sutra (Thread). Nagasutra is a medicated thread, which is impregnated with latex of Snuhi Kshira, Arka Kshira, Naga bhasma and Haridra powder. This prepared sutra is known as Nagasutra which can prove to be effective and useful in the treatment of various anorectal disorders. Objective: The objective is to study and analyze the importance and utility of Nagasutra, in the treatment of anorectal disorders. Data Source: Nagsutra, Nag (Lead) and Sutra (Thread) related literature from various journals, articles and previous research papers related to this subject. Review Methods: All the published and unpublished literature related to Nagasutra, Nag (Lead) and Sutra are reviewed by comparing and analyzing the different meanings and thoughts of classical as well as contemporary authors. Result and Conclusion: This article highlights the utility and importance of Nagasutra in place of Ksharasutra for the treatment of various anorectal disorders.

Harmonic Scalpel Hemorrhoidectomy Versus Bipolar Diathermy Hemorrhoidectomy – A Prospective Evaluation

Background Hemorrhoidal disease is a very common anorectal disorder occurring more frequently in individuals who are older than 40 years. Although early-stage diseases can be managed conservatively, late-stage diseases usually need surgical treatment. Aims and Objectives The aim of the study was to compare harmonic scalpel hemorrhoidectomy with bipolar diathermy hemorrhoidectomy in terms of operative time, intraoperative bleeding, hospital stay, pain expectation score, time to start normal activity, and complications if any. Materials and Methods The study entitled, "Harmonic scalpel hemorrhoidectomy versus bipolar diathermy hemorrhoidectomy-A prospective evaluation" was conducted in the Department of General and Minimal invasive Surgery SKIMS and SKIMS Medical College Srinagar from July 2017 to June 2019. The study was performed on all patients with Grade 3 and Grade 4 hemorrhoids. The total number of patients studied was 64, who were randomly subjected either to the harmonic scalpel hemorrhoidectomy or to bipolar diathermy hemorrhoidectomy. Results Thirty-one patients were subjected to harmonic scalpel hemorrhoidectomy and 33 patients were subjected to bipolar diathermy hemorrhoidectomy. Mean operative time and intraoperative bleeding were significantly less in harmonic scalpel hemorrhoidectomy as compared to that of bipolar hemorrhoidectomy. The patients who underwent harmonic scalpel hemorrhoidectomy experienced significantly less pain and had significantly shorter hospital stay and early return to routine work in contrast to bipolar diathermy hemorrhoidectomy. Conclusion Harmonic scalpel hemorrhoidectomy is recommended in patients with symptomatic Grade 3 internal hemorrhoids in association with large external components and those with Grade 4 hemorrhoids.

Randomized controlled clinical trial to study the efficacy of Priyangvaadi Gana Siddha tail in the management of Parikartika w.s.r. to fissure-in-ano-An Ayurvedic management protocol

Sushruta explained about Guda-Roga, i.e. Ano Rectal Disease in Shalya Tantra. It includes no. of disease out of them one is Parikartika," i.e. Fissure – in – Ano. Lifestyle diseases are mainly caused by improper work pattern, stressful life, improper diet intake and improper sleep habits. These causative factors produce indigestion which leads to various lifestyle disorders, specially anorectal disorders like piles, fissure in ano, fistula in ano etc., constitute a significant group. Priyangvaadi Gana siddha tail in the management of Parikartika. The present study is designed as a Randomized, single-blind parallel in which 60 patients will be enrolled. Priyangvaadi Gana Siddha Taila Pichu and Yastimadhu tail Pichu will be given for basti twice a day. Assessment will be done 0th, 7th day, 14thday, and 28th day. The changes are expected to be observed in subjective parameters such as pain bleeding per rectum with itching as well as with objective parameters such as Parikartika Healing. The study is expecting the nonsurgical management of fissure in ano with respect to the impact of Priyangvaadi Gana Siddha tail pichu and Yastimadhu tail Pichu. The research is expecting to be a baseline and benchmark of the prospective studies in Acute Fissure in ano (Parikartika).

Translating Fecobionics Into a Technique That Addresses Clinical Needs for Objective Perineal Descent Measurements.

