Ayurveda accentuates on the role of healthy diet and physical work in maintaining a state of well-being and coping up with health hazards even more than the actual therapy or drugs. In present scenario of swift life style, sedentary culture, irregular and inappropriate diet, prolonged standing and psychological disturbances like anxiety, depression etc., the number of diseases are flourishing and have become a part of each and every individual affecting negatively. Etiology of all diseases is collection of toxic (Excretory) products in the body. Which happens due to faulty diet and change in life style. For healthy body we need balanced healthy diet, balanced physical activity and balanced sleep. These are explained in Ayurveda as three sub pillars of healthy body, which helps to maintain three pillars (Three Doshas) of living body. Here, we are discussing about most common and emerging diseases of Ano rectal region.

Among the list of Ano-rectal disorders, following are commonly seen-

Hemorrhoid’s (Arsha): Constipation increases the back pressure on the hemorrhoidal vessels to produce Hemorrhoid’s.

Fissure-in-ano (Parikartika): Constipation leads to generation of hard stool which when expelled leads to trauma in anal canal and ultimately generates Anal-fissure.

Fistula-in-ano (Bhagandara) /Ano-rectal abscess (Guda vidradhi): Crypto-glandular infection leads to Ano-Rectal Abscess and Fistula-in-Ano.

Rectal prolapse (Guda Bhramsha): Long term constipation, causes weakness of ligaments and muscles, causing the rectum to prolapse.

The commonest aetiopathogenesis of these diseases is constipation, Constipation is an awkward problem that a lot of men and women suffer from on a daily basis due to busy life schedule and it is a risk factor for metabolic diseases.

The cause for constipation includes the aggravation of Vata. According to Ayurveda, causes of Gudaroga includes Intake of heavy, sweet, cold, channel blocking, burning, antagonistic, uncooked, too little and unsuitable food, eating meat of cow, fish, oar, buffalo, goat and sheep, constant use of decomposed, dried and foetid meat, preparations of flour, rice cooked with milk, products of sesamum and jaggery, use of black gram soup, sugarcane juice, tubers, dried vegetables, vinegars, garlic, buttermilk, lotus rhizome, germinated or fresh owned cereals and legumes and uncooked radish, intake of heavy fruits and vegetables, pickles, salads, intake of stale, putrefied, cold and mixed up food, intake of immature curd, use of defective and heavy water, excessive use of unctuous substances, avoiding evacuation, abstaining from physical exercise, indulgence in improper sexual activity, excessive sitting, irregular sleep habits or emotional disturbances like stress, grief, fear & worry, day sleep, suppression of impelled urges etc.

All these causes lead to Mandagni and resulting constipation and thereby Guda Vikaras. Acharyas have also mentioned Vishtambha (Constipation) as the prodromal symptom of Guda Vikaras like Arsha. Thus constipation seems to be the very important cause for most of these disorders.

If, we go in depth of Ayurveda, main aim is to prevent constipation, Anorectal diseases and metabolic diseases by maintaining proper digestive activity. Ayurveda deals with both prevention and management of Anorectal diseases.

Preventive aspect explained under headings of Dincharya, Ritucharya, Dashaharavidha visheshayatana, Aaharopyogivarg, Sadavrita and Neendra. Primary principal treatment of disease in Ayurveda is to correct and ignite our Agni (Digestive Fire) along with detoxification of body. This will maintain our normal metabolic activity and makes us healthy.

Rules of Taking Food (Ahara Vidhi Vidhan)

Diet-(Aahar) In Anorectal Disorders Diet is an essential factor in the formation of our body. According to Acharya Charaka, consuming improper diet in improper way is the main cause of disease. This is explained under heading of Ashta aharvidha vishesayatana.

• Ushnamashniyat (Consuming warm food)
• Snigdhamashniyat (Food should be unctuous)
• Matravatashniyat (Balanced diet)
• Jeerneashniyat (Fresh meals should be taken only after complete digestion of the previous one.)
• Veryaviruddhamashniyat (Avoid food with contradictory properties)
• Ishtsdeshe Ishtasarvopkarnam chaashniyat (Meal should be taken at proper place and with proper utensils)
• Na Atidrutam Ashniyat (Avoid eating too fast)
• Na Ativilambitam Ashniyat (Avoid eating too slowly)
• Ajalpana ahasan Tanmana bhunjita (Eating without talking or laughing, Mindful eating)
• Atmanamabhisamikshya bhunjita (Eating after analyzing once needs).

