Common Anorectal Conditions Research Articles

IJCM_180A: Risk factors for hemorrhoids among patients attending selected tertiary care hospitals in Mangalore: A matched case control study

Background: Hemorrhoids is a common anorectal condition affecting a vast majority of population all around the world. The establishment of a definite association of hemorrhoids with bowel habits and other factors like BMI is less explored. Objectives: To find out the association of hemorrhoids especially with bowel habits and to establish the association of BMI with respect to the onset of hemorrhoids. Methodology: This case control study was conducted among 90 cases and controls from the hospitals affiliated to Kasturba Medical college, Mangalore. Data were analyzed using SPSS version 29. Uni-variate analysis was done, and the odds ratio and confidence levels were tested and determined using binary logistic regression. Results: Majority of the controls were normal with respect to BMI categorization (36.8%) whereas 34.9% of the cases were obese (p=0.095) . The number of people who consumed mixed diet was greater in the cases (72.3%) than in the controls (64.4%). 61.5% of patients complained of blood in stools compared to 2.2% of controls, there were 10.5% of cases with pus in stools and none in controls (p=0.249). Use of laxatives was seen in 27.7% of cases and only 2.1% of controls (p=0.001). A total score of >=15 was indicative of constipation. 12.8% showed constipation compared to none in the controls. (p=0.026). Conclusion: Association of constipation with hemorrhoids was statistically significant. The occurrence of hemorrhoids was not associated with the body mass index of the individual and the occurrence of diarrhea was not significant with respect to hemorrhoids.

Rectal prolapse in the pediatric population-a narrative review of medical and surgical management.

Although more frequent in the adult population, rectal prolapse is a common anorectal condition that can occur in children and adolescents. While many cases spontaneously resolve without the need for intervention, the advent of newer minimally invasive procedures and operations have provided options for pediatric patients. Here, we review the pathophysiology, etiology, presentation, diagnosis and principles of management of rectal prolapse in the pediatric population as it has evolved over the past several decades. The literature was queried from free databases available to the public including the National Institute of Health National Library of Medicine MEDLINE and PubMed for manuscripts published from January 1, 1975 to December 1, 2023. Manuscripts without an accompanying English translation or those written entirely in foreign languages were excluded. Numerous conditions contribute to rectal prolapse in children, including constipation, gastrointestinal infectious and non-infectious etiologies, cystic fibrosis, malnutrition, neurogenic, anatomic, lead points, and abuse. Initial management of rectal prolapse is medical management, addressing the underlying condition associated with rectal prolapse along with attempted manual reduction. For patients with recurrent rectal prolapse, a variety of noninvasive and procedural management options are available including injection sclerotherapy and anal encirclement in addition to surgical rectopexy by open and newer minimally invasive methods. Despite significant advances in the evaluation, procedural and surgical management of pediatric anorectal conditions in the last few decades, there continues to be substantial variation in clinicians' and surgeons' practice for the treatment of rectal prolapse in children and adolescents. Much remains to be studied in the future to improve clinical outcomes for this patient population.

