The Clinical Efficacy of Medicated Anal Infiltration in the Management of Parikartika (Fissure-in-Ano): A Pathophysiological and Sphincterometric Review

Background: Parikartika, which closely corresponds to an anal fissure in modern proctology, is an exceptionally painful condition characterized by a linear tear in the distal anoderm. It is driven and sustained by a chronic cycle of internal anal sphincter (IAS) hypertonia and resulting tissue ischemia. Traditional treatments often rely on temporary topical ointments that carry high recurrence rates or trigger systemic side effects like severe headaches. Contemporary Shalya Tantra clinical practice has increasingly shifted toward medicated anal infiltration—the prolonged intra-anal retention and irrigation of specialized formulations like Murivenna, Durvadi Tailam, or Jatyadi Tailam—to directly target sphincter hypertonia and promote effective mucosal repair. Objective: This review examines the physiological mechanisms, classical rationale, and safety profile of medicated anal infiltration. It highlights how high-resolution sphincterometry provides empirical data verifying the therapy's capacity to reduce Maximum Anal Resting Pressure (MARP) and safely break the chronic, spastic cycle of non-healing fissures. Conclusion: Medicated anal infiltration offers a safe, non-invasive, and sphincter-sparing therapeutic strategy. By ensuring sustained drug delivery directly across the high-pressure zone of the anal canal, it provides an excellent, cost-effective clinical alternative to traditional surgical sphincterotomy.