According to Acharaya Sushruta, a person suffering from Anorectal disorders should take Snigdha, Ushna, Alpa and Taral aahar as it subsides vitiated Vata.

General instructions about meal – Do’s

• The diet taken during constipation must be easily digestible.
• Food items, medicine and drugs pacifying Vata and Agnideepak
• Flour- Mixed grains flour like wheat, barley, gram, soybeans etc. However wheat flour with husk (without refining) can also be used.
• Vegetables- Bottle gourd, raddish, turnip, cabbage, cauliflower, raw green papaya, carrot, fenugreek leaves, chenopodium leaves, spinach leaves, tomato, potato and other green leafy vegetables.
• Onion- Useful in patients suffering from excessive bleeding and vitiated Vata in piles.
• Fruits– Papaya, Coconut, Apple, Litchi, Figs, Watermelon, Guava etc.
• Citrus fruits– Citrus fruits i.e pomegranate relieves constipation, plums, Amalaki, Imli.
• Pulses– Masoor, Moong, Arhar Gram, Soybean etc.
• Meat– Mamsa rasa useful in bleeding piles.
• Dry fruits– Almonds, Pistachio, Dried grapes etc.
• Juices– Coconut water, Bottle gourd juice, Apple juice, Mixed fruit juice, Aloe vera juice, Wheat grass juice, Trifala ras
• Spices- Ajwain, Hingu– These relieve pain.
• Dhanyaka-It is Agnideepak and Anulomana
• Jeeraka-It is Arshanashaka
• Dhanyak,Ajwayan,Vidlavana,Saindhavlavana,Bilva,Maricha,Harada along with Godugdha and Dadhi does Mala and Vatanulomana and cures Gudabhramsha and pain.
• Hingu,Lavana along with fermented soup of Kulatha relieves pain in Bhagandara
• Rice– Pathya for Arsha like Rakta shaali & Mahashaali (Basmati rice)
• Ghee-cooking oils: Cow’s ghee, mustard oil, olive oil, groundnut oil, soybeans oil etc
• Takra and Dadhi ; Acharya charaka mentioned Takra and Dadhi as Arshonashak as Takra increases weak digestive fire & Dadhi gives strength to digestive fire.
• Tikta dravyas– Such Dravyas enlightens digestive fire, arrests bleeding, and pacifies
• Intake plenty of water, about 3-4 litre in cold weather & 5-6 litre in hot season.
• Drink one litre of warm water and walk around for a few minutes
• Drinking hot green tea or hot water (With Psyllium husk) every morning, to get things rolling. Drink a glass of warm milk before going to bed helps in easy evacuation in the morning. In case of severe constipation, mix two teaspoons of castor oil in the milk.

Thus the diet and drugs should be carminative for the wind and promote digestive power.

General instructions about meal – Don’ts

• Don’t eat while being engaged in some activity as like television, excessive conversation or reading.
• Don’t eat fruits immediately – Immediately eating fruits after meals will cause stomach to be bloated with air. Therefore take fruit one to two hours after meal or one hour before meal.
• Avoid meals when thirsty and water while hungry.
• Avoid meals after exertion.
• Avoid meals when you are having no appetite.
• Don’t suppress the appetite as it leads to body pain, anorexia, lassitude, vertigo and general debility.
• Don’t suppress the thirst as it leads to general debility, giddiness and heart diseases.
• Avoid spicy food, fast food, junk food, cold drinks, chocolates etc. Because these foods disturb the digestive system & lead to constipation.
• Tea/Coffee should not be taken in excess. As it is the major cause to decrease the digestive fire and may lead to sour eructation, gas and constipation.
• Fried foods, beans, gas forming vegetables like cabbage, cauliflower and broccoli, nuts and dried fruits should be avoided.
• Do not mix too many kinds of foods in one meal.

Role of Yoga

Yoga is the science of right living and, as such, is intended to be incorporated in daily life. It works on all aspects of the person: the physical, vital, mental, emotional, psychic and spiritual.