MALADIE HEMORROIDAIRE TRAITEE PAR LA METHODE DE MILLIGAN MORGAN A L’HOPITAL NATIONAL DONKA

Introduction: Hemorrhoids are a common anorectal condition. Hemorrhoidectomy according to Milligan Morgan consists of the excision of varicose hemorrhoidal nodules. This technique is considered the “gold standard”. However, it is associated with significant postoperative morbidity. The aim of our study was to report our experience in the management of hemorrhoids treated according to Milligan, Morgan. Methodology: This was a retrospective, descriptive study over 3 years from January 1, 2015 to December 31, 2017. The patients treated by Milligan Morgan formed the study population. Our variables were epidemiological, therapeutic and prognostic. Results: we collected 2.76% (n=56) of patients treated by the Milligan Morgan technique of all hospitalizations (N=2,025). The average age was 45.3 years; extremes (24 and 85 years). The age group of 30 to 39 years was the most represented 37.5% (n = 21). Anal pain 100% (n=56), rectorrhagia 55.35% (n=31) and prolapse 44.64% (n=25) were the reasons found. The average duration of evolution was 4.13 years; extreme (0.16 and 31 years). The comorbidities were diabetes 12.5% (n= 7), hypertension 7.14% (n= 4) and HIV 5.35% (n= 3). More than forty four percent (n=25) were grade 3 hemorrhoids; 21.42% (n=12) grade 4 and 14.28% (n=8) grade 2 complicated by rectal bleeding. The postoperative course was simple in 80.35% (n=45). The postoperative complications encountered were urinary retention 10.71% (n=6), hemorrhage 7.14% (n=4), suppuration 7.14% (n=4) and constipation 1.78%. (n=1). Conclusion: despite the multitude of therapeutic techniques for hemorrhoids; Milligan-Morgan hemorrhoidectomy remains widely practiced due to the lower cost of the operation, and is the most effective treatment available in our practice setting.

Effect of Ksharsutra in the management of Arsha - A Case Study

There are several anorectal disorders facing by large number of population with diverse group of pathologic conditions. Among them anorectal disorders like Arsha (haemorrhoids), Parikartika (fissure) and Bhagandar (fistulas) are among the most common anorectal conditions. These conditions are the cause of significant discomfort and disability to the patient and can impair a person’s quality of life. Ayurveda is playing important role and contributing to modern technology with its own originality with authenticity. Advantage of Ksharsutra therapy in the management of Arsha is that it is a minimally invasive surgical procedure and can be performed under local anaesthesia and have good results in wound healing. In the presented study, Ksharsutra ligation was performed on a patient aged 23 years suffering from Arsha on 3 ‘o’ clock position prolapsed without bleeding but with irritation, pruritis ani and mild mucous discharge. Ksharsutra has been found to be effective, economic, easy to prepare and use. Moreover the daily routine of the patient is not disturbed. As this study performed on a single patient, more such trials are required to reach concrete conclusions.

A COMPARATIVE STUDY BETWEEN LASER HEMORRHOIDOPLASTY PROCEDURE VS OPEN HEMORRHOIDECTOMY IN THIRD AND FOURTH DEGREE HEMORRHOIDS.

Haemorrhoids are common anorectal condition which can be dened as a symptomatic enlargement and distal displacement of normal anal cushion. It affects both gender and all ages equally and is believed to be caused by chronic constipation. Haemorrhoids affect the daily routine of the affected individual and common symptoms include rectal bleeding, pain, anal irritation and prolapse. Management of haemorrhoids can be divided into surgical and non-surgical methods and many techniques are used to treat haemorrhoids. All patients cannot be treated with only one procedure and in this study, we are comparing laser haemorrhoidoplasty with open haemorrhoidectomy technique. To compare the outcomes of Objectives: laser haemorrhoidoplasty versus open haemorrhoidectomy among patients presenting with second- and third-degree haemorrhoids. Methodology: A hospital based prospective cross-sectional comparative study design was adopted for our study and the source of our data were the patients attending surgery OPD at Navodaya Medical College with a clinical diagnosis of second and third degree haemorrhoids. Study duration was for 18 months and 80 was our sample size based on sample size calculation. who were recruited based on purposive sampling technique. Once recruited patients were randomly divided into two groups with 40 patients each and one group underwent laser haemorrhoidoplasty and another group underwent open haemorrhoidectomy. All the patients were followed up on day 0, day 1, day 2, day 7, one month and at 6 months postoperatively to record post-operative pain, return to work, wound infection, rectal bleeding and any other complications if encountered. All the ndings were compared between the groups to assess better technique with respect to various parameters included. Majority of the Results: patients were in the age group between 30 to 50 years and male predominance (76.25%) was seen. Bleeding and prolapse were the major complaints and 55% of them presented with 3rd degree haemorrhoids and 45% with 2nd degree haemorrhoids. Patients who underwent laser haemorrhoidoplasty had signicantly lesser duration of surgery, shorter hospital stay and less post-operative pain compared to open haemorrhoidectomy technique. Incidence of post-operative urinary retention, constipation, bleeding, sub-mucous abscess was slightly more among patients who underwent open haemorrhoidectomy compared to laser technique. Also, patient who underwent laser haemorrhoidoplasty returned to work earlier and had no recurrence, while patients who underwent open haemorrhoidectomy took more time to return to work and recurrence was seen in two patients. Laser haemorrhoidoplasty seemed to be Conclusion: better technique compared to open haemorrhoidectomy considering duration of surgery, required hospital stay, post-operative pain, post-operative return to work, constipation, bleeding and other complications. Laser technique had better outcome compared to open technique.

