Fissure in Ano, also known as Anal Fissure, is basically a small longitudinal cut in skin that lines the opening of the anus. Fissures cause bleeding and severe pain in the bowel movements. These are very common in the general public, but often confused with other pain. A fissure can happen at any point in your lifetime and can have equal general distribution.

Types of Fissure in Ano:

  Acute Fissure: Fissure in Ano less than 6 weeks of duration is known as Acute Fissure.

  Chronic Fissure: Anal Fissure with more than 6 weeks of duration is known as Chronic Fissure. 

Causes of Fissures in Ano:

  Anal fissures are basically caused by stretching of the anal muscles beyond its capability.

  In adults, it is caused by the passing of large stools, constipation or by prolonged diarrhea.   In older adults it is caused by the less flow of blood to that area.

  It is also caused by sexually transmitted infections (syphilis, chlamydia, herpes) and it results in fissures.

  Anal sex can also be the cause of fissures.

Symptoms of Fissures in Ano:

  Tear in the skin around the anus

  Small lump of skin, or skin tag next to the tear

  Pain during bowel movement

  Stools with blood or pus

  Itching and burning in the anal area 

Preventions During Fissures in Ano:

  One should drink enough water.

  One should have high fibre diet so that one does not suffer from constipation.

  Be careful and hygienic after anal defecation.

  In case of suspected fissure or any kind of pain, use a lubricating ointment.

  Sit in lukewarm water

Treatment for Fissures in Ano

Surgical treatments are not recommended, but there are some other measures that can be taken and are listed as follows:

  Some prescribed medication to lower the severity of pain.

  Nitroglycerin ointment may help heal the fissure.

  Having a rich fiber diet as a lifestyle change.

  Drink enough water as that helps in softening the stool.

  Sometimes Stool softeners may be required to soften the bowel movement.

When Anal Fissure does not heal with all of the above listed things, then a surgery may be required:

  Lower most part of the internal anal sphincter is divided laterally. With this acute fissure heals of its own. In chronic cases one may require to undergo fissurectomy.

  The surgery decreases the anal pain and spasm, allowing the fissure to heal.

  If a sentinel pile is present, it is removed to heal the fissure. 

It is important to note that any kind of treatment requires 6-10 weeks to recover. However, the pain may disappear just after 2-4 days after the surgery. One must consult a doctor before going for any treatment. This surgery can also be performed with LASER,where there is less trauma and early recovery is posssible.

Fissure In Ano

AV or arterio-venous fistulas are unusual linkages between arteries and veins. In general, pure blood passes from the arteries to the capillaries to the veins and becomes devoid of nutrients and oxygen (becomes  impure ) by the time it reaches the veins. The capillaries in between absorb the nutrients, to supply them to the tissues and organs lying beneath them. In the case of AV fistulas, the capillaries are bypassed and blood passes directly between the arteries and the veins. Thus, organs are deprived of nutrients.

This can be a severe condition, leading even to heart failure.

AV fistulas and dialysis

Sometimes, AV fistulas have to be deliberately created on the body, to treat for severe kidney ailments requiring dialysis.

What is the surgical procedure for creation of AV fistulas for dialysis?

Following are the steps-

  A vascular specialist checks your arteries and veins to make sure they are sturdy enough to be able to support an AV fistula.
  Then, with the help of wave techniques or an angiogram, the depth of your blood vessels is recorded.
  Anaesthesia is then used on the spot, which is chosen for your AV fistula. Local anaesthesia (anaesthesia of only that spot) is preferred over central anaesthesia (anaesthesia of the whole body).
  With the help of a small cut on the skin surface, the surgeon accesses your blood vessels and makes a connection between arteries and veins.

After this process is completed, dialysis takes usually some weeks to begin.

Why should you go for AV fistula?

Following are the advantages-

  Foreign chemicals or devices, which may cause invasion and damage to vital internal organs, are not introduced in your body.
  As only local anaesthesia is administered, you have to spend significantly less recovery time or  downtime  after surgery.
  There is less chance of the wound becoming infected.
  There is a reduced danger of clotting.

AV fistulas are in essence an unusual connection between your arteries and veins, leading to undernourished organs due to capillaries being bypassed. In some cases like dialysis, AV fistulas need to be created and closely monitored. There are several advantages to this, but you will also need recovery time after the procedure is over.

AV Fistula - Its Surgery & Creation Of AV Fistula For Dialysis!

Fistula-in-Ano is a type of an abnormal hollow cavity that is lined with granulation tissue. It connects a primary opening inside the anal canal to the second opening in the perianal skin. Ayurveda has perfect surgical techniques which can help you root out this problem without leaving any chances of recurrence.

