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

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

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?

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 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?

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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