Anal fistula, a challenge for modern surgery, but can be cured with grade ksharsutra in Ayurveda (Indian system of medicine).  Anal fistula is a disease for which different methods of treatment have been advocated time to time, even today when we are talking about robotic surgery, this disease has no satisfactory method of treatment in modern surgery. The latest method of video assisted anal fistula treatment (VAAFT) is not satisfactory due to high incidences of recurrence after the surgery. But at Sushruta Anorectal Institute New Delhi; with the help of Graded KsharsutraTM all these patients of complex Anal fistula are being successfully treated.

In Ayurveda about 2000 yrs ago Acharya Sushruta has indicated ksharsutra treatment to treat fistula-in-ano. Late professor P J Deshpandey at the faculty of Ayurveda Institute of Medical Sciences B H U; had done extensive research in this field and established a treatment module to cure this disease. In 1990 Indian council of medical research has clinically evaluated this Ayurvedic treatment module at four premiere institutes in our country including AIIMS Delhi & PGI Chandigarh. Subsequently, it was concluded by I.C.M.R. that in the patients of fistula in ano, ksharsutra treatment is more effective& convenient as compared to modern surgery.

Ksharsutra is a thread coated with certain Ayurvedic medicines known for their antiseptic, debridement & healing properties. After u v sterilization this medicated thread (ksharsutra) is used under complete aseptic precautions in the patients. The patient is routinely investigated with special reference to any other associated disorder like hypertension, diabetes mellitus, tuberculosis etc. The next step lies in the proper identification& evaluation of the fistulous tract. It is mandatory to define the fistula tract wrt its depth, direction & branching pattern. This may be achieved by careful probing under expert hands using malleable probes& if required help may be taken from other investigations like x-ray fistulogram or MRI fistulogram. 

Once the tract has been clearly defined the Ksharsutra is placed in it with the help of certain instruments, under local anesthesia. This entire procedure is usually completed in ten to fifteen mins. As there is no cutting of tissues hence no bleeding, no pain & patients can go home after half an hr rest in the daycare room. The medicine-coated on the thread is gradually released in the tract. The cumulative effect of the coated drugs exerts a powerful debridement effect on the fistula tract & induces healing by the fresh & healthy granulation tissues. Thus Ksharsutra is the mechanism of drug delivery precisely at the tissues involved. 

Every seventh or tenth day the old sutra is replaced with a new Ksharsutra till there is a final cut through. It has been observed that the tract heals @ 0.5-1 cm per week. The post-operative complications like recurrence of the disease, fecal incontinence, bleeding is not seen with Ksharsutra treatment. Further, this therapy is performed as an OPD procedure. No general anesthesia & no hospitalization is required. Patient maintains his normal routine activities as usual during the treatment period. 

 At Sushruta Anorectal Institute; Rohini - New Delhi, we have been working on this disease including piles fissures & pilonidal sinus for the last 30 yrs. Here we have developed the concept of Graded KsharsutraTM which has given us a more effective & convenient way to treat anal fistula. At Sushruta Anorectai Institute we have treated on record thousands of patients of anal fistula from different states including overseas patients. We have records to prove that the patients of high anal complex fistula, those have been operated two or three times but failed to heal were successfully treated at this institute.

How to Treat Anal Fistula Naturally without Surgery

Peptic ulcer, often referred to as stomach ulcer, is usually a misunderstood disease. Most people are unaware of the reasons why the ulcer is caused and are also unaware of the early symptoms of the disorder. Here is a look at some of the strange facts about peptic ulcers that you may not know.

Stress does not cause ulcers: The myth that stress causes ulcers is just that- a myth. Ulcers are not caused by stress and tension. However, if you are already affected by an ulcer, stress can alleviate the symptoms and make matter worse. Non-steroidal anti-inflammatory drugs can result in ulcers. So, if you have already been diagnosed with peptide ulcer, try not to stress too much.
Ulcer pain is not caused due to food: Contrary to popular belief, ulcer pain is not alleviated when you eat something. In fact, pain increases if your stomach remains empty for a long period of time. So, if you are an ulcer patient, make a point of eating at regular intervals. In fact, the American College of Gastroenterology claims that people with ulcers do not need to follow a bland diet in order to recover from the condition.
Heartburn medication is effective against ulcer: Stomach acid is the common link between heartburn and ulcer, as both of these disorders are caused as a result of excess acid formation in the stomach. This is why physicians often prescribe antacids to ulcer patients.
Untreated ulcers can be problematic: Ulcers are easy to cure and can be completely treated with proper medication and adherence to restrictions. However, you should seek treatment for ulcers as soon as it is diagnosed. If left untreated, this ulcer may go on to cause severe issues for the patient. For instance, untreated ulcers may lead to internal bleeding and scar tissue. The same also impedes the digestive process. So, do not leave ulcers untreated and think that they will be repaired automatically over time.
Endoscopy is the best way to diagnose ulcers: Even though X-rays may often reveal ulcers, a normal X-ray cannot detect certain smaller ulcers. Endoscopy is the best way to detect the disorder. In this process, a small tube, containing a light and a camera, is inserted inside the patient s esophagus. The camera reveals any abnormal growth or infection inside the stomach. If you suspect an ulcer, book an appointment with the doctor as soon as possible. 