Surgery of Simple and Complex Anal Fistulae in Adults: A Review of the Literature for Optimal Surgical Outcomes.

Anal fistulas are common anorectal conditions, and surgery is the primary treatment option. In the last 20 years of literature, there exist a large number of surgical procedures, especially for the treatment of complex anal fistulas, as they present more recurrences and continence problems than simple anal fistulas. To date, there are no guidelines for choosing the best technique. We conducted a recent literature review, mainly the last 20 years, based on the PubMed and Google Scholar medical databases, with the goal of identifying the surgical procedures with the highest success rates, lowest recurrence rates, and best safety profiles. Clinical trials, retrospective studies, review articles, comparative studies, recent systematic reviews, and meta-analyses for various surgical techniques, as well as the latest guidelines of the American Society of Colon and Rectal Surgeons, the Association of Coloproctology of Great Britain and Ireland, and the German S3 guidelines on simple and complex fistulas were reviewed. According to the literature, there is no recommendation for the optimal surgical technique. The etiology, complexity, and many other factors affect the outcome. In simple intersphincteric anal fistulas, fistulotomy is the procedure of choice. In simple low transsphincteric fistulas, the patient's selection is crucial in order to perform a safe fistulotomy or another sphincter-saving technique. The healing rate in simple anal fistulas is higher than 95% with low recurrence and without significant postoperative complications. In complex anal fistulas, only sphincter-saving techniques should be used; the optimal outcomes are obtained by the ligation of the intersphincteric fistulous tract (LIFT) and rectal advancement flaps. Those techniques assure high healing rates of 60-90%. The novel technique of the transanal opening of the intersphincteric space (TROPIS) is under evaluation. The novel sphincter-saving techniques of fistula laser closure (FiLac) and video-assisted anal fistula treatment (VAAFT) are safe, with reported healing rates ranging from 65% to 90%. Surgeons should be familiar with all sphincter-saving techniques in order to face the variability of the fistulas-in-ano. Currently, there is no universally superior technique that can treat all fistulas.

Herbal Treatment for Hemorrhoids (Piles)

Swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the cutaneous anus region (external hemorrhoids). Nearly three out of every four adults will get haemorrhoids occasionally. Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions.They are a significant medical and economical issue that affects millions of people worldwide. There have been numerous claims made regarding the etiologies of hemorrhoid development, involving continuous straining and constipation. One of the most important symptoms of hemorrhoid disease is aberrant vascular channel dilatation and distortion, together with damaging changes in the connective tissue that supports the anal cushion. Hemorrhoids may show signs of vascular hyperplasia and an inflammatory response. The etiology and other clinical contexts of hemorrhoid illness were first covered in this article, followed by a discussion of the most recent non-surgical and operative therapy strategies.[1]

Combination of Botulinum Toxin and Topical Diltiazem Versus Lateral Sphincterotomy in Treatment of Chronic Anal Fissure