INTRODUCTION:Perineal descent is a phenomenon associated with anorectal dysfunction. It is diagnosed by defecography but subjected to manual measurements on the images/videos and interobserver bias. Fecobionics is a simulated feces for assessing important physiological parameters during defecation. Here, we translate Fecobionics into a new method for estimation of perineal descent based on electronic signals from the embedded inertial measurement units (IMUs).METHODS:A displacement measurement method by a combined zero-velocity update and gravity compensation algorithm from IMUs was developed. The method was verified in a robot model, which mimicked perineal descent motion.RESULTS:The method correlated well with the reference (R2 = 0.9789) and had a deviation from the peak displacement (range 0.25–2.5 cm) of −0.04 ± 0.498 cm. The method was further validated in 5 human experiments with comparison to the benchmark defecography technology (R2 = 0.79).DISCUSSION:The proposed technology is objective, i.e., electronic measurements rather than by fluoroscopy or MRI. The development may impact clinical practice by providing a resource-saving and objective technology for diagnosing perineal descent in the many patients suffering from anorectal disorders. The technology may also be used in colon experiments with Fecobionics and for other gastrointestinal devices containing IMUs such as ingestible capsules like the Smartpill.

Three-dimensional high-resolution anorectal manometry in children after surgery for anorectal disorders.

Three-dimensional high-resolution anorectal manometry (3DHRAM) is the most precise tool for assessing the function of the anal canal. Our aim was to evaluate children after surgery for anorectal disorders using 3DHRAM. We prospectively enrolled 43 children (30 males; mean age: 7 years) after surgery for Hirschsprung's disease, anal atresia, or after proctocolectomy. Manometric data were compared to raw data obtained from previously studied children without symptoms arising from the lower gastrointestinal tract. Correlations between manometry and symptoms were evaluated. The lowest values of the resting pressure, squeeze pressure, and pressure of the puborectalis muscle were observed in the anal atresia group (55.6 mmHg, 121.7 mmHg, and 44.17 mmHg, respectively). Compared to asymptomatic children, the lowest mean resting pressures were observed in those with non-retentive fecal incontinence (61.3 mmHg, p<0.000). The receiver operating curve cut-off value for the mean resting pressure between asymptomatic children and incontinent patients was 68.5 mmHg. The thresholds of urge were significantly higher in constipated patients compared to asymptomatic patients (87.5 cm³ and 30 cm³, respectively; p=0.003). 3DHRAM may be a useful tool for assessing the function of the anorectum of children after surgery (NCT02296008).

Ayurvedic Protocol on Effectiveness of Pippalyadi and Suranadi Ointment in Management of Arsha (Haemorrhoids)

Background- Ano-rectal disorders are progressively increasing in the society. Out of many of the causes, someimportant are sedentary lifestyle, irregular and inappropriate diet, prolonged sitting or standing and certainpsychological disturbances too. Arsha is one among the ano rectal diseases which occurs in Gudapradesha,which is a sadhyopranaharaMarma[1]. In Arsha bleeding per anum is the principal symptoms .Arsha is agift of modern diets and busy lifestyles and many people are suffering from some sort of Anorectal disorder,it may be simple constipation to complex carcinoma, in which prominent disorder is Arsha. It is manifesteddue to multifold factors viz. disturbed lifestyle or daily routines, improper or irregular diet intake, prolongedstanding or sitting, faulty habits of defecation etc. which results in derangement of Jatharagni leading tovitiation of Tridosha, mainly VataDosha.

The effect of biofeedback interventions on pain, overall symptoms, quality of life and physiological parameters in patients with pelvic pain : Asystematic review.

