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?

An anal fissure or fissure-in-ano is a small, cut in the skin in anal passage which results because of trauma to skin by passing hard stool in this region. Sometimes pain is so severe that patient tends to avoid passing stool in an attempt to stay away from pain.

Symptoms of Anal Fissure: 

  Pain in anal region while passing stool; it may be burning/pricking/Itching in nature.

  Bleeding may or may not be there.

  If untreated for long time; a skin tag known as Sentinel tag or Sentinel Piles develops from the lower end of fissure.

Causes 

The causes related to the emergence of an anal fissure include:

  Passing hard stool which causes frictional injury to inner lining of anal passage.

  Repeated bowel movement or diarrhea

  Trauma to anal canal like by enema nozzle 

Why non surgical treatment is better than Surgery:

Usually surgery (Lateral sphincterotomy) is advised in a view to relieve spasm in anal region so that Fissure starts healing but there are certain complications like stool incontinence etc. associated with this procedure which makes non surgical approach better than surgical intervention. Some of the reasons which make non surgical approach better than surgery for anal fissure are as follows: 

  Acute anal fissure can be conveniently treated by Graded Kshar Karma Treatment. In this treatment a specialized Ayurvedic medicine is applied in fissure region which debrides the fissure and promotes healing. In this way fissure heals completely. So, no need for any surgery at this stage and thus no complication like bleeding, pain, stool incontinence, etc.

  When Fissure is not treated at this stage; a skin tag known as sentinel piles develops from the lower end of fissure. This condition also can be managed by Graded Ksharsutra TM Treatment. In this treatment, Graded Ksharsutra TM - a specialized medicated thread is ligated at the root of sentinel piles and sentinel tag gets detached in 3-5 days. No hospitalization or bed rest is required in this treatment. So, at this stage also fissure can be managed without surgery.

  Delayed healing and Recurrence of Anal fissure are other complications seen after Anal Fissure surgery. Such complications are not seen in Graded Kshar Karma and Ksharsutra Treatment.

  In some case stool incontinence (inability to hold stool; which is far worse than Anal fissure itself) is also seen after Anal Fissure surgery. However, there is no harm to stool control in Graded Kshar Karma and Ksharsutra Treatment.

  No hospitalization or bed rest is required in Graded Kshar Karma and Ksharsutra treatment. Hospitalization and bed rest for a considerable time period is necessary in surgery.

  Graded Kshar Karma and Ksharsutra are more economical than surgery. With this discussion; it is for sure that non surgical treatment for Anal Fissure is far better than Surgery.

Anal Fissure - Non Surgical Treatment Is Better Than Surgery!

There are glands inside the anus that secrete fluids. Sometimes these glands can get clogged. Pus builds up in the blocked clogs, which get infected. This is called an abscess. Unless the abscess is treated right away, it will keep growing. It eventually punches a hole through the skin near your anus to drain the infected tissues and pus. This tunnel that leads from the gland to the hole is called a fistula.

Usually, it is an abscess that causes a fistula. But sometimes a fistula can be caused by tuberculosis, a bowel illness or sexually transmitted diseases.

What are the symptoms of anal fistula?

The symptoms of anal fistula are-

  Pain while sitting down
  Soreness around the anus
  Swelling and redness
  Bleeding
  Painful defecation
  Fever
  Foul secretion from a hole near your anus

How is fistula diagnosed?

If you complain of any of the above symptoms, a doctor will perform a physical examination on you.

Sometimes a physical examination does not reveal a fistula because the fistula can close for a while and then open up again. So then your doctor might ask you to get the following tests done-

  A blue dye test
  Computerized tomography (CT Scan)
  Anorectal ultrasound
  Colonoscopy.

Treatment for anal fistula

Unfortunately, there are no medicines that can treat fistula. If you are diagnosed with fistula, you will require surgery. However, it is a minimally invasive surgery with no risks involved.

The surgery is performed under general anaesthesia. A fistula surgery can be done in the following ways-

  If the fistula is located beneath the sphincter muscles, the surgeon cuts the fistula open so that it can heal and new healthy tissues can develop there.
  If the fistula passes through the upper part of the sphincter muscles, then the surgeon runs a special stitch through the fistula (seton stitch) so that the fistula can drain properly and heal. It takes 6 weeks for the pus to drain and the wound to heal
  Sometimes, a doctor will simply plug the fistula so it does not seep pus.

General and specific complications of a fistula surgery

Though it is a safe surgery, some complications may arise, but rarely. These may be general or specific.

General complications-

  Bleeding and pain
  Scarring around the region of the surgery

Specific complications-

  Pain while urinating
  The involuntary passing of wind or lose faeces

An anal fistula is a painful condition that refuses to go away and the only way to cure it is surgery.

Can Medication Treat Anal Fistula? Find Out!

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!

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!

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

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