Introduction: Chronic anal fissure (CAF) is a common anorectal condition with treatment modalities being introduced to avoid the complications of surgical intervention.
 Aims & Objectives: To compare LIS versus combination of botulinum toxin injection and topical diltiazem in terms of frequency of healing in patients with chronic anal fissure. The outcome was measured frequency of healing of CAF within four weeks after treatment. Study design was randomized controlled trial (RCT)
 Place and duration of study: The place was Surgical Department, Chaudhry Mohammad Akram Lahore. And duration of study is 6 months (1st Jan 2022 to 31stJune 2022)
 Material & Methods: Total 100 patients were enrolled and randomly allocated into two groups A& B (50 in each group). In Group A patients LIS (open technique) was performed. While in group B, patients were administered, 20 U of botulinum toxin A diluted in 2 ml normal saline was injected via 27 G insulin needle into the internal sphincter around the fissure area. Furthermore, diltiazem paste was applied twice daily up to two weeks. All patients were assessed for healing of the fissure weekly up to four weeks. Data was analyzed using SPSS version-24, P-value<0.05 was taken as significant
 Results: Out of 100 patients, 82 (82%) patients showed complete healing within four weeks of treatment. The healing within four weeks was 94% in group A and 70% in group B (p value 0.002).
 Conclusion: The frequency of healing of CAF by LIS is significantly higher than the combination of botulinum toxin plus topical diltiazem. The results can be applied after satisfactory confirmation from the larger RCTs.

A study on management of hemorrhoids: Comparison between conservative management and injection sclerotherapy

Background: Hemorrhoidal disease is one of the most common anorectal conditions encountered in daily practice for centuries. Conservative management of hemorrhoids (with oral diosmin, calcium dobesilate cream local application) and injection sclerotherapy with 3% polidocanol-both are very commonly practiced, cost effective, and outpatient department-based management of hemorrhoids which bear rare adverse effects. Comparative efficacy of injection sclerotherapy and conservative management in cases of hemorrhoids is still confusing and contradictory to each other according to different studies. Aims and Objectives: This study was conducted to compare the effectiveness between conservative management of hemorrhoids and injection sclerotherapy. Materials and Methods: This institution-based experimental study done over 74 patients of first- and second-degree internal hemorrhoids. Thirty-seven patients were randomly selected and managed with conservative management, and the rest with injection sclerotherapy. Treatment responses were assessed after 3 weeks and in unsatisfactory responses, treatment was repeated for another 3 weeks. Reassessment was done after 6 weeks and 6 months. Results: This study demonstrated that both injection sclerotherapy and conservative management had improved per rectal bleeding after 3 and 6 weeks of treatment, but the former had a significant edge over the counterpart after 6 months of treatment (56.8% vs. 35.1%, P = 0.002). In case of reduction of hemorrhoidal mass – injection sclerotherapy had significantly better outcome in all the follow-up visits, that is, 3 weeks (54.1% vs. 13.5%, P = 0.001), 6 weeks (70.3% vs. 35.1%, P = 0.008) and 6 months (59.5% vs. 27.0%, P = 0.003). Injection sclerotherapy had superior overall treatment outcome after 6 weeks of treatment (73% vs. 45.9%, P = 0.04) and long-term periods (56.85% vs. 27%, P < 0.01). Conclusion: Injection sclerotherapy shows significantly better and long-lasting improvement in symptomatic hemorrhoids in comparison to conservative management which is mainly able to limit per rectal bleeding only for a short period of time.