Yoga word is mentioned in Veda, Upanishadas, Geeta and Puranaas. The word is derived from Sanskrit word “yuja” which means to join and this unity or joining can be described as union of the individual consciousness or soul with the universal consciousness or spirit. According to the yogic philosophy the health of the body depends on the harmonious flow of specific vital energy which is called as “Prana”. Any obstruction in the flow of the energy produces disease. Regular practice of Pranayam along with Yogasanas, Mudras assures free and harmonious flow of energy and hence health.

As we know that food is important for life similarly Vyayama is also important to build up healthy body. Practicing Vyayama in the form of Yogasana provides bodily strength and keeps away diseases like diabetes, heart diseases, obesity, Vata roga, blood pressure, mental health, and Anorectal disorders.

Physical and mental therapy is one of the yoga’s most important achievements. What makes it so powerful and effective is the fact that it works on holistic principles of harmony and unification. According to medical scientists yoga therapy is successful because of the balance created in the nervous and endocrine systems which directly influences all other systems and organs of the body.

Yoga is far from simply being physical exercises; rather it is an aid to establishing a new way of life which embraces both inner and outer realities and this way of life will become living knowledge only through practice and experience. Modern science has proved that the regular practice of Yogasanas

• Improves the tone and reflex activity of all the muscles in the body including visceral organs like heart, liver, intestines, lungs.
• Improves the venous and lymphatic drainage of all the intra – abdominal and intra – thoracic and intra – cranial organs avoiding chronic congestion. This improves the functioning of all the visceral organs in the cranium, chest and abdomen including the endocrine glands.
• It improves neuro-muscular co-ordination.

As far as Anorectal problems are concerned along with routine Asanas the specific Yogasanas advised are Uttanpaada asana, Paada angushtha asana, Pavanmukta asana, Bhujanga asana, Sarvangaasana, Trikona asana, Dhanura asana, Hala asana, Matasya asana, Tada asana, Nauli, Uddiyan, Yogamudrasna, Sidha asana, Maarjara asana and Ashwini mudra, Laghu shankhaprakshalan, Moola shodhanam.

However, in yoga therapy the concept is to treat the diseased person as a whole rather than the disease only. Hence every person is advised to do the whole course which takes care of all the body parts in general and the diseases part in particular.