Peptic Ulcers - Strange Things About It!

Diarrhea occurs when the body is expelling germs out of it. An episode of diarrhea can last anywhere from a couple of days to a week. Dehydration, cramps, vomiting, nausea and fever often accompany diarrhea. Usually, children tend to get diarrhoea more than adults.

Diarrhea treatment according to causes behind it

Treating diarrhea due to infection: Some common causes of diarrhea include infection from rotavirus, salmonella (a type of bacteria) and rarely giardia (a type of parasite). In children, virus is a common cause of diarrhea. Besides watery or loose stools, viral gastroenteritis infection symptoms include fever, headache, stomach ache and vomiting. Gastroenteritis diarrhoea can last for 5-14 days. During this time, fluid loss must be prevented. In younger children, oral rehydration solution (ORS) or breast milk is enough. Just feeding them water won t replenish the potassium, sodium and other nutrients they lose. Older children, to prevent fluid loss, can be given ORS and popsicles to counter dehydration and vomiting.
Treating diarrhea due to medications: Antibiotics or laxatives can cause diarrhea in children. If the diarrhea is mild, make sure your child is hydrated. If the antibiotics are causing diarrhoea, you need to continue medication, but do consult your doctor immediately.
Treating diarrhea due to food poisoning: When it comes to food poisoning induced diarrhea, the same method as countering infection-induced diarrhea should be followed. Keep your child hydrated and call your doctor.
Diarrhea and children - recognising dehydration

The most serious complication of diarrhea is dehydration, especially if the diarrhea is severe. Severe dehydration is critical as it can cause brain damage, seizure, even death. Your child may need immediate medical attention, if you notice the following symptoms:

Light-headedness and dizziness
Sticky, dark mouth
Dark yellow urine
No or few tears when crying
Dry, cool skin
Loss of energy
When should you visit a doctor

Diarrhea resolves within a few days, but it can have serious complications. Call your doctor if you notice signs such as:
1. Looks very sick
2. Diarrhea has persisted for more than 3 days
3. Your child is less than 6 months old
4. Your child is vomiting bloody yellow or green fluid
5. Seems dehydrated
6. The fever reads above 105 degree Fahrenheit
7. Bloody stools
8. Rashes
9. Stomach pain persists for more than 2 hours
10. Infrequent urination

Diarrhea - How to Treat it in Children?

Abdominal pain can be triggered by a number of factors. Sometimes, it's mild enough to be overlooked while at others, the pain can be debilitating. Most abdominal problems start with the same symptoms and hence the cause of this pain can be a little difficult to pin point. In many cases, the location of the pain can help understand the factors that are triggering it.

Generalized pain can be simply be triggered by indigestion. On the other hand, it could also be a symptom of a number of illnesses like irritable bowel syndrome, appendicitis, viral gastroenteritis and intestinal obstructions etc. However, the former are more common. This type of pain resolves itself without medical intervention.

In other cases, abdominal pain can be localized to the upper or lower abdomen on the right or left side or in the centre of the abdomen. This sort of pain is usually sporadic and comes and goes with great intensity. In most cases, this sort of pain is a symptom of a serious problem and should not be ignored. One of the most common examples of localized abdominal pain is the pain caused by appendicitis in its later stages. Severe pain that is located just above the centre of the belly button could be a sign of pancreatitis. A burning sensation and severe cramps in the center of the stomach could point towards stomach ulcers that could cause perforations if left untreated. Other causes for this type of pain include endometriosis, ovarian cysts, angina, kidney infections and a spleen infection.

Mild stomach pain whether localized or general can be relieved using home remedies and does not often require medication. However, if the pain is severe or if it comes on suddenly, you must immediately consult a doctor. Another reason to consult a doctor is if the pain persists for more than 24 hours. If the pain is accompanied by black or bloody stools or vomiting and nausea, do not ignore it. Black stools are often an indicator of the presence of blood in the digestive tract. Abdominal pain that worsens with movement or is tender to touch is also something that should be shown to a doctor. Other reasons to consult a doctor are abdominal pain with persistent vomiting following meals and unexplained weight loss and a loss of appetite.

