Fistula Treatment

Ksharsutra Treatment (Fistula Treatment without Surgery) is highly recommended!

Fistula in ano is a disease which is manifested as a small nodular swelling around the anal region, with occasional pus or watery discharges. It has been noticed in some of the patients that swelling & pain has subsided after the pus has discharged out however after a certain interval of time; the swelling and pain may reappear which is again followed by pus discharge and subsequent relief in the symptoms. This cycle goes on.

However in other cases regular discharges & stickiness in the anal area may be noted. Even today when the modern surgery is at its peek, fistula in ano is still a challenge to the surgeons for its incidence of recurrence after surgery & postoperative complications like stool incontinence, pain and bleeding etc.

The Ksharsutra Therapy devised by ancient ayurvedic surgeon i.e. acharya sushruta is the highly effective method available to treat anal fistula. The efficacy of this ksharsutra treatment is better than the most recent VAAFT or MAFT techniques advised by modern surgeons for treating this disease.

Indian Council of Medical Research has clinically evaluated this technique. Trials of Ksharsutra therapy has been clinically conducted at four centers including AIIMS New Delhi and PGI Chandigarh. The results of these trials have been released officially. Ksharsutra is more effective and convenient treatment for treating anal fistula. (**Multicentric Randomized controlled clinical trial of Ksharsutra (Ayurvedic medicated thread) in the management of Fistula-in-Ano; Indian J Med Res (B) 94, June 1991, pp 177-185)

Ksharsutra – A medicated thread is prepared by applying the coatings of apamarg kshara, haridra churna and many other ayurvedic herbs. All these herbs are mixed with snuhi ksheer. Ultraviolet radiation is used for sterilizing the thread. The combined effect of all these herbs exert strong debridement effect and thus induce healing by the fresh and healthy granulation tissues.

The latest concept of Graded Ksharsutra™ {A Research product of Sushruta Ano Rectal Institute in new Delhi} is more effective than the conventional ksharsutra therapy.**Multicentric Randomized controlled clinical trial of Ksharsutra (Ayurvedic medicated thread) in the management of Fistula-in-Ano; Indian J Med Res (B) 94, June 1991, pp 177-185

Routine checkup of the patient is done with special reference to other disorders like hypertension, diabetes mellitus, tuberculosis etc. The next step involved in this treatment is identification & evaluation of the fistulous tract. Careful probing with malleable probes helps in the proper assessment of fistula tract regarding its length, depth and branching pattern.

USG or fistulogram emerges as a primary requirement in complicated cases like high anal fistula, recurrent fistula and fistula with multiple openings and branching patterns. After accurately defining the tract, it has to be ligated with Ksharsutra. The replacement of the old sutra with a new Ksharsutra is done every seventh day till there is a finale cut through.

As per observations, the length of the tract heals by 0.5 to 1 cm per week. But several factors influence healing rate of fistula tract.

The Kshar present in Ksharsutra acts as powerful debriding agent & selectively acts on the unhealthy tissues, pus pockets etc. This process of debridement & healing starts from deeper tissues & travels towards periphery in stages.

Benefits of Ksharsutra Treatment over Surgery:

1. In Ksharsutra treatment, the postoperative complications such as fecal incontinence, recurrence of the disease, bleeding etc. are not seen.
2. No GA (General Anesthesia) is required hence GA related complications are not seen.
3. No hospitalization or bed rest is required.
4. Patient maintains his normal routine activities as usual during treatment period.

Other indications of Ksharsutra

1. Hemorrhoids
2. Anal fissures
3. Chronic discharging sinuses with osteomyelitis
4. Pilonidal sinuses
5. Non healing wounds
6. Milk fistula
7. Tubercular sinuses
8. Genital warts

Other methods of application of Kshara

1. Kshara varti
2. Kshara pitchu
3. Kshar pratisaran

What is Fistula?

Fistula-in-ano or anal fistula is a tract lined by unhealthy tissue, which is a seat of chronic infection. The tract on one side is connected to anal canal & the other end opens on the skin. This problem presents it self as a small swelling or opening in the peri anal region. Some times the swelling increases in size & there may be some pain. However as soon as this swelling bursts; the pus & blood discharges come out & there is relief in the pain. But this cycle gets repeated again and again.

What are the Fistula symptoms?

The most common symptom of fistula is pus , blood or watery discharges through anus or through a mildly painful nodular mass present in the perianal region. In an inactive form; there may not be any symptoms but when active there might be all associated symptoms as already mentioned.

How does it occur?

It results because of the chronic infection in the anal wall or in the internal gland of the anus. The long periods of infection along with chronic inflammation may be the possible reason. However, it is commonly seen that a chronic fissure may lead to anal fistula. Similarly peri anal abscess may lead to anal fistula after incision & drainage of the abscess. It is not necessary that all the perianal abscesses convert in Anal Fistula. Anal Fistula can also be seen without pre-existing perianal abscess.

How is it diagnosed?

