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.


Don't Confuse Fissure With Fistula!

Anal fistula presents itself as a nodular swelling in perianal region. Off and on pus discharge is also seen from this swelling. When pus gets accumulated it gives rise to pain which subsides once the pus discharges out. Usually surgery (Fistulectomy/ VAAFT/ MAFT/ Laser etc.) is advised to manage Anal Fistula. But it is not a good choice as the chances of recurrence of Fistula are very high after these procedures. Whereas Anal Fistula can be completely treated by Graded KsharsutraTM Treatment. 

Clinical trials conducted by Indian Council of Medical Research (ICMR) at AIIMS - New Delhi and PGI - Chandigarh; have confirmed that Ksharsutra treatment is more convenient and more effective than surgery in patients suffering from Anal Fistula. 

What is Graded KsharsutraTM Therapy? How does it Works?

The Ksharsutra therapy is a specialized procedure of Ayurvedic surgery. Ayurvedic surgeon has to first evaluate the anal fistula by clinical examination and if required MRI Fistulogram may be done. Graded KsharsutraTM treatment involves the use of a specialized medicated thread which is placed in Fistula tract. Before placing the Graded KsharsutraTM; it is mandatory to define the fistulous tract properly by careful probing and MRI Fistulogram. 

Medicine released from Graded KsharsutraTM debrides the fistula tract and induces healing. This medicine works for 5-7 days. So, old Ksharsutra needs to be replaced by a new one at a week or 10 days interval till fistula heals completely.

Why Graded KsharsutraTM Therapy Better Than Surgery/VAAFT?

  In appox. 20% cases fistula recurs after surgery however chances of recurrence of Fistula after Graded KsharsutraTM Therapy are predictably NIL.

  Fistula surgery is done under spinal or general anesthesia. So, anesthesia related complications like headache, backache, effect on brain, urinary retention etc. are usually seen while Graded KsharsutraTM is done under local anesthesia which is comparatively safe and there is no complication in it.

  Complications like stool incontinence (inability to hold stool) etc. are seen in surgery. Such complications are not seen in Graded KsharsutraTM Therapy.

  Other complications like pain, bleeding, infection etc. are also seen after surgery. There is no fresh tissue injury in Graded KsharsutraTM so such complications are not seen.

  Hospitalization is necessary in surgery for Anal Fistula. However, Graded KsharsutraTM Therapy is an OPD procedure and hospitalization is not necessary.

  Surgery is followed by bed rest. Bed rest is not required in Graded KsharsutraTM Therapy and patient can continue his normal daily routine activities as usual during this treatment.

  Graded KsharsutraTM Treatment is also more economical and convenient than Surgery. 

Therefore, patients suffering from Anal Fistula are advised to SAY NO TO SURGERY and opt for a better treatment i.e. Graded KsharsutraTM.

Anal Fistula - Why Is Graded Ksharsutra Therapy Better Than Surgery/VAAFT?

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!

An anorectal condition can be difficult to live with and often remains undiagnosed, due to it being perceived as an embarrassing ailment. Fistulas are conditions where two body parts, that are not meant to be connected, become linked as part of the disorder. Rectal fistulas can be painful and standard treatments are available, which can cure the condition. However, these treatments come with serious side effects.

Most people prefer Ayurvedic fistula treatments over the conventional medications for the lack of side effects as such. Ksar sutra is one such branch of treatment in Ayurveda, which has shown tremendous results against fistulas. Here is a look at all that you need to know about Kshar Sutra.

What does Kshar Sutra mean?
Kshar Sutra is a form of treatment, which uses threads laced with the juices of medicinal herbs to treat rectal fistulas.  Kshar  refers to the herbs and  Sutra  stands for the thread used for the treatment. It is a minimally invasive surgical procedure with almost no side effect or danger. The Kshar Sutra form of treatment was first discovered by Sushruta, Vagbhata and Charak. In recent times, BHU s Shalya Tantra Department has once again proved its efficacy in case of rectal disorders.

How is the treatment done?
Once the thread has been coated with the medicinal herbs, the same thread needs to be inserted into the fistula in ano. The patient is anaesthetized and the thread is inserted into the fistula using a probe. The thread is then taken out from the other side and the two ends of the thread are tied together. This thread is changed after every 7 days. This thread insertion effectively cuts the tract and unhealthy tissue is removed from the region.

Why is Kshar Sutra beneficial?
Benefits for this form of treatment include-

Lower risk of anal incontinence, which may occur in case of conventional medicine and surgery.
Lower risk of the anal canal getting narrower after the treatment is completed.
Minimally invasive treatment, which is why patients can resume normal life after just 3-4 days of recovery.
Apart from the treatment, patients should also follow a diet rich in fibre, fruits and vegetables. Drinking large quantities of water will also result in a better prognosis. Lastly, engaging in daily walks will also help you deal with the condition. 

Ksharsutra in the Treatment of Fistula in Ano, Anorectal Disorders!

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? 

A fistula is an abnormal, tube-like connection, a passage or hole that forms between two organs or an organ in your body and your skin. There are various types of fistulas that can develop in different parts of your body but the most common types are-

1. Obstetric Fistulas: This is the name given to a hole between the vagina and rectum or bladder. A vaginal fistula that opens into the urinary tract is called a vesicovaginal fistula and one that opens into the rectum is called a rectovaginal fistula. 

A woman with obstructed labour or labour that is not attended by a doctor or a midwife, can suffer labour pain for up to six or seven days. And as the labour produces contractions that push the baby s head against the mother s pelvic, the soft tissues between the baby s head and the pelvic bone are compressed and do not receive adequate blood flow between the mother s bladder and vagina and/or between the rectum and vagina.
This means that a hole forms on the vaginal wall between the urinary tract and her rectum. The urine and faeces thus start to leak from the vaginal opening causing soiling and foul smell.

Apart from labour, hysterectomies that damage the vaginal wall can also cause such types of fistulas.

Enterovaginal   A woman may have gas and foul smelling fluids leaking out of her vagina due to an enterovaginal fistula which is a hole between the vagina and the digestive tract. It s usually caused due to inflammatory bowel disease or IBD and ulcerative colitis.

2. Anal fistula

These are fistulas that form between the end of the bowel and skin near the anus.

An anal fistula usually develops due to a previous or current anal abscess. An anal abscess is an infected cavity filled with pus found near the anus due to an acute infection in the internal glands of the anus.

Common symptoms are:

Pain in the anorectal area
Swelling
Redness
Fever
Rectal bleeding
Urinary symptoms, such as trouble initiating urination or painful urination
Causes:

Inflammatory bowel disease   a chronic condition of the GI track which causes inflammation
Diverticulitis   An infection in the large intestine
Tuberculosis, HIV
Surgery near the anus
Anal abscess and likewise anal fistula are treated by surgical drainage in which an incision is made in the skin near the anus to drain the infection causing an anal abscess. Hospitalization may be required for patients who have impaired immunity like diabetics.

Anal fistula though has no medical treatment and surgery is almost always necessary to cure it.

If the fistula is straightforward which means one that involves minimal sphincter muscle, a fistulotomy may be performed. This involves cutting open the whole length of the fistula so it heals.
Seton is another procedure in which a surgical thread called a seton is placed in the fistula and left there to help it heal.

Different Types of Fistula and Treatments!

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