A Clinical and Pathological Study of Fistula-in-ANO

Introduction: Fistula-in-ano is a very common ano-rectal condition with wide spectrum of aetiology with a prevalence 8.6 to 10/100,000 of the population per year. Establishing a cure is problematic due to location of the diseased part, that makes the patient refrain from early consultation and this delays in treatment. Fistula causes appreciable morbidity and inconvenience to the patient and there is scarcity of studies on its etiopathogenesis, clinical features, investigations and treatment. Hence, this study was undertaken to study the clinical and pathological presentations, efficacy of surgical modalities and treatment outcomes. Material And Methods: An observational study was conducted during the study period (April 2017 to March 2018) on patients admitted at Kamalnayan Bajaj Hospital for the evaluation of Fistula in ano, 90 patients were enrolled in the study after fulfilling inclusion and exclusion criteria and taking written/verbal informed consent. The patients underwent either fistulectomy and fistulotomy according to the criteria decided. Results: In our study, incidence was noticed more in the age group of 31-40 years 40%, and more in males. 70% of patients belonged to lower socio-economic status; incidence was more common in among drivers 30%. The commonest mode of presentation was discharging pus in 70% of cases. Majority of the patients 80% underwent fistulectomy. Among 72 patients who underwent fistulectomy, all the patients responded with complete healing after surgery. Conclusion: It was concluded that history, clinical examination, per rectal and perineal examination helps to diagnose the condition. Proctoscopy, sigmoidoscopy and MRI examination helps in diagnosing complicated cases. It is curable disease by the treatment of surgery along with necessary antibiotics, analgesics and good post-operative wound management.

Rectal Artery Embolization for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques.

Chronic hemorrhoidal disease is a common anorectal condition that leads to hemorrhoidal hyperplasia, which affects millions of people worldwide and is a significant medical and socioeconomic issue. Rectal bleeding is one of the main chronic symptoms. Recurrent rectal bleeding can alter an individual's quality of life and, more rarely, cause anemia. Pain is less common, occurring only in the event of complications such as congestive exacerbation, external hemorrhoidal thrombosis, or fissures. The most standard treatment involves dietary and hygiene measures, use of phlebotonic drugs, and nonsurgical treatment such as infrared photocoagulation or elastic band ligation. Excisional treatments such as hemorrhoidectomy and hemorrhoidopexy are the reference standards for treatment of hemorrhoidal disease. Embolization of the rectal arteries (ie, emborrhoid) has recently emerged as an effective treatment option, with few reported adverse effects, minimal blood loss, and a same-day hospital procedure. Hemorrhoid embolization is performed by using femoral or radial access. The inferior mesenteric artery and then the superior rectal arteries are catheterized with a microcatheter. Embolization can be performed by using different agents. Studies have shown improvement in symptoms and high technical success rates after treatment. The basic principles of hemorrhoid embolization that must be understood to achieve effective treatment, including those related to patient evaluation, the arterial anatomy, basic embolization, and published results, are reviewed. An invited commentary by Thompson and Kelley is available online. ©RSNA, 2022.

Importance of homoeopathic therapeutics in management of haemorrhoids including its repertorial approach

Haemorrhoids is one of the common anorectal conditions seen in society but least revealed. But this condition is manageable either conservatively that is with medicines, changing life style & diet or by surgical interventions depending on the degree of haemorrhoids and severity of complaints. Homoeopathic medicines serve wonderful results for the above condition & can also avoid or prolong the surgical interventions because of its holistic approach. It has a high impact on quality of life and daily routine of the person. Haemorrhoids can be managed by conservative and surgical management. Treating the cases with the homoeopathy having the holistic approach and the treating the disease condition that is individualization. Treating the diseased person in his all expression that characterized the person as well as the disease symptom should be taken into the consideration to find out the similimum.