Kshar Sutra is basically an ayurvedic parasurgical treatment that involves management of Anorectal disorders for treating Fistula-in-Ano. The technique is minimally invasive in nature. Following are some of the tips related to the Ayurvedic Management & Kshar Sutra in Fistula-in-Ano:

Safe and Extremely Cost-Effective: This type of surgery uses a thread, also known as Kshar Sutra, especially prepared by herbal chemical cauterization. Cauterization is the medical practice of getting part of the body burnt, for either removing or closing off a particular part to cure diseases like Fistula-in-Ano. Hence, people can safely go for this treatment procedure because there is absolutely no risk element involved. Moreover, as the use of thread is involved in treating the problem, so basically, the minimum expense is involved. So, patients need not pay much.



Customized Treatment: Usually, three kinds of Kshar Sutra get used, depending upon the number of coatings and the quality of materials implemented. Coatings are created with ayurvedic herbs and treatment for each and every patient takes place in a customized manner depending upon their individual requirements.

Can Get Rid of Other Disorders: While undergoing the Kshar Sutra treatment for Fistula-in-Ano, patients are even routinely investigated with a special type of reference for any other associated disorder like Hypertension, Tuberculosis, Diabetes Mellitus etc.

So, Kshar Sutra not only helps people to get relief from the problem of Fistula-in-Ano but also assists in getting rid of other associated problems.

Maintenance of Diet as Part of Ayurvedic Management: Those patients, who suffer from the painful disease of Fistula-in- Ano, Ayurveda instructs them to maintain a healthy diet in the form of fruits and vegetables. On the contrary, they must avoid the excess amount of spicy foods, along with items that cause constipation and even make sure to not have too much of garlic, chillies and potato.
Keep Yourself Hydrated: Drinking plenty of water is extremely essential as this helps to clear off the channels and also allow people to flush off stools and toxins from the body.

Fistula-In-Ano - Ayurvedic Management & Surgery (Ksharsutra) For It! 

The area in and around anal region is some time affected with pain swelling and pus or watery discharges. This abnormal presentation may be due to anal fistula. It is characterized by a nodular swelling in or around anal region with occasional pain and watery or blood mixed pus discharge. The symptoms might be mild but as the time passes the fistulous tract may become deep and develop multiple branches with multiple openings. This makes the treatment more difficult. Therefore it is always advisable as soon as this condition is diagnosed it should be treated promptly to avoid further complications. 

Causes: The causes of anal fistula are many. The major reason is the formation of pus. Incompletely cured abscess, microbial infection, ulcers, inflammation of anus and the region around it, and complications that arise out of a surgery can cause the anal fistula. The individuals suffering with diabetes, ulcerative colitis, malignancies and also individuals undergoing chemo or radiotherapy or having some other immune compromised conditions are prone to develop anal fistula. 

Treatment: Practically it has been noticed that any amount of oral medications either from allopathy/ homeopathy or Ayurveda is not of much help. In allopathy the surgeons usually advice Fistulectomy i.e. complete excision of fistulous tract or VAAFT   Video Assisted Anal Fistula Treatment. However in both these case a fairly high incidence of recurrence has been noticed. In Ayurvedic surgery; Fistula has been categorized among eight diseases which are difficult to cure. A highly specific Ksharsutra procedure has been advised in Ayurvedic surgery to treat this problem. Subsequently, efficacy of this Ksharsutra therapy was compared with surgery in 1991. This clinical trial was conducted by Indian Council of Medical research at AIIMS New Delhi and PGI Chandigarh. They have clearly reported that Ksharsutra treatment is more convenient and more effective as compared to surgery in the patients of Anal fistula. The recent concept of Graded Ksharsutra has further improved the efficacy of this therapy. Facility of Graded KsharsutraTM is available only at Sushruta Ano rectal Institute Rohini; New Delhi. 

Ksharsutra Therapy: It is a highly specific and most effective amongst all available treatments for the patients of Anal Fistula. In this treatment; the first step consists of proper identification of fistulous tract with respect to depth, direction and branching pattern. This is usually achieved by careful probing or taking the help of MRI Fistulogram, Ultrasound etc. One the tract has been defined Ksharsutra is placed in the tract with the help of malleable probes under local anesthesia. Since there is no injury to the soft tissue hence no pain or bleeding is expected after this treatment. Patient can continue his routine activities as usual from the very first day. The Ksharsutra   medicated thread is changed at weekly interval. Usually the Fistula heals @ 0.5 to 1 cm per sitting. Therefore the anal fistula which is 4-6 cm long they usually heal in 8-10 sittings. After Ksharsutra Treatment the sphincter control remains normal and the fistula heals completely.

