pt c/o pain, burning sensation in snap region and constipation since 1 year ..sometime bleeding pr Amy's... age 43 ..sentinal tag 12 nd 6 o clock.. suggest treatment doctor.



@Dr. Rina Upadhyay Ma'am, Sentinel tags or Sentinel Piles at 12 and 6 O' clock are a result of Protection to the Chronic Anal fissures which are ultimately due to prolonged Constipation. Your major Aim is to prevent Constipation and Correction of Agni. No need to operate the Anal Skin Tags. So advise him or her - 1. Nidan Parivarjanam ( Avoid Guru and Pittavardhaka Aahar ) 2. Drink sufficient amount of water as per body's demand not in excess 3. Fibrous diet 4. Sitz bath with Pancha Valkala Kashayam and Sphatika Drava. 5. Kankayana Gulika 1 tab x 2 times after food with Luke warm water 4. Chiruvilwadi Kashayam 20 ml x 2 times in empty stomach with 1/2 glass Luke warm water 5. Mustakarishtam or Rohitakarishtam 20 ml x 2 times after food with 20 ml water. 6. Aayapan vati 2 tab x 2 times after food with Luke warm water to stop bleeding per anus. Do proctoscopy examination to rule out Internal Haemorrhoids.

Thanku so much sir

@Dr. Rina Upadhyay pic pt suffering 6 o'clock and 3 o'clock senital tag but rule out d by finger DX and proctoscopy for more detail of disease..... Because it may be case of internal hemorrhoids WD anal fissure plz rule out in detail WD also WD d further investigation..... Then u can suggest d TT acc to cause of disease. TT...first u should give conservative tt....for 3 to 5 days For eg..1.arshakuthar Ra's 1 bd or TDs aft meal 2.Trifala guggulu vati 1 bd aft meal 3.Bolbadhraras 1 TDs aft meal 4.Abhyaristha 15 ml WD same quantity of wtr. 5.Panchasakar churna 1 tbspn only night time aft meal WD Luke warm wtr. 6.Apply pichu of jatydi ghrita and kasisadi tail 7.Then lastly u can suggest d kstt .

Thanku so much sir

Agree with @Dr. Niranjan Ram and @Dr. P. G. Shah sir... Usually Tags are harmless no need of KS Ligation for them.... but if patient wants then you can go for it.... Burning sensation and pain is Classic Sign of Parikartika You can advise for Avipattikar Churna / Panchashakar Churna according to need... Chitrakadi Vati 1 tab BD Triphala Guggulu 1tab BD Panchatikta Ghrita Guggulu 1 tab BD Drakshasava 20ml TID with equal quantity of water Jatyadi Tailam 5ml P/R twice in a day Sitz bath with luke warm water and Sphatika Bhasma SOS Educate about Pathya-Apathya and Nidana If needed go with Proctoscopy

Chronic fissures ant & post tag some times it bleeds & pain means it is because of on & off constipation so take out the tag's by agnikarma & open the fissures by dilatation during procedure if hypertrophied pappaillae presence do agnikarma. Rest off symptomatic orally medication

Very well explained sir

If it is acute onset of chronic fissure then avoid proctoscopy. Check whether bleeding is mixed with stool or after stool it will hlp you to know about internal haemorrhoids. You can prescribe Abhyarishta 4 tsf bd with equal water Arshkhthar ras 1 bd Triphala guggul 1 bd Jatyadi oil for matra basti Tab nityam 1 -2 hs depinding on condn of pt. For this tag either you can tie them with kshar sutra or you can use cautery (agni karma) to remove this. Tag on both positions shows that pt have chronic constipation, so the spasm of sphincter is also present it can be rule out with DRE. if spasm present it is one of the major cause of constipation and pain during daefication for that you can opt LORD'S PROCEDURE ( anal dilation) which is also described in sushrut samhita or you can opt LATERAL SPHINCTEROTOMY. this will give you good results and there will be less chances for reoccurrence.

Yes u should do protoscopy To rule out internal piles Diet regeim is much more imp Avoid all spicy meal Rx - tab zenarsh 1 hs wid warm water - abhyarishta 4 tsf bd wid equal water - triphala guggul 2 bd - jatyadi taila l/a - drink plenty of water

Piles Use this medicine 1 cap p 9 two bd 2 tab arsh kuthar ras one bd 3 sheikh Pachan churan one tea spon ate night with warm water 4 syp abhyarisht 10 ml two time daily

Sorry Bleeding per anus

रोगी की विबन्थ के लिए त्रिफला चूर्ण 10 ग्राम रात सोते समय दूध के साथ दे। सर्व प्रथम रोगी को विबनध नहीं हो।कब्ज दूर हो जाने पर सभी कष्ट दूर हो जाते है

Burning at anal region and tags probably suggestive of chronic fissure in ano. Do inspect first to rule out fissure / chronic unhealed whitish ulcers at anal region. Ask about no. Of normal deliveries if pt.ll female Ask for straining for internal hemorrhoids grades 2,3... Bulging near primary site of anus ruled out internal hemorrhoids also. Do DRE if no fissure.. Treatment portion same as said above by our Drs.

Thanku sir @Dr. Gunwant Gabhane
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