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

An anal fistula, is also called as fistula- in -ano, it is a small channel that develops between the end of the large intestine called the anal canal and the skin near the anus. This is a painful condition, especially when the patient is passing stools. It can also cause bleeding and discharge during defecation.

Genesis of fistula-in-ano
Almost all anal fistulae occur due to an anorectal abscess that begins as an infection in one of the anal glands. This infection spreads down to the skin around the anus causing fistula-in -ano. The anorectal abscess usually leads to pain and swelling around the anus, along with fever. Treatment for anorectal abscess involves incising the skin over the abscess to drain the pus. This is done usually under local anesthesia. A fistula-in-ano happens when there is failure of the anorectal abscess wound to heal completely. Almost 50% of patients with an abscess go on to develop a chronic fistula-in-ano.

Symptoms

Pain- Constant pain which gets worse when sitting down
Irritation around the anus, like swelling, redness and tenderness
Discharge of blood or pus
Constipation or pain while evacuation
Fever
Diagnosis
A clinical evaluation, including a digital rectal examination under anesthesia, is carried out to diagnose anal fistula. However, few patients may be advised screening for rectal cancer, sexually transmitted diseases and diverticular disease.

Treatment
The only cure for an anal fistula is surgery. The type of surgery will depend on the position of the anal fistula. Most patients are treated by simply laying open the fistula tract to flush out pus, called Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months.

Seton techniques: A seton is a piece of thread (silk, plastic) which is left in the fistula tract to treat anal fissures. This is used if a patient is at high risk of developing incontinence after fistulotomy.
Advancement flap procedures: When the fistula is considered complex, carrying a high risk of incontinence, then this advanced technique is used.
Other techniques like Fibrin glue and Bioprosthetic plug are also used to surgically treat anal fistulas. In the Fibrin glue technique, glue is injected into the fistula to seal the tract, after which the opening is stitch closed. Bioprosthetic plug is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. After this stitches are used to keep the plug in place. 

Whatever the surgical technique, one can experience minor changes in continence. Patients usually don t require antibiotics after surgery but have to take pain medication. They may also have to use gauze to soak up drainage from anus. After surgery, patients should seek help if they have increased pain or swelling, heavy bleeding, difficulty in urination, high temperature, nausea or constipation.

Fistula-in-Ano or Anal Fistula - How It Can Be Treated?

Anal fissure is a condition that is caused when the skin surrounding the anus tears due to excessive strain. Generally, constipation causes the condition, as people have to put a lot of strain during bowel movements. Here is a look at some simple ways to prevent anal fissure.

Natural Ways to Prevent Anal Fissure-
Since the primary cause for anal fissure is constipation, the preventative methods involve reducing constipation.

Increasing fibre content in the diet, with the help of fruits and vegetables can help against constipation.
Staying hydrated and drinking plenty of fluids throughout the day, can also ease stool passage and make it softer.
Avoid straining excessively during bowel movement.
Avoiding spicy foods and chillies in the diet is vital, as such foods can aggravate the difficulty during defecation.
Avoid eating excessive meat and non-vegetarian products.
Drinking buttermilk can also provide relief from the constipation.
Ayurvedic Remedy for Anal Fissure-
Medications for the condition include both oral remedies, which deal with the underlying constipation, as well as topical medicines that can be applied at the site of the problem. Two main Ayurvedic treatment for anal fissure include-

Kshar sutra ligation: In this specialized procedure, a string is attached around the affected region. However, before the string is tied, it is coated in a mixture of healing herbs and natural products. After the string is tied tightly, the benign tissue falls off after 5-10 days. The underlying tissue also gets repaired in a couple of weeks.
Sitz bath: Another easy and effective Ayurvedic remedy for anal fissure is to fill warm water inside a tub. Add a splash of antiseptic liquid in the water and sit inside the tub in such a manner that the anus and buttocks remain submerged in the water. This treatment reduces the pain and discomfort associated with the diseases and keeps the anus hygienic.

Anal Fissure - Ayurvedic Treatment Options For It! 

An abnormal junction or connection between two organs or tissues is referred to as a  fistula . It targets two hollow organs, vessels, or tissue structures. It occurs mostly in the rectum, vagina, however can affect the intestines and the eyes too. It results in extreme pain, discomfort and should be treated as immediately as possible to prevent infection.