A Comparison between Stapled Hemorrhoidopexy and Conventional Milligan Morgan Procedure in the Treatment of Hemorrhoids

Background: Hemorrhoids is a very common anorectal condition distinct as the symptomatic enlargement and distal displacement of normal anal cushions. Several factors have been claimed to be associated with hemorrhoidal development, including prolonged straining and constipation. Several treatment methods along with the Milligan-Morgan procedure are applied in treating hemorrhoids. Aim of the study: The aim of this study was to compare the effectiveness and outcomes of stapled hemorrhoidopexy and conventional Milligan Morgan procedure in treating hemorrhoids. Methods: This comparative observational study was conducted at the Department of Surgery, Rajshahi Medical College, Rajshahi, Bangladesh during the period from January 2019 to December 2019. In total 100 patients with grade 3 or 4 hemorrhoids who fulfilled the criteria were included in the study subjects. In total 50 patients were denoted as group A patients who underwent stapled hemorrhoidopexy and the other 50 patients denoted as group B underwent conventional open (Milligan Morgan Procedure) hemorrhoidectomy. Patients were reviewed immediately after surgery and at 1, 3, 6 weeks, and 6 months post-operatively. All data were processed, analyzed, and disseminated by MS Office and SPSS programs as per need. Results: In this study, the mean ± (SD) duration of hospital stay was 2.88 ± 0.48 days in group B which was extremely significantly higher than that (1.77 ± 0.12 days) of group A (P <0.0001). After 6, 12 and 24 hours of surgery the pain scores in group A were significantly lower than those in group B (P-Values: 0.001, 0.005, and 0.014 respectively). The mean (±SD) patient satisfaction score was found extremely significantly higher in group A (4.13 ± 0.61) than that of group B (3.27 ± 0.57) where the P-value was <0.0001. The mean (±SD) ‘time taken to return to work in days was found extremely significantly lower in group A (9.06 ± 2.43 days) than that of group B (16.66 ± 2.79 days) where the P-value was .......

Polyherbal formulation Anoac‑H suppresses theexpression of RANTES and VEGF for themanagement of bleeding hemorrhoids and fistula.

Hemorrhoids and fistula are considered the most common anorectal conditions in the general population. These conditions affect the quality of a patient's life by causing pain and bleeding during defecation or even in the resting state. Lower grades of hemorrhoids may be controlled by traditional measures. However, surgery is an effective treatment option in recurrent-lower and higher-grade hemorrhoids. Surgical procedures are associated with various complications, including pain and delayed wound healing. Recurrence of hemorrhoids is also a major concern in the post-operative period. An anal fistula is the connection between the anus and the skin and causes severe pain, swelling, as well as blood and pus discharge. Fistula has serious social and economic consequences. Hence, it is important to understand the pathophysiology and molecular pathology of hemorrhoids and fistula, to identify the molecular targets and to develop pharmacological-interventions. In a previous study by our group, the polyherbal formulation Anoac-H was developed for the treatment of different stages of hemorrhoids and fistula, and it was demonstrated that Anoac-H is an effective formulation for treating hemorrhoids. However, the molecular mode of action of Anoac-H on hemorrhoids and fistula had remained elusive. In the present study, it was determined that this formulation reduces the migration of mesenchymal (fibroblasts) and immune (RAW 264.7) cells without affecting their viability. It was also observed that Anoac-H suppresses the expression of regulated upon activation, normal T cell expressed and presumably secreted (RANTES) and VEGF in fibroblasts and macrophages. Inflammation and elevated expression of RANTES and VEGF were observed in hemorrhoids and fistula. However, inflammation, as well as the expression of RANTES and VEGF, were significantly reduced in treated human hemorrhoid and fistula tissues as compared to untreated ones, confirming the in vitro results.

Minimal Lateral Internal Sphincterotomy (LIS): Is It Enough to Cut Less Than the Conventional Tailored LIS?