• Uttanpaada asana and Paada angushtha asana– This Asana give strength to intestines, keep them disease free and keeps away constipation, gas, and thereby enlighten digestive fire.
• Pawanamuktaasana– This asana is best for Udaragat vaayu and hence for anorectal diseases. The term Pawanmuktasana is a combination of the words ‘Pavana’ (the Sanskrit word for wind), ‘mukta’ which means to relieve or release and Asana (meaning posture). As the name suggests, Pawanmuktasana helps to release abdominal gas and ease digestive disorders that is why it is one of the most commonly recommended yoga postures for people with digestive problems.
• Bhujanga asana– This Asana resembles serpent with its hood raised. It awakens kundalini. The Tiryak bhujangasana squeeze and massage sigmoid colon and rectum. It stimulates digestion and relieves constipation.
• Sarvanga asana– Induces abdominal breathing, massages the abdominal organs. It releases the normal gravitational pressure from the anal muscles relieving hemorrhoid’s.
• Trikona asana– It improves digestion, stimulates appetite, activates intestinal peristalsis, and alleviates constipation.
• Dhanura asana– It leads to improved functioning of the digestive and excretory organs and helps to remove gastrointestinal disorders dyspepsia and chronic constipation.
• Hala asana– It massages all the internal organs, activates the digestion, relieving gas, constipation and dyspepsia.
• Matasya asana– This Asana stretches the intestines and abdominal organs and is also useful for all abdominal ailments. To remove constipation, drink 3 glasses of water and then perform this Asana. This asana is useful in inflamed and bleeding piles.
• Tada asana-The Tadasana mainly acts on the stomach and stretches the colon.
• Yogamudra asana-Best to practice for abdomen, increases digestive fire and remove gas, indigestion and constipation.
• Sidha asana– The name comes from the Sanskrit word Siddha meaning “perfect” and “adept.” It is beneficial for diseases like hemorrhoid’s. It is the best Asana for awakening
• Maarjara asana– Helpful in conditions like Guda bhramsha.
• Markata asana-It alleviates abdominal pain, constipation and gas hence lightens the stomach.
• Nauli– Nauli massages and tones entire abdominal area. It generates heat within the body and stimulates appetite, digestion, assimilation, absorption and excretion. The regular practice of Nauli alleviates constipation, indigestion, flatulence.
• Uddiyan bandha– Uddiyana means to ‘‘rise up’’ It is abdominal contraction performed in padmasana. It corrects stomach ailments, constipation, and indigestion. The digestive fire gets stimulated and abdominal organs are all massaged and toned.
• Moola bandha– It is known as perineal contraction. It awakens Mooldhara chakra. It simulates pelvic nerves and tones the urogenital and excretory systems. Intestinal peristalsis is also stimulated, relieving constipation and piles. It is also beneficial for anal fissures.
• Apana mudra– It removes foreign aliments and keeps away constipation, Guda vikar and Vaayu vikar. Apana mudra facilitates smooth and harmonious downward moving force in the digestive and reproductive organs of the body to regulate the movement of body toxins downward. It relieves constipation and makes the bowel movements regular. It increases sweating and urination also.
• Ashwani mudra– Ashwa means “horse” in Sanskrit, and mudra is a “gesture” or “sign.” The simple practice of a rhythmic contraction of anal sphincter, awakens the shakti (Kundalini), which allows directing the Prana (Apana) flow upward the spine through the main energy channel called In a physical plane the Asana stimulates the abdomen and pelvis area including reproductive and digestive organs. It keeps the body free from gas, constipation and all diseases of rectum, it gives strength and vigour and prevents premature death.
• Moola shodhana– The word Moola literally means ‘‘root’’ and the word Shodana means ‘‘Purification.’’ This technique is also known as Ganesh Kriya. It is for purification of rectum, it is important to purify rectum for free flow of Apana vayu. This exercise must be performed with greatest care. The middle finger or Haridra stalk of the root is used and the rectum is washed again and again carefully. This helps in to maintain strength of external and internal sphincters and keeps away Anorectal diseases. This ends constipation, hemorrhoid’s, indigestion and dyspepsia, and improves beauty and vigour of the body and enlightens the sphere of the digestive fire.
• Pawan basti– This removes vitiated Vayu and cures disease like Hemorrhoid’s.
• Sthala Basti– This could be practiced in Paschimottana asana, move the intestines slowly downwards, then contract and relax sphincter muscles of anus with Ashwani mudra. This practice cleans colon, cures constipation and flatulence and increases digestive fire.
• Shankhaprakshalan– It is also known as Varisar dhauti (Full wash of intestine). The word Shankha means ‘‘conch’’ and Prakshalan means ‘‘to wash completely’’. The word Shankha intended to represent intestines with their cavernous and coiled shape. Shankhaprakshalan alleviates digestive problems such as indigestion, gas, acidity and constipation. It generally tones the liver and other digestive organs and gland. It also gives strength to the immune system. Shankhaprakshalan recharges the entire pranic body, removes blockages from Nadis and purifies all the Laghu shankhaprakshalan- It is short intestinal wash, which is only intended to encourage normal functioning of the intestines. Laghu shankhaprakshalan is highly suggested to persons suffering from digestive disorders like constipation, flatulence, acidity, indigestion.

Yogic Therapy Is Holistic In Nature and It Includes

• Proper diet and water intake.
• Proper exercises and rest.
• Regular practise of Asanas, Pranayam, meditation.
• Practise of Yama and Niyama in day to day life.
• Learn to live moment to moment with awareness.
• Regular practise ‘Laughing Yoga’ One should remember that Yoga therapy is not just practising a few Asanas or breathing exercises but it is an art of total living in such a way that one learns to live free of mental tension Anorectal disorders are an alarming problem for our society today.

Acharyas have mentioned that the root cause for all diseases is Mithya aahaar vihaara, so one should take utmost care of the type of diet consumed i.e the food taken should be Agnideepak & Vatanulomak and thereby corrects Mandaagni and hence Anorectal disorders. In addition to this, Yogic practices, as mentioned in the present study should be practiced as these increase digestive fire, relieve constipation, releases gas, cures dyspepsia and lightens the stomach. By intake of proper healthy fibrous diet and practicing some Yogasanas one can avoid use of medicines.

Hence for the prevention of these diseases, it is compulsory that one should take healthy diet & perform Yogic exercises. Life style modifications can effectively control the increasing incidence of these diseases. So it is necessary to follow Pathya in diseased and healthy state to avoid being a prey of such Anorectal disorders.