It can induce sensations of:

Extreme irritation or itching
Discharge with unusual odor (if the fistula is located near the anus/vagina)
Irritable bowel syndrome
Excess pus
High body temperature
Blood discharge
Diagnosis
In case or prolonged tension and pain in these areas, a proctoscopy should be conducted for diagnosis. It most commonly occurs in women who have sustained prolonged labor (over 2-3 days). However, other causes include:

Digestive malfunction
Abscesses(formation of pus in hollow organs)
An unhealthy lifestyle which includes excessive indulgence in alcohol and tobacco

Ayurvedic treatment for fistulas are available which aim to sooth the inflammation by slowly remedying the wound through natural and safe measures. Since Ayurvedic practices are non-toxic, non invasive and completely safe, one can avoid the drastic measures that surgery consists of, and also avoid the side effects of medicines.

Ayurvedic remedies of fistulas include
Ayurvedic doctors have developed several oils, ointments and medications that are readily available in the market. The medications usually consist of a mixture of herbs, roots and plants that aim to restore the physical systems and also soothe the affected area.

The importance of buttermilk added with rock salt and black pepper also allows the enzymes of our body to multiply and thereby cure the fistulas internally.
Radish juice with a pinch of cumin is also recommended to be consumed after meals to improve digestion and empower the immune system.
A healthy lifestyle and fitness routine consisting of yoga and exercises also contribute to improve conditions in the patient by facilitating blood circulation and metabolism.

Fistula - Treating It With Ayurveda!

Anal Fissure is a small tear in the anal area. This can happen due to injury while passing hard formed stool or even by repeated bowel motion. It may be very painful especially at the time of passing hard stool. 

Symptoms

Most commonly sought symptoms in Anal Fissure are as given below: 

  A noticeable tear in the skin close to the anus. 

  Cutting or burning pain in anal passage while passing stool which may persist for a considerable time

  Sometimes pain is so severe that patient stops eating in an attempt to avoid defecation to avoid pain

  Blood stains on stools may also be there

  If not treated in time; skin starts growing from the lower end of fissure to form a tag known as sentinel tag/sentinel piles.

  At times; sentinel tag may get inflamed.

Causes

  Passage of hard stool through anus. 

  Chronic Diarrhoea

  Trauma to the anus and anal canal like during childbirth

  Inflammation in anus because of crohn's disease or some other inflammatory disease 

Anal Fissure treatment: Diet: High fiber diet like green leafy vegetables, salads, fruits like papaya, chikku are advised. Resins with milk can also be taken in night. Adequate quantity of liquids especially butter milk is advised. Banana, apple etc. should be avoided. 

Graded Kshar Karma & Ksharsutra: Anal Fissure can be completely treated by Graded Kshar Karma and Ksharsutra treatment. In acute anal fissure; stool softener along with Graded Kshar Karma is advised. In this treatment; Graded Kshar - a specialized Ayurvedic medicine is applied in fissure region. This medicine debrides the fissure and induces healing. Usually pain subsides in a week or 10 days time period when fissure is still in healing phase.

Considering pain has subsided; some patients discontinue the treatment to further aggravate and complicate the problem. For complete healing of anal fissure usually 3-5 Graded Kshar Karma sittings are required at a weekly interval. In between these weekly sittings patients are advised to apply certain medicines in anal passage by themselves. If anal fissure has progressed to development of sentinel tag then Graded Ksharsutra TM treatment is the treatment of choice. 

In this treatment Graded Ksharsutra TM is ligated at the root of sentinel tag. Medicine released from Ksharsutra blocks the blood supply of sentinel tag and it sheds off in a week or 10 days time period. No hospitalization or bed rest is required in this treatment. Patient can continue his normal routine activities as usual during his treatment. So, you can say no to surgery in Anal fissure.

Anal Fissure - Say No To Surgery!

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. There are certain conventional surgical methods like Fistulotomy and Fistulectomy, which have been used but they involve certain complications like delayed healing, narrowing down of the blood vessels or other tubular organs. Modern surgical techniques also come up with similar kinds of issues. Thus modern surgery cannot provide satisfactory modes of treatment for this problem.
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 Treatment Of Fistula-in- Ano with Kshar Sutra:

1. 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.

2. 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.

3. No Side-Effects:
As the coatings for the Kshar Sutra involve the use of ayurvedic herbs, so there is absolutely no chance of any side-effect as herbs are completely natural, having antiseptic, debridement and healing properties.

4. 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.

5. 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 garlic, and potato.

6. 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.

Treatment Of Fistula-In-Ano With Ksharsutra!

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