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?

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!

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!

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!

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! 

Anal Fistula is a tunnel like communication structure between anal canal and outer skin. There are certain glands in anus whose secretions keep the anal passage lubricated. If due to any reason infectious agent invades these glands abscess formation occurs which subsequently spreads towards the skin and bursts outside forming an external opening.

So Anal Fistula presents itself as a nodular swelling in area surrounding anal opening. Intermittent pus discharge is seen from this swelling. When pus has accumulated there will be swelling and pain which subsides once the pus has been discharged and this cycle goes on.

Anal Fistula Treatment:

Anal Fistula cannot be treated by oral medicines only - Homeopathic/ Allopathic or Ayurvedic whatever it may be. Continuing oral medicines in hope for fistula treatment only worsens the problem. Different surgical options have been tried to treat Anal Fistula like Fistulectomy/ VAAFT/ Laser/ LIFT etc. but not satisfactory results have been found. A high incidence of recurrence around 20-25 % has been observed with these procedures. 

Besides this other complications like stool incontinence etc. are also seen if there is some damage to sphincter muscles. However Anal Fistula can be completely treated by Graded KsharsutraTM Treatment. Clinical trials conducted by Indian Council of Medical Research (ICMR) at AIIMS new Delhi; PGI Chandigarh and other premier institutes of medical sciences; have proved that Ksharsutra treatment is more convenient and more effective than Surgery in patients suffering from Anal Fistula.

In this treatment; first of all Fistula tract is defined with respect to depth, direction and branching pattern by careful manual probing and MRI Fistulogram. Once the Fistula tract has been defined properly; Graded KsharsutraTM - a specialized medicated thread is placed in Fistula tract. Medicine released from 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 thread at week or 10 days interval.

No. of Ksharsutra changes required for complete healing of Fistula depends on length of Fistulous tract. It has been observed that a Fistula tract of 3 cm length usually requires 4-5 Graded KsharsutraTM sittings at weekly intervals for complete healing. Thus with this recent concept of Graded Ksharsutra treatment of Anal Fistula has become more easy and more effective.

Anal Fistula - How Non Surgical Treatment Is Better Than VAAFT/Surgery?

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