PurposeAnal fissure is a common anorectal condition, yet its pathogenesis remains unclear. Lateral internal sphincterotomy (LIS) is the gold standard treatment for chronic anal fissures that do not respond to conservative treatment; however, it has a risk of anal incontinence. We believe that fibrosis of the internal anal sphincter is an important factor in the pathogenesis of chronic anal fissure. In this study, we describe the minimal LIS method, a minimally invasive method where only the fibrotic portion of the internal anal sphincter is cut. We also describe the outcomes of this method.MethodsWe performed a retrospective review of 468 patients (270 male and 198 female) who underwent minimal LIS for chronic anal fissure in 2017 at Seoul Song Do Hospital. We analyzed the patients’ clinical characteristics, manometry data, complications, and outcomes of minimal LIS. The outcomes of the surgery were assessed via questionnaires during the postoperative outpatient visits, beginning 2 weeks postoperatively.ResultsThe overall complication rate was 4.0% (19 patients). Delayed healing occurred in 14 patients (3.0%), perianal abscess was present in 3 patients (0.6%), and gas incontinence occurred in 2 patients (0.4%). All complications were improved with conservative treatment. Recurrence, defined as the recurrence of anal fissure more than 4 weeks after healing, was present in 6 patients (1.3%).ConclusionMinimal LIS is a safe and effective treatment option for patients with chronic anal fissure. Postoperative complications, especially incontinence and recurrence, are rare.

Randomized, open-label, controlled, comparative clinical study to evaluate the safety and efficacy of Pilex Forte tablets in combination with Pilex Ointment application for the effective management of common ano-rectal conditions

Introduction. Haemorrhoids and anal fissures are considered as the most common anorectal conditions. Aim. To evaluate the safety and efficacy of Pilex Forte tablets in combination with Pilex Ointment as compared to the Standard of Care in common anorectal conditions Material and methods. Randomized, open-label, controlled comparative clinical study conducted on 162 patients of either sex, aged between 18-50 years, confirmed with common anorectal conditions. As per randomization, patients received either standard of care or Pilex Forte tablet along with Pilex Ointment at a recommended dose of two tablets twice daily and twice daily local application (anal) for a period of 4 weeks. Clinical safety and efficacy assessments were carried out at study specific scheduled visits. Laboratory assessments were carried out only at screening and at the end of the study. Results. Patients who completed the study were considered for statistical analysis. Significant clinical improvement was observed in patients with anorectal conditions who received Pilex Forte tablet and Pilex Ointment than to those who received standards of care. No abnormal lab values were recorded and there were no adverse events reported during the study period. Conclusion. Pilex Forte tablet along with Pilex Ointment at recommended dose is safe and effective in the management of anorectal conditions like haemorrhoids and fissure-in-ano.

Effect of Ashwini Mudra as an adjuvant on pain in post-operative cases of ano-rectal diseases - An Ayurvedic management protocol

Ano-rectal disorders refer to the illness of the anal canal and rectum. Fissure in ano, Fistula in ano and haemorrhoids are among the most common ano-rectal conditions. In these cases, symptoms like pain, itching, burning, bleeding and swelling can significantly affect a patient's lifestyle. In Today’s Era, for pain management in post-operative cases of ano-rectal diseases, yoga plays an important role in pain management. Yoga is a way of living that aim towards a healthy mind in a healthy body. Ashwini mudra is a tantric practice used to generate and move prana (life force energy) upward along the spine, via the main energy channel of the subtle body known as sushumna nadi. The practice involves contracting the anal sphincter in a rhythmic way, thereby generating and containing intense energy within the lower body before pumping it upwards As the ano-rectal disease require long term conservative treatment and also surgical intervention. Due to this patients are suffering for long term problems. To minimize the side effects of medicine in post-operative cases, certain measures are needed. Yoga is a way of living that aims towards a healthy mind in a healthy body. Sushruta and Vagbhata have described that the total length of Guda is 4½ Angula only. Vagbhata had also told measurement of Guda as Atmapanitala (palm of hand) Ashwini mudra is very easy to perform and can be done during any time and by any age group.