BackgroundBiofeedback is recognized as an effective additive method for treating certain phenotypes of chronic pelvic pain syndrome and is a therapeutic option in other pelvic pain conditions. This review aims to evaluate evidence from the literature with a focus on the effect of biofeedback on pain reduction, overall symptom relief, physiological parameters and quality of life.MethodsA systematic literature search was conducted using the databases PubMed, MEDLINE, Embase, Cochrane Library and PEDro from inception to July 2020. Data were tabulated and a narrative synthesis was carried out, since data heterogeneity did not allow a meta-analysis. The PEDro scale and the McMaster Critical Review Form—Quantitative Studies were applied to assess risk of bias.ResultsOut of 651 studies, 37 quantitative studies of primary research evaluating pelvic pain conditions in male and female adults and children were included. They covered biofeedback interventions on anorectal disorders, chronic prostatitis, female chronic pelvic pain conditions, urologic phenotypes in children and adults and a single study on low back pain. For anorectal disorders, several landmark studies demonstrate the efficacy of biofeedback. For other subtypes of chronic pelvic pain conditions there is tentative evidence that biofeedback-assisted training has a positive effect on pain reduction, overall symptoms relief and quality of life. Certain factors have been identified that might be relevant in improving treatment success.ConclusionsFor certain indications, biofeedback has been confirmed to be an effective treatment. For other phenotypes, promising findings should be further investigated in robust and well-designed randomized controlled trials.

Current concepts in the pathogenesis of cryptoglandular perianal fistula.

Cryptoglandular perianal fistula is a common benign anorectal disorder that is managed mainly with surgery. A fistula is typically defined as a pathological communication between two epithelialized surfaces. More specifically, perianal fistula manifests as an abnormal tract between the anorectal canal and the perianal skin. Perianal fistulas are often characterized by significantly decreased patient quality of life. The cryptoglandular theory of perianal fistulas suggests their development from the proctodeal glands, which originate from the intersphincteric plane and perforate the internal sphincter with their ducts. Involvement of proctodeal glands in the inflammatory process could play a primary role in the formation of cryptoglandular perianal fistula. The objective of this narrative review was to investigate the current knowledge of the pathogenesis of cryptoglandular perianal fistula with the specific aims of characterizing the potential role of proinflammatory factors responsible for the development of chronic inflammation. Further studies are crucial to improve the therapeutic management of cryptoglandular perianal fistulas.

External Anal Sphincter Fatigability: An Electromyographic and Manometric Study in Patients With Anorectal Disorders.

Background/AimsExternal anal sphincter (EAS) plays an important role in fecal and gas voluntary continence. Like every muscle, it can be affected by repeated efforts due to fatigability (physiological response) and/or fatigue (pathological response). No standardized fatiguing protocol and measure method to assess EAS fatigability has existed. The aim is to test a simple, standardized protocol for fatiguing and measuring EAS fatigability and fatigue to understand better the part of EAS fatigability in the pathophysiology of fecal incontinence.MethodsPatients with anorectal disorders evaluated with anorectal manometry were included. They had to perform 10 repetitions of maximum voluntary contraction (MVC) of 20 seconds. Measurement was made with an anorectal manometry catheter and a surface recording electromyography (EMG). The primary outcome was the difference in EMG root mean square between the first and the last MVC. Secondary outcomes were differences in other EMG and manometry parameters between the first and the last MVC. Difficulties and adverse effects were recorded.ResultsNineteen patients underwent the fatiguing protocol. All patients completed the entire protocol and no complications were found. No difficulty was declared by the examiner. A significant decrease in root mean square was found between the first and last MVC (0.01020 ± 0.00834 mV vs 0.00661 ± 0.00587 mV; P = 0.002), in maximum anal pressure area under the curve of continuous recordings of anal pressure and mean and total EMG power (P < 0.05).ConclusionsThis protocol is simple and minimally invasive to measure EAS fatigue and fatigability. We highlighted a fatigue of EAS in many patients with anorectal disorders.

Hemorrhoids: Incidence &amp; Risk Factors in a Corporate Hospital of Eastern India