The bottom line is, that when it comes to abdominal pain, it's better to consult a doctor and be told that there's nothing to worry about rather than self medicate and wait for it to worsen.

Abdominal Pain & When To Consult A Doctor

The liver is the engine of the human body. It is basically composed of 2 types of cells (a cell is the basic building block of the human body)   hepatocytes (liver cells) and cholangiocytes (bile duct cells). It also has other supporting tissue and their respective cells. The hepatocytes are by far the most numerous cell type, not surprisingly tumours (otherwise called mass or lump.  Tumor  means lump in Latin), of this cell form the majority of abnormal growths in the liver. Abnormal growths can be benign (that is, they do not grow rapidly, spread to other parts of the organ or to other parts of the body) or malignant (grow rapidly, spread to other parts of the organ and to other parts of the body, i.e. cancer). These abnormal growths from liver cells are Focal nodular hyperplasia (FNH), Adenomas (the benign variety) and hepatocellular cancer (otherwise called Hepatoma/HCC, the cancerous type). What we need to recognize is that certain adenomas can turn into HCC, over a period of time. The other type of growths in the liver are those that have originated elsewhere in the body and spread to the liver, for example a growth of the breast spreading to the liver. These are in fact the commonest tumours of the liver. I will discuss these at a later date.

Benign growths of the liver

Common benign growths are Haemangiomas, FNH and Adenoma. Most of these are identified when a scan is performed as investigation for some other problem. Accurate diagnosis of the nature of these lumps is important to determine the type of treatment needed. This can be ascertained by a carefully selected scan like an Ultrasound, CT scan or an MRI. The technology of these scans is continuing to evolve and get better year on year. There are different types of Ultrasound, CT and MRI scans with different applications, based on whether contrast is used or not, the different phases of scanning, the type of MRI scanning sequence etc. Therefore, these scans although commonly available and used very frequently, need to be performed under the supervision of a team involving Liver doctors and radiologist who is well versed in the diagnosis of liver lumps, for accurate diagnosis without the need for unnecessary tests (Box 1).

Haemangiomas are by far the commonest. It is estimated that 5% of the adult population harbor this lump in their livers! They occur in both sexes and at all ages but are commonest between 30 to 50 years in women. Most of them are small, less than 4-5 cms in diameter and are are identified on Ultrasound. MRI and its various applications is the scan of choice for accurate diagnosis. This is crucial as most of them do not need treatment.

Focal Nodular Hyperplasia (FNH) are the second most common liver lumps. They are usually single and small (less than 4 cms) and occur in women between 35   50 years of age. About 2.5-3% of population harbor this lump in their livers. Special MRI techniques using special contrast agents is diagnostic and the findings are quite distinct from haemangiomas. Again treatment is not recommended apart from selected circumstances. Assessment in a dedicated Liver team is recommended for accurate diagnosis and a proper management plan to be formulated.

Hepatic adenomas (Hepatocellular adenoma, HCA) are rare lumps and occur in 0.2 to 0.3% of the population, again occurring mostly in young women during their reproductive period. They are again solitary and most usually 3-4 ms in diameter.

There are a couple characteristics which make this lump different from the previous 2, there is a strong relation between hormones the development of HCA and some of these HCA can turn into the malignant Hepatocellular carcinoma (HCC). Therefore, accurate characterization and diagnosis of these HCA is essential. Sometimes biopsy of the lump, molecular and genetic tests maybe necessary to determine if the HCA has a high chance of progressing to HCC. Imaging tests are generally adequate, contrast MRI Liver and its different techniques is accurate in diagnosing HCA and sub-typing it, however CT and contrast-enhanced Ultrasound is sometimes necessary along with MRI.

Generally, a HCA in a male is recommended for surgical resection. While in women, discontinuation of the OCP pill/ any other such hormone is recommended for a period of 6 months, if the HCA does not have any worrying features and size is less than 5 cms. IF HCA is larger than 5 cms and has features suggestive of a high risk for change to HCC, surgery is advised. Again these decisions have to be made as a part of a Multi-disciplinary team (Box 1)

Malignant growths beginning within the Liver

As mentioned earlier, usually malignant growths which are seen in the liver spread to it from elsewhere in the body. Hepatocellular cancer/Hepatoma (HCC) is the commonest malignant tumour beginning within the liver, as apposed to those that spread to the liver from elsewhere. It occurs between 40-70 years of age and occurs commonly in men. It is estimated that 17000 new patients develop this tumour every year in India. The vast majority (> 80%) of these develop in patients who have chronic liver disease (cirrhosis). Importantly the number of HCC cases is increasing year on year as cirrhosis due to fatty liver disease, Hepatitis B (3% of Indian population carry this virus, ie nearly 40 million individuals) and alcohol are continuing to increase in India. Nearly overall it is the 4th or 5th most common cause of cancer and the second most common cause of cancer-related death. This is continuing to increase too. We do not have a national policy in India to screen and diagnose these lumps in the liver at an early stage. Most patients present at a late stage when effective treatment is not possible.

