Imperforate anus or anal atresia is a congenital anorectal malformation, involving surgical interventions such as posterior sagittal ano-rectoplasty, colostomy, anoplasty, which can lead to lifelong complexities such as fecal incontinence, further degrading the quality of life. Rectal mucosal prolapse is a frequent complication after pull-through operations for high imperforate anus. Although there are diverse options of surgical management of rectal prolapse, no optimal solution is proved yet. Considering the limitations and drawbacks associated with conventional system of medicine, Ayurveda may offer possible solutions to manage the associated conditions such as fecal incontinence (encopresis) and rectal prolapse. However, there is very limited published evidence for the same. In the present case, a 7½-year-old male child was brought to the Ayurveda hospital with complaints of frequent soiling and no control on passing stools. The parents have to excessively rely on the diapers which subsequently lead to inflamed, ulcerated, and painful anal region. On detailed discussion with parents and based on the clinical features, he was diagnosed with Vatika atisara (~Diarrhea due to vitiated Vata dosha ). The treatment protocol was planned based on the pertinent textual discussions and traditional pediatric practices focusing on Shamana chikitsa (~pacification therapy), involving Ayurveda internal medicines along with local therapeutic procedures such as Avagaha sweda (~sudation by sitting in a tub) and Dhupana (~fumigation). The parents were also given dietary advice and asked to engage child in physical exercise-related game to strengthen the pelvic floor. There was complete relief with incidental to nil recurrence of soiling and complete healing of the inflamed anal region. The case report shows the efficacy of individualized clinical approach based on Ayurveda diagnostic assessment and therapeutic interventions in the management of clinical complexities associated with surgical repair of congenital anorectal malformation.
Preetha Anand (Tue,) studied this question.