Dr. Sucheta Malhotra

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.  

 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.

Contrary to what most girls have been led to believe about the hymen being a flat tissue that covers the vagina and is ripped during penetrative intercourse, the truth is that hymen is a fringe of tissue around the vaginal opening. It is not an intact tissue draping across the vaginal wall because without any outlet for the menstrual blood, girls would get periods only after they lose their virginity. (Know more about Irregular Periods)

Here are a few mind-boggling facts about the hymen.

1. Just like labia, every woman's hymen varies in color, size and shapes. 
2. It is elastic and stretchy in most cases. Vaginal delivery makes the hymen less visible by smoothening and stretching it.
3. Despite popular belief, the pain women experience when they have sex for the first time is not due to your hymen breaking, but because your vaginal muscles are too tense and/or you're going at it too rough and fast without adequate lubrication.
4. Simple exercises such as walking, riding bicycles, doing splits as well as horseback riding may rip your hymen long before you have had intercourse. 
5. Hymens should not be perceived as the indicator of sexual activity because they are extremely stretchy and stay with you your entire life. Even sexually active people have hymens. 
6. If you do not resort to any sexual activity (including penetration during masturbation), the hymen returns to its default position in your vulva. 
7. Very few women have an imperforate hymen in which the opening is too small for penetration whether by tampons, fingers, sex toys or an erect penis. A simple surgery needs to be conducted in such a case where parts of the hymen are snipped away. 
8. There is a growth in hymenoplasty, also known as hymen reconstruction surgery, in the past few years because hymen is viewed as an indicator of virginity and there have been cases of annulment, public humiliation, torture and even death because they believe that the hymen is not intact due to sexual activity; therefore making hymenoplasty an effective solution. 
9. Although, not an indicator of the amount of sexual activities performed, one must seek immediate medical attention after being sexually assaulted because it can be examined to prove sexual abuse. (Learn more about Sexual Activity Affects Vaginal Health). If you wish to discuss about any specific problem, you can consult a Sexologist.