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Fistula Surgeries Tips

Can Ayurveda Cure Fissures?

Can Ayurveda Cure Fissures?

Piles, fistula and fissures are the most common problems affecting the rectum and the anus. Both the rectum as well as the anus has a very rich vascular supply. There could be swelling of these blood vessels or tearing which can lead to the above conditions. Read on to know additional details about each of these conditions. 

Piles: In simple words, swollen blood vessels of the anal region are called piles. It can be internal or external, depending on how far it is from the anal canal. If it is located farther inside the anal canal, it is called internal piles.

Causes:

  • Chronic constipation, where the person has to strain to pass stools
  • Smoking and genetics can also lead to piles.

Symptoms: Starts off as painless bleeding, which happens in drops after bowel movement; the swelling happens much later. They can continue to grow and develop blood clots.

Treatment:

  • In the early stages, once identified, simple topical medications for symptom relief are sufficient.
  • Diet should be rich in fiber, with fruits and vegetables
  • Increased water consumption
  • Surgery if the disease has reached the stage of blood clots
  • Prevention is advised if there is a family history by consuming a fiber-rich diet and maintaining hydration

Fistula: When an infected anal gland bursts into the anal canal, it constantly discharges pus into the anal canal and becomes a fistula. Hygienic toilet habits can help in preventing fistulas.

Symptoms:

  • A constant wet feeling in the anal area, due to pus discharge.
  • This would be intermittent, and there would be periods with no discharge.
  • There could be a foul smell due to pus discharge.

Diagnosis and Treatment:

  • Identifying the exact location is important as surgery may be required.
  • An ultrasound scan or an MRI is usually done.
  • Newer techniques like Video Assisted Anal Fistula Treatment (VAAFT) are used. This locates the piles accurately and uses electric current to seal it with staples and surgical glue.
  • Conventional surgery is also used for economic or accessibility reasons.
  • Fissures: These cracks anywhere in the length of the anal canal are extremely common.

Symptoms

  • Very painful and the person may not want to go to the toilet
  • Rarely bleeding is also seen, maybe in very small amounts

Treatment:

  • Over 90% of the fissures do not require surgery
  • Switching to a high-fiber diet and improving hydration will help in managing these symptoms.
  • Topical relief can be provided by medications.
  • When they are recurrent, a procedure known as lateral sphincterotomy is done. This is an outpatient procedure and provides immediate relief.

Though one condition can lead to another, in most people, there is a strong genetic component, and working towards prevention is highly recommended.

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Anal Fistula - Knowing The Causes Behind It!

Anal Fistula - Knowing The Causes Behind 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 fistulacan develop.

Other factors responsible for the occurrence of anal fistulae are- 

  1. Crohn’s disease- a chronic condition where the digestive system becomes inflamed. 
  2. Diverticulitis- an inflammation of the small pouches that develop along the intestinal walls. 
  3. 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- 

  1. Irritation or discomfort on the skin around the anus 
  2. Occasional throbbing pain, especially while seated, moving around or having a bowel movement 
  3. Nodular swelling around anal region 
  4. 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.

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Fistuloplasty For Hemodialysis Fistula!

Fistuloplasty For Hemodialysis Fistula!

A fistula connects an artery to a vein, and is the blood vessel which is used for kidney dialysis. A graft is a tube that connects an artery or a vein artificially and is used for dialysis in case a fistula can’t be created.

An arteriovenous fistula is best able to access the blood stream for long-term hemodialysis and is created by connecting the artery to a vein, usually in the wrist or upper arm. It helps to transfer blood into a dialysis machine and back again during the procedure.

A fistulogram helps examine the problems inside the fistula like blockage or narrowing and involves taking X-Ray pictures of it by injecting dye into the graft or fistula. Fistuloplasty is a way of treating too narrow fistula or graft in which the fistula is inserted with a small balloon that is inflated resulting in stretching the fistula or graft, thus making it easier for blood flow. A Fistuloplasty is generally performed with a fistulogram at the same time by an interventional radiologist.

Why is Fistuloplasty Needed?

When there is a problem of narrowed or blocked fistula or graft, a fistulogram and Fistuloplasty is recommended. A narrowed fistula makes placing needles for dialysis, can prevent the smooth working of the dialysis machine or can cause complete blockage of the fistula. A narrowed fistula prevents its proper development. Also, the aging of the fistula decreases its effectiveness and function.

A treatment might not be possible if there is some problem with the fistula. A new fistula is too underdeveloped to be used for dialysis. If there is complete blockage but regular dialysis is required, a dialysis catheter or permcath is required to be inserted into the neck, which has a higher risk of complications.

Alternative:

The problems with fistula or graft can be diagnosed with an ultrasound scan, but its treatment is not possible. The main alternative to Fistuloplasty is forming a new fistula through surgery. But, it is advisable to preserve and make it possible to function with the older fistula as long as it can perform because there are only limited blood vessels in the body which are suitable to form fistulas.

The Procedure:

  1. The patient lies on the back of the X-Ray table. Heart rate and blood pressure are monitored. Oxygen masks might be required in some cases.

  2. The radiologist looks at the fistula with an ultrasound scanner.

  3. The skin over the fistula is cleaned with an antiseptic fluid and the patient is covered with a sterile sheet.

  4. A local anesthetic is then inserted near the fistula to make skin numb.

  5. A small catheter is then placed into the fistula into which an X-Ray dye is injected for taking pictures of the fistula.

  6. When a Fistuloplasty is needed, a fine tube is threaded through the catheter into the fistula with a balloon at its tip.