Hepatitis B is a vaccine-preventable disease, there are good drugs to treat it and decrease the risk of cirrhosis and HCC in HBV patients, therefore it is important to test for this virus infection. The fatty liver disease can cause chronic liver damage and HCC, regular exercise and consuming a balanced diet can reduce the risk of fatty liver disease.

The usual mode of detection of these growths is when a scan is done for some other reason. Occasionally patients can develop pain in the abdomen or jaundice which leads to an investigation. The treatment of HCC depends on the extent of tumour, the extent of the chronic liver disease (the stage of cirrhosis) and the overall condition of the patient. These patients are best seen, assessed and treated in a team (Box 1) which specializes in the treatment of Liver disease.

The best treatment for HCC is surgery. However, this is suitable only for certain carefully selected patients. This can take the form of liver resection (where a portion of the liver with tumour is removed) or liver transplantation (where the whole liver is removed and a donated liver (full or partial) is replaced into the patient. Indeed surgical has excellent survival rates; more than 75% of patients survive for more than 5 years after resection or transplantation making treatment for these cancers one of the most satisfactory.

Other treatments which can be combined with surgery in selected patients or can be combined with patients not suitable for surgery are different types of Interventional radiological therapy   chemotherapy or radiotherapy delivered through fine catheters introduced into the blood vessels of the liver (TACE: Transarterial chemotherapy, TARE: Transarterial radiotherapy) and or heat energy delivered to the tumour area by means of carefully placed needles/probes (RFA: radiofrequency ablation, MWA: microwave ablation).

HCC is unique cancer as its treatment should be tailored to the patient, the treatments are varied and range from catheter-based non-invasive treatment to major surgery and transplantation. This necessitates that HCC patients are best managed in a multidisciplinary team which is highly skilled in and specializes in the management of liver diseases.

Box 1: A liver tumour multidisciplinary team   Integrated Liver Care team

The team should be one with expertise in the management of benign liver lesions and should include a Hepatologist, a Hepatobiliary & Transplant surgeon, Diagnostic and Interventional radiologists, Medical oncologist and a Pathologist.

Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions.

The team should be one with the skills required not only to appropriately manage these patients but also to manage the rare but known complications of diagnostic or therapeutic interventions.

The Increasing Problem Of Liver Tumours In India!

Think you may be constipated? For somewhere in the range of, a bowel development each other day is totally ordinary (however, Ayurveda would at present prescribe a few methodologies to expand consistency). For others, only one day without a bowel development is a certain indication of clogging. Likewise with most things in Ayurveda, the setting of every person (and his or her experience of the circumstance) is significantly more critical than any one-size-fits-all meaning of what is healthy or typical.

The Ayurvedic Perspective
As indicated by Ayurveda, blockage happens when vata's cool and dry qualities irritate the colon, repressing its appropriate working. The remedy is to include warmth, oil, and hydration to the framework with a specific end goal to counter the overabundance vata. The accompanying procedures particularly counter vata's cool and dry qualities and can be exceptionally useful in supporting the arrival of ordinary bowel movements.

Drink Lots of Warm or Hot Water and Herbal Tea: Drink no less than 80 ounce of water or natural tea every day. Warm and hot liquids are best since they adjust vata's frosty quality. It's additionally imperative to drink the larger part of these liquids far from dinner, no less than 20 minutes prior, or 1 hour in the wake of eating.
Expand the Quantity of Organic Oils in Your Diet: Top notch oils grease up the tissues so that a fitting measure of oil or fat can stay in the stool. While most oils are for the most part steady, the best oils for vata are sesame oil, ghee and olive oil.
Eat Plenty of Fruit: Natural product is hydrating, sinewy and for the most part assuaging to vata. Particularly strong decisions incorporate ready bananas, peeled apples, drenched raisins, doused prunes, and peaches. Be certain to eat the organic product no less than one hour before or after different sustenance and bite them altogether to get the most extreme advantage.
Drink Some Fruit Juice: Pineapple squeeze and prune juice are especially viable at moving abundance vata in the colon. It is likewise fine to warm or weaken natural product juices with water.

Proper Bowel Movement - Easy Ayurvedic Remedies for it

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