English

BACKGROUND Haemorrhoids are one of the most common anorectal conditions encountered in clinical practice and are recognised as a common cause of rectal bleeding, perianal itching and anal discomfort. Therapeutic treatment of haemorrhoids needs to be tailored according to grades and complication of haemorrhoids, patient preference and expertise of procedure. Very limited data is available regarding effectiveness of retrograde endoscopic injection sclerotherapy for the management of bleeding haemorrhoids. We wanted to study the effectiveness of retrograde endoscopic sclerotherapy (REST) for the management of various grades of bleeding internal haemorrhoids. METHODS A prospective study, included 87 patients with Gr. I, II and Gr. III symptomatic bleeding internal haemorrhoids. They were subjected to retrograde endoscopic sclerotherapy using Inj. Polidocanol to study its effectiveness in controlling bleeding. Effectiveness of the procedure was defined by stoppage of bleeding at 3 months follow up. RESULTS Bleeding stopped in 95.3 % cases after retrograde endoscopic sclerotherapy at 3 months follow up. No significant complications were observed with the procedure during the study period. CONCLUSIONS Retrograde endoscopic sclerotherapy is a safe, well tolerated and effective modality for the management of bleeding internal haemorrhoids. KEYWORDS Haemorrhoids, Retrograde Endoscopic Sclerotherapy

Anal fissure – anatomy, pathogenesis and treatment

Anal fissure is a common anorectal condition. While it often presents as a small oval tear in the anoderm, it can cause significant pain and anguish to the patient. The exact etiology is still debatable but increased anal tone is associated with most fissures. The initial management is medical with agents intended to reduce the anal tone. More chronic fissures usually require surgical intervention. Lateral internal sphincterotomy has a high success rates and is considered the gold standard of interventions. In this article we review the relevant anatomy, pathophysiology and contemporary treatment options for anal fissures.

Fundamentals of Anorectal Technical Skills: A Concise Surgical Skills Course.

Anorectal diseases, among the most common surgical conditions, are underrepresented in medical training. The Fundamentals of Anorectal Technical Skills course was developed to provide cost-effective formal training in diagnosis of common anorectal conditions and in commonly performed anorectal procedures using the theories of deliberative practice and perceptual and adaptive learning. First- through third-year general surgery and internal medicine residents and third- and fourth-year medical students participated in a course consisting of didactic instruction and hands on skills stations. The course covered common anorectal conditions, including internal and external hemorrhoids, fissures, condylomata, abscesses, fistula-in-ano, rectal prolapse, pilonidal disease, pruritis ani, and anal and rectal cancer, as well as common procedures such as anoscopy, excision of thrombosed external hemorrhoids, banding of internal hemorrhoids, rigid proctoscopy, incision and drainage of an abscess, administration of local anesthesia, and reduction of rectal prolapse. Before the course, participants completed a questionnaire consisting of demographics; previous anorectal experience, as measured by procedural case volume; confidence diagnosing and treating anorectal conditions; and a clinical knowledge multiple-choice quiz. Immediately following the course, participants took an additional survey reassessing their confidence and testing their clinical knowledge. This study was granted an educational exception by the Institutional Review Board at Walter Reed National Military Medical Center. Forty-three learners participated in this course. Forty-six percent of participants had not participated in any anorectal cases, 26% had participated in 1 to 5 cases, 17% had participated in 6 to 10 cases, 6% had been involved with 11 to15 cases, and 6% had been involved with more than 15 cases. For learners who had no prior experience, 1 to 5 prior cases, or 6 to 10 cases, there were statistically and educationally significant increases in confidence for all diagnoses and procedures. Additionally, there were statistically and educationally significant increases between pre-course and post-course quiz scores for learners who had no prior experience (7.8±2.0 vs. 11.8±2.5, P<0.01, Cohen's d=1.8) and for those who had only participated in 1 to 5 cases (11.0±3.7 vs. 14.2±2.0, P=0.04, Cohen's d=1.1). The changes in quiz scores for learners who previously had been involved with six or more cases were not statistically significant. This course provides a cost-effective training that significantly boosts learners' confidence in diagnosis of common anorectal procedures and confidence in performance of common anorectal procedures, in addition to improving objectively measured anorectal clinical knowledge.