Anal fistula is clinically diagnosed by its typical presentation, however the proper evaluation of the anal fistula w.r.t. its depth, direction & branching pattern is done by M.R.I. fistulogram, ultrasound or clinically by probing.

What are the Causes of Anal fistula?

1. Due to infection of anal fissure
2. Due to trauma by passing hard stools, that may get – subsequently infected to develop into anal fistula.
3. The diseases like ulcerative colitis, chrohns disease, diabetes, ca rectum are likely to develop anal fistula.

Where to find specialized fistula treatment doctor/clinic in Delhi?

Dr.S.K.Singh (Gold Medalist), M.S.(Ayurveda) B.H.U, is a famous Ayurvedic doctor in Sector-7, Rohini Delhi-110085. He provides the effective Graded Ksharsutra™ Treatment for Fistula without surgery.

What are the benefits of ksharsutra treatment?

Ksharsutra Therapy has its origin from the roots of Ayurveda. The therapy is carried out for the treatment of various types of fistula, & pilonidal sinus. Ksharsutra Therapy is more convenient and effective than surgery. This has been clinically proven by various national and international researches. (**Multicentric Randomized controlled clinical trial of Ksharsutra (Ayurvedic medicated thread) in the management of Fistula-in-Ano; Indian J Med Res (B) 94, June 1991, pp 177-185)

Being minimally invasive in nature, the technique is rather a very convenient one. The success rate of the graded ksharsutra™ involves a good percentage of 99.9. The recurrence rate being zero to less than one percent is far lower than other treatment methods. It does not require to go through hours of surgery but is performed in minimum time using local anesthesia. Apart from this; in Ksharsutra therapy the after care does not require a prolong use of antibiotics & hospitalization. *(There is no guarantee of specific results and the results can vary.

How can we take care Anal Fistula?

1. There are a number of things that patients need to take care during and after the ksharsutra treatment. The most important ones are outlined here –
   While defecating, it is very important that one does not put extra strain on the system. Take the help of some mild laxatives(stool softeners)
2. Eat food items that are rich in dietary fibers and avoid fried, spicy foods, junk food that may cause burning, irritation & constipation.
3. Follow light exercise routine and make sure that the morning and evening walks are included in daily routine.
4. Avoid sitting for longer hours.
5. Frequent Local applications of sushruta ointment, sushruta oil & some local anesthetic gels are very beneficial for their soothing effects.
6. Frequent use of sitz bath is also very helpful.

What are the popular modes of treatments available?

Fistula in Ano is a disease for which large no. of surgical procedures have been tried. This is because with each surgical procedure chances of recurrence have been associated. Till date various procedures like conventional surgery, By pass Colostomy, Ceton ligation, Glu technique, Laser, VAAFT/MAFT have been tried in anal fistula. But with all these procedures; in about 15-20 % of the cases recurrence has been reported. This disease is infamous for the chances of recurrence after the above described treatments. There is old dictem that “If you want to defame a surgeon; send him a case of Anal Fistula.”

In Ayurveda also Fistula has been categorized in the list of eight most difficult diseases to treat. Ksharsutra therapy in Ayurveda ensures complete healing of Anal Fistula. This treatment has been scientifically evaluated for its efficacy over surgery.

Anal Fistula Surgery Complications ?

Most common complication in Surgery for Anal Fistula are:

Infection: All surgeries carry some risk of infection. In some complex fistula; surgery might be carried out in several stages. In such cases; infection can spread to surrounding tissue.
Bowel incontinence: Fistula surgery has the potential to damage muscles of anal sphincter specially when fistula involves sphincter muscles. These muscles are responsible for controlling bowel movements. When sphincter damage occurs; the strength of muscles is compromised and there can be some loss of control of the bowels leading to leaking of feces from rectum. This is referred to as bowel or fecal incontinence.
Recurrence of Fistula: Recurrence rate after surgery for anal fistula is as high as 15-20%; depending upon type of fistula and surgical procedure used to remove fistula.
Pain: Anal region is very sensitive area so there can be very intense pain after surgery for anal fistula.

Some other complication after surgery for Anal Fistula include Urinary retention, Heavy bleeding or discharge from surgery site etc. These possible complications after surgery for Anal Fistula; make surgery a bad choice for fistula treatment.

Types of Fistulas?

Fistula can be divided into subcategories which are as follows:
Inter-sphincteric fistulas . In such type of fistulas the the fistulous tract only crosses the internal sphincter and lies between the internal and external sphincter, in the intersphincteric space.  .
Trans-sphincteric fistulas – These pass through external, internal sphincter in areas located between perianal skin and anal canal.
Supra-sphincteric fistulas – These pass upward around the external sphincter after crossing internal sphincter right above the puborectalis muscle.
Extra-sphincteric fistulas – These are the ones that are rare to find and also the most tough ones to be treated. In this type of fistula, the tract bypasses both the anal canal and sphincter, then pass from the levator ani muscle and ischiorectal fossa before exiting its way into the rectum.
Superficial fistulas – These types of fistula neither cross the internal sphincter nor the external ones. There is strong possibility that the fistula is present because of the crohns disease.