  7. The balloon is inflated to stretch the fistula which might be uncomfortable but short-lasting.

  8. Rarely, a metal support called a stent is put inside the fistula, which is permanently helping the fistula stay open.

  9. When the Fistuloplasty finishes, the catheter and the balloon tube are removed. The small hole will be closed with stitches.

Take Away:

Hemodialysis fistulas can be defined as surgically created connection between an artery and a vein. A fistulogram and Fistuloplasty is generally a safe and quick way to find and treat problems with dialysis fistula or graft.

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Fistula-In-Ano - 7 Must Know Things To Avoid Surgery!

Fistula-In-Ano - 7 Must Know Things To Avoid Surgery!

Anal fistulas or fistula-in-ano generally cause discomfort due pus or watery discharges and sometimes pain. This is a condition where a nodular swellingappears in area surrounding the anal opening. Intermittent pus discharged is noticed from this nodular swelling. Instead of a nodular swelling; there might be simply an opening in this region. An anal abscess is one of the most common causes for this condition.

Here are ten things you should know about these anal fistulas:

  1. It is curable through Ayurveda only: Till date many treatment options are tried to cure Anal Fistula which include Anal Fistula Surgery/ Glu technique/ cutting seton/ Colostomy/ Fistula plug/ VAAFT and many more. But all of these treatment methods have pretty high recurrence rate of about 20-25 %. However with Ksharsutra treatment for Anal Fistula; chances of recurrence are negligible. Other complications generally seen in surgery like bleeding, incontinence (inability to hold stool); are not seen with Ksharsutra Treatment. Clinical trials conducted by Indian Council for Medical Research (ICMR); at AIIMS New Delhi and PGI Chandigarh in 1992 have proved that Ksharsutra treatment is more convenient and more effective than Surgery in the patients of Anal Fistula. 
  2. There are symptoms you can look out for: Some of the symptoms that indicate anal fistulas include appearance of a nodular swelling in area surrounding Anal opening. Intermittent pus discharge is also observed from this swelling. Usually pain subsides and opening closes after the discharges; and patient feels relief. But after certain interval of time again pus accumulates; swelling re-appears with some amount of pain which is again relieved after the discharge. This cycle is repeated at varying interval in the patient of anal fistula.
  3. Medication can only provide temporary relief: Anti biotics and painkiller might give temporary relief from the symptoms. But after some time there will be again pus formation and associated swelling & pain in area surrounding anal opening. 
  4. Anal fistulas can recur after surgical treatment: As discussed above all the treatment options tried by modern medicine (including most recent treatment VAAFT) have high incidence of recurrence (about 20-25%) Whereas there are negligible chances of recurrence after Ksharsutra Treatment for Anal Fistula. . 
  5. Anal fistulas treated by Graded Ksharsutra do not recur: Ayurvedic treatment for anal fistulas is known as Kshar sutra therapy. This involves the use of medicated thread being ligated in Fistula Tract. The medicines present in this thread act as a strong debriding agent and induces healing of Fistula tract. In few weekly sittings of Ksharsutra change; Fistula gets healed completely and it do not recur. Pt. maintains his normal routine life during treatment period. 
  6. Sitz bath can be beneficial: This involves sitting in a tub filled with warm water so that the affected site is submerged. An antiseptic and astringent agent like Triphala decoction may be added to the water if needed. A sitz bath soothes the skin and provides relief from pain. This also helps keep the area clean and thus reduces chances of infection
  7. Oily and spicy foods should be avoided: When dealing with anal fistulas, you should try and take a diet that keeps your stool soft and regular. Hence use of oily and spicy foods should be reduced. Eat plenty of fiber and drink lots of water. Alcohol should also be avoided. 

Comparative Study: 

Ksharsutra vs Surgery in Anal Fistula Patients-

  1. Ksharsutra is done under Local Anesthesia. Hence complications of General Anesthesia are avoided. Surgical procedures are done under GA with all impending complications of General Anesthesia. 
  2. Ksharsutra being a parasurgical procedure hence no bleeding/ cutting of tissue is involved. Surgery involves cutting/ bleeding. 
  3. No hospitalization or bed rest is required in Ksharsutra Treatment. In Surgery hospitalization is must. 
  4. In Ksharsutra; patient can continue his normal daily routine Surgery may require bed rest. 
  5. Complications like incontinence (inability to hold stool) and recurrence are seen after surgery
  6. Ksharsutra is a safe procedure and these complications are not seen. 
  7. Ksharsutra Treatment is more economical as compared to VAAFT surgery. VAAFT Surgery is comparatively too expensive.
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Fistula-in-Ano Or Anal Fistula - How To Diagnose It?

Fistula-in-Ano Or Anal Fistula - How To Diagnose It?

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 a 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

  1. Pain- Constant pain which gets worse when sitting down
  2. Irritation around the anus, like swelling, redness and tenderness
  3. Discharge of blood or pus
  4. Constipation or pain while evacuation
  5. 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.

  1. 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.
  2. Advancement flap procedures: When the fistula is considered complex, carrying a high risk of incontinence, then this advanced technology 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.

2919 people found this helpful

Fistula-in-Ano or Anal Fistula - How Can You Get It Treated?

Fistula-in-Ano or Anal Fistula - How Can You Get It Treated?

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 anesthesiaA 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:

  1. Pain- Constant pain which gets worse when sitting down
  2. Irritation around the anus, like swelling, redness and tenderness
  3. Discharge of blood or pus
  4. Constipation or pain while evacuation
  5. 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 fistulaMost patients are treated by simply laying open the fistula tract to flush out puscalled Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months.

  1. 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.
  2. 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.

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