Brief Answer: need more information Detailed Answer: Dear XXXXXXX Thanks for contacting Ayurveda with your health concern and following points need(s) more information for Ayurveda Lifestyle Management and Medicines 1. since Anal lesion can vary from piles-perianal abscess-fistula in ano, thus your Doctor has advised to go for scan to confirm the pathology. 2. It is no harm to undergo a scan, since it will provide additional detail on the disease. 3. i. Is this lump/boil associated with bleeding or blood mixed stools?? ii. are you able to sit properly on a chair or willing to sit on the edge?? iii. any discharging sinus or scar in the vicinity of anus [noted by surgeon or you]?? iv. any associated constipation? v. as part of questionnaire, I usually enquire for the following conditions in my patients and same is requested from your side: . any history of: . Sexually transmitted infections . Inflammatory bowel disease . Diverticular disease . Rectal cancer please revert back with following information, till then you can start incorporating following Dietary Regime and Management: -take fresh fruits and vegetables,avoid milk and milk products in diet, excess of tea,coffee,tobacco,alcohol and carbonated beverages. - eat slowly,avoid haste-irregular eating and sweet/heavy food which are difficult to digest and cause indigestion. - take less of strong spices (ginger,garlic), oily-fried-fatty food and flatus producing foods (peas,beans,dals) - take old rice,bottle gourd,moong dal XXXXXXX marich, pomegranate,jaiphal,hot water, adequate rest and sleep. - take fried cumin seeds 500mg, fried asafetida (hing) 125mg, XXXXXXX parpati 500mg, mix them and take with honey three times a day. - 1 glass lukewarm water every morning and night. - drink 1 cup potato juice daily for 1 month. - 4tsf sugar+ 4tsf bitter gourd juice and drink for 1 month - take: elephant yam, papaya, butter milk, pistachio, almonds, pear, XXXXXXX old rice, milk, crystallized sugar, raw radish and avoid tea,coffee,garlic,onion,fish,hot spices, sitting for long hours. - Trifla because of its high nutritional-detoxification [Shodhan] and cleansing value is very helpful in treating your present complaints. [take 3 gm with XXXXXXX warm water at bed time] PS: . if job demands sitting, make sure you get up every half an hour to relax for 5 minutes and then sit back,make a sponge cushion for your chair. . taking amla & aloe vera juice will help in cleansing the liver to speed up the metabolism. . Do not strain while passing stool,and use warm water or wet toilet paper but without perfume or alcohol(without soap) to clean your anus after each motion . Avoid cold/tap/jet (western seat) water. PS. since knowing our limitations, Dietary Regime and Management has been provided from my side, but since you were examined by a surgeon [proctologist] who is in better position to explain the prognosis be in his regular guidance. Dr. Munish Sood Consultant & Physician Naimittika Clinic

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Brief Answer: Prophylactic Treatment Detailed Answer: Dear XXXXXXX Thanks for reverting back with your concern(s) 1. Since willing to sit on the edge, then probably perianal abscess or prolapsed thrombosed piles is likely [consider second opinion and examination] 2. Keeping faith in Present Doctor, just go for Scan. 3. Since only boil is near anus and no sinus or scar is there, hopefully fistula-in-ano is not there [still have another opinion] 4. Since occasional bleeding is there, please mention the following [to the best of your knowledge] i Is bleeding painful or painless? ii. Does bleeding come as spurts, or as few drops and is associated with severe pain or burning during the act? iii. Blood is mixed with stool or comes after motion or comes as streak, by the sides of the faeces? 5. You haven’t mentioned about associated constipation? 6. Neither you have clarified points ii,iii,iv of 5th question [although sexually transmitted diseases are NO] 7. Because Medicine or Therapeutic procedure(s) will be based on the outcome of the scan, make sure you get it done and revert back, till then start the regime as described earlier. PS. complications of fistula [if there] are worrisome, so go for scan/second opinion to rule out the same. Dr. Munish Sood Naimittika

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Brief Answer: Surgical Intervention Detailed Answer: Dear XXXXXXX Thanks for providing with additional details [scan reports] and after consulting my fellow Doctors from both Ayurveda and Allopathy, surgery is the main choice of treatment because of the following reasons: 1. Scan reports confirm fistula in ano which mean there is an open track [which is communicating from exterior to interior], as a result healing won't be there despite any conservative line of treatment. 2. If surgical intervention is not done it will/may lead to multiple openings [fistula tracks] 3. make sure after surgery the excised tissue is sent for histopathological examination [for the cause of infection] because post operatively you will require antibiotics and examination will reveal whether infection is general [simple antibiotics] or it is tubercular in origin [ATT regime] will follow. 4. You can consult with an Ayurveda Surgeon regarding Kshar XXXXXXX or with an Allopathy Surgeon regarding Fistulectomy. PS. CBC [complete blood picture] and Routine Laboratory Investigations are mandatory. Dr. Munish Sood Naimittika

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