Anal Fistula - How Can It Be Treated Using Ayurveda? 

If you think fissure and fistula are the same, you are mistaken. While the term fissure refers to the tear of the skin, fistula refers to the abnormal tube-like passages or connections between organs. Fissures get cured with or without treatment in a few days to few weeks, and do not lead to complications. On the contrary, fistulas when left untreated may lead to complications.

So, read on further to know about the distinction, how to recognize the symptoms and avail treatment.

What is anal fissure?
An anal fissure can occur due to various reason, such as prolonged diarrhea, anal sex, vaginal childbirth, rectum cancer, etc. For majority of the cases, it is usually due to constant constipation or strained bowel movements, that tear down the muscles controlling the sphincters to the inner rectum or the anal canal.

What is anal fistula?
Anal fistulas are not tears but abnormal abscesses near the anus, filled with pus. In fistula, a tunnel is formed under the skin which connects these abscesses to the infected glands. Fistulas are usually the results of present or previous abscesses. If ignored or left untreated, one single fistula can lead to the development of a more complex fistula, where the single fistula tract ends up creating multiple openings.

Symptoms of anal fissure and anal fistula
Some of the common symptoms of an anal fissure are excruciating pain in the anal area every time the bowel movement occurs, constant itching or burning sensation in and around the anus, bloody stool and visible tears and cracks around the anus.

For anal fistula, some of the very common symptoms are a throbbing pain in the anus, which continues to increase, difficulty in sitting down for longer period, swelling and redness around the anus, accompanied by skin irritation, discharge of blood and pus, and at times fever.

Treatment options
To completely cure anal fissure and fistula, it is the various surgical options that are the most effective ones. However, when diagnosed in its earliest form, medications like antibiotics, analgesics, and antipyretics can often help. It is solely depending on the location, type, and size or severity of the fistula or fissure, the treatments may vary from person to person and so does the recovery time.

Though, these conditions cannot be cured with dietary changes or exercise, following a healthy diet can boost healthy bowel movement, reducing chances of constipation or diarrhea that results in fissures.
Prevention is always better than cure. Therefore, it is essential that you visit the nearest medical facilities once you notice any signs of fissure or fistula , to avail the right treatment and get relief from the symptoms quickly.


Is It Fissure Or Fistula? Don't Get Confused!

Anal Fistula - What Causes It? 
An anal fistula refers to a small infected tunnel connecting the anus to the outer skin. Your body eliminates solid waste products or feces through the anus. When any of the glands inside the anus becomes infected or blocked, an abscess may form, which in turn results in formation of anal fistula. In about 50% of the cases, abscesses develop into fistulae. What are the causes for anal fistula? Anal fistulae occur primarily due to the formation of an abscess or infection in the anus. If the abscess does not heal completely after the pus has been drained away, a fistula can develop. 

Other factors responsible for the occurrence of anal fistulae are- 

Crohn s disease- a chronic condition where the digestive system becomes inflamed. 
Diverticulitis- an inflammation of the small pouches that develop along the intestinal walls. 
Hidradenitis suppurativa- a chronic painful skin condition which causes scarring and abscesses on the skin. Apart from these, people with HIV or infected with Tuberculosis disease also develop anal fistulae. If you ve had a surgery around the anus, then post-surgery complications may lead to infection or abscess on the skin. 
What are the symptoms to watch out for? 
The commonly observed signs and symptoms of anal fistulae include- 

Irritation or discomfort on the skin around the anus 
Occasional throbbing pain, especially while seated, moving around or having a bowel movement 
Nodular swelling around anal region 
Intermittent Discharge of blood or pus from an opening near anal orifice. 
How does Ayurveda treat anal fistulae? 
Ayurveda recommends Ksharsutra treatment for complete healing of Anal Fistula. 

In this procedure; Ksharsutra   a medicated thread is placed in Fistula tract. Medicine released from Ksharsutra debrides the fistula tract and induces healing. This medicine remains active for about 5-7 days so this thread needs to be changed with a new thread at weekly interval. No. of Ksharsutra changes required for complete healing of Fistula depends on length depth and branching pattern of fistula. It has been observed that Fistula heals at the rate of 0.5 to 1 cm per Ksharsutra changes so for a fistula tract of 3 cm length about 4-5 weekly thread changes are necessary for complete healing. Clinical trials conducted by Indian Council of Medical Research at AIIMS New Delhi have proved that Ksharsutra treatment is more convenient and more effective than Surgery in case of Anal Fistula. In this way Ksharsutra is the best way to treat Anal Fistula without Surgery.

Anal Fistula - What Causes It?

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