MANAGEMENT OF CONSTIPATION ASSOCIATED WITH AGNIMANDYA AND SECONDARY ANORECTAL LESIONS: A CASE REPORT

Chronic constipation is a common gastrointestinal disorder that significantly impairs quality of life and may predispose to secondary anorectal pathology due to persistent straining and altered anorectal dynamics. In Ayurveda, Agni is regarded as the central determinant of digestion and metabolism. Impairment of digestive fire (Agnimandya) results in Ama formation and vitiation of Apana Vata, leading to Vibandha (constipation) and its complications. A 33-year-old male presented with severe constipation, abdominal distension, hyperacidity, persistent urge for defecation, anal pain, and perianal swelling for one year. Digital rectal examination revealed increased anal sphincter tone with papillomatous growth at the 10 and 11 o’clock positions and a sentinel tag. Ayurvedic assessment demonstrated Mandagni with features of Vidagdha Ajeerna and Apana Vata Dushti. Management included Deepana–Pachana therapy, dietary regulation, Vatanulomana measures, and Pitta-shamana medications. Due to persistence of structural lesions, anal dilatation followed by surgical excision was performed. The symptom severity score reduced from 17 to 5 following integrative management. This case highlights the importance of correcting Agnimandya in chronic constipation and supports an integrative therapeutic approach for preventing and managing secondary anorectal pathology.