Background: Hemorrhoids are the most common benign anorectal disorder diagnosed in surgical practice. Commonly associated risk factors of this condition are low fiber diet, chronic irregular boel habit, straining during defecation, pregnancy, sedentary lifestyle, obesity etc. Treatment options for symptomatic first-degree, second degree and early third-degree hemorrhoids are banding and sclerotherapy. Patients with fourth-degree or abnormally large thirddegree hemorrhoids is usually surgery. Methods: This prospective study was conducted in the department of surgery at The Peerless Hospital &amp; B.K.ROY Research Center, Kolkata INDIA on cases of Haemorrhoids over two year’s period from January 2018 to December 2019. 540 adult patients with diagnosis of hemorrhoids, admitted in surgery department were included in this study. All the demographic data and relevant details were obtained. Results: Most of the patients (48.1%) belongs to the younger age (15-30 years). 63.8% were male patients and 36.2% were female patients. Patients with lower socioeconomic status were the most common sufferers (37.2%) of hemorrhoids. Commonest symptom was rectal bleeding. Present study found risk factors for hemorrhoids were low fiber diet, mixed diet, poor hydration, and chronic irregular bowel habit like constipation or diarrhea, straining during the defecation, low physical activity and obesity. Sclerotherapy (17.8%) and rubber band ligation (4.1%) were non operative treatment of choice. Open hemorrhoidectomy were performed in 73.1 % and stapled hemorrhoidopexy in 5 %. Conclusion: This clinical study of hemorrhoidal disease in this region may help to better understand the trends of this commonly occurring disease in our society. Proprer patient education to minimise the risk factor will lead to lowerin the incidence of this common disease and avoidassociated morbidity.

Effect of bowel and bladder habits in anorectal disorders (piles, fistula, and fissure): A case–control survey study

Introduction: As per Ayurveda, suppression or forceful creation of natural urges always results in diseases, including anorectal disorders such as piles, fistula, fissure, and other diseases. Bowel and bladder habits come under the umbrella of “Vegadharana,” i.e., suppression of natural urges. In the present scenario, maximum people suppress natural urges and indulge in erroneous lifestyle and suffer from a variety of disorders. Hence, a case–control survey study was conducted in healthy and patients suffering from anorectal disorders. Aim: The aim is to study the effect of bowel and bladder habits in anorectal disorders. Methodology: The study comprised 110 subjects suffering from anorectal disorders (study group) and 110 healthy subjects (control group). Detailed history was obtained using a specially designed questionnaire. The data collected was computed in MicroSoft Excel Sheet and analyzed using Chi-square test and interpreted accordingly with the help of the percentage. Results: Subjects in the study group suppressed defecation urge (Purisha Vegadharana) comparatively more (P < 0.0001). Maximum subjects in both groups (98.1% and 99.1%, respectively) had the evacuation of bowel within 1 hr of waking up. Further, maximum subjects had the habit of bowel evacuation after drinking water/tea/after breakfast, i.e., 64.5% and 60% in the study and control groups, respectively. A statistically significant number of subjects (45.5%) in the study group evacuated bowels 2–4 times in a day and 5.5% evacuated once in 2 days; it showed that subjects were constipated (P < 0.005). Maximum subjects in the study group had late waking-up and sleeping habits. The difference was statistically significant, with P = 0.04. Conclusion: Subjects with anorectal disorders (piles, fistula, and fissure) had the habit of suppression of defecation urge and also showed strong association between bowel and bladder habits and anorectal disorders. The waking-up and sleeping habits also showed statistically significant effect in causation of anorectal disorders.

Importance of Aahar-Vihar in Anorectal disorders (Gudarogas) According to Ayurveda

Importance of Aahar-Vihar in Anorectal disorders (Gudarogas) According to Ayurveda

Review on Annavahasrotodushti with Respect to Arsha Vyadhi

Digestion is a main process of human body. Food is essential for body and digestion, conversion of foodtakes place in digestive tract.AnnavahaSrotasDushti leads to indigestion, anorexia, lack of interest towardsfood which leads to Anorectic disorders like Arsha,Parikartika etc.Contrarily this seems to be an increasingincidence of the commonest of all anal disease, i.e. Haemorrhoids and fissure in ano. Though Sushrutahasdescribed detailed of, however as lifestyle has been changed significantly therefore it is of great importanceto study other causes of Haemorrhoids according to modern era. Hence, the diseases of ano-rectal area arethe commonest of all the diseases of GI tract. This study aimed at Annavahsroto-dushti and its relationin Pathogenesis of ArshaVyadhi and its management.They were well known for time immemorial to thephysician and surgeon due to the worldwide distribution and trouble caused by them.