A fistula in ano is a tunnel
like- pipe like track, developed in the perennial region,
usually having one or more external openings around the anus
leading to an internal opening in the mucosa of the anal canal
or the rectum.
Anal fistula is termed "Bhagandara"
in Ayurveda. In Ayurveda fistulas, like other diseases have
been classified according to the vitiation of one per more
of the three doshas i.e. the vata, the Pitta & the kapha.
They have been classified also according to the shape &
site of the track of the fistula. Special treatment for such
different kinds of fistulas is mention in detail. It is worth
noting that the complex & most challenging horse shoe
fistula ( complex Ischio-rectal fistula) has been dealt with
in detail in Sushruta a classical Ayurveda text) even as early
as 300 ad.
The Ksharsutra treatment was
probably first advised per this type of fistula named Parikshepi
Bhagandara by Sushurta. This Ksharsootra treatment, with a
little modification has proved its worth even in modern times.
Anal fistula, a rare
condition, is a chronically inflamed, abnormal tunnel between
the anal canal and the outer skin of the anus. It often drains
watery pus, which can irritate the outer tissues and cause
itching and discomfort.
How does it occur?
An anal fistula usually results
from an infection that forms in the tissue lining the anal
canal. The infection may be caused by spread of bacteria that
normally exist in the rectum. Occasionally, it may occur as
a result of :
A healed sore in the rectal area
Ulcerative colitis, a disease associated with ongoing
breakdown of tissues that causes a sore in the lining
of the colon
Diverticulitis, inflammation of harmless growths in
the wall of the intestines
Crohn's disease, a chronic inflammation of the intestines
Cancer of the large intestine.
What are the symptoms?
of anal fistula may include :
A patient of fistula in ano often suffers from a recurrent,
small or large boil/boils/abscess surrounding the anus,
accompanied with pain, discomfort & pus/blood discharge.
The symptoms subside when the boil / abscess burst spontaneously
causing some more discharge for a couple of days.
The boil / abscess "heals up" temporarily but almost
always reappears after some times.
of watery pus, irritation of tissue around the anus, discomfort
& pain these are the main symptoms of the fistula in ano
How is it diagnosed?
To diagnose an anal fistula, the doctor will review
your symptoms, give you a physical exam, and may use the
Anoscopy / Proctoscopy ,
a procedure in which the doctor inserts an instrument
called an anoscope into the rectum to inspect the anus
and lower part of the rectum
Probing examination: a procedure in which the surgeon insert an instrument
called anal probe it to the external fistulous opening
to internal fistulous opening.
Sigmoidoscopy , a procedure
in which a doctor uses a flexible or rigid scope to inspect
the lower part of the intestine for inflammation and/or
A biopsy to evaluate for inflammation or cancer
Lower gastrointestinal (gi) series, a procedure that
uses a special fluid to show the intestines better on
A lower gi series requires a clean, clear gi tract.
The doctor will prescribe a special diet, including plenty
of water, for the day before the procedure. In addition,
you may be given an enema the morning of the procedure.
In a few cases there is a previous history of ano-rectal
Some times a fissure in ano/ anal fissure gets infects
& the infection travels down to form a track or a
However in most cases there
are no definite causes found.
Tearing of the lining of the anal canal.
Infection from an anal gland
Chron's, ulcerative colitis, tuberculosis
Guide lines to approach an
expert for investigating a possibility of anal fistula.
Recurrent boils developing
at the same site. (around the anus)
Burning sensation or pain in perennial region
Pus discharge /blood discharge in perianal or from the
Modes of treatments
Anal fistulas are almost never
found to heal spontaneously. The inner wall of the fistula
develops fibers tissue & payogenic membrane not allowing
The most commonly followed mode of treatment is laying
open the entire track of the fistula and removing the
fibrous tissue & payogenic membrane. This sometimes,
in complex fistulas is done in two or more sittings. In
certain cases a silk setone is passed through parts of
the track. (see detail )
Ayurveda has a unique way
of treating fistula in ano. Simple as well as complex fistulas,
high anal fistulas, fistulas with multiple track, recurrent
fistulas, chron's fistula, tubercular fistula, all respond
well to the Ksharsutra ligation procedure.
What is Ksharsutra
The Ksharsootra /Ksharsutra
is a type of thread / medicated setone prepared by coating
and recoating the thread 15 to 21 times with different drugs
of plant origin. The mechanical action of the treads and the
chemical action of the drugs coated on the thread, to gather
do the work of cutting, curetting, draining, and cleaning
the fistulous track, thus promoting healing of the track/
And natural antibiotic like
haridra powder, guggulu, etc are used in the preparation of
different kind of Ksharsutra. It takes a number of days to
prepare this Ksharsutra since the previous coat has to dry
before the next is applied.
Different kinds of Ksharsootra
are prepared using different drugs. These Ksharsutra are passed
through the track (usually under short anesthesia) and the
two ends of the thread are tied forming a loop.
coated on the thread are continually released through out
the length of the track there by cutting, curetting, draining
cleansing and healing the track simultaneously in the track
after about eight days the thread loosens because it has cut
through some of the tissues and also is now almost bare (
with no drugs on it). A new thread is now replaced in the
track by a special method.
The changing of the thread is a
simple opd procedure taking about 1 to 2 minutes and requires
the thread gradually cuts through
the tissue. The tissues above the thread heal up. Hence when
at last the loop of thread comes out, the track is healed.
Ksharsootra (medicated setone) therapy is practiced in India since times
immemorial. Modified and revived by the late Dr. P. J. Deshpande.
The Ksharsootra therapy is a unique treatment of Ayurveda
gaining popularity globally.
Special types of
medicated setone are used in this procedure Found to be effective
in any ano rectal conditions, it has many advantages in the
treatment of Anal fistulae.
Benefits of the ksharsutra
ligation procedure over other methods
The Ksharsootra ligation method
is an age old, time tested procedure originally performed
by Sushruta (the father of surgery) around 300 ad. The fact
that it is still in practice to day is a proof in it self
of its efficacy.
The Ksharsutra procedure is performed under short acting
anesthesia / local anesthesia and some times even without
The procedure usually dose not require hospitalization
for more than 4 to 5 hours.
The patient requires minimal bed rest & can resume
his / her daily routine within 12 to 24 hours.
It gives freedom from pain full dressings.
There is no loss of glutial mussels and hence the anatomy
of the peri anal region is not distorted.
The procedure lives just a pencil scar at the site.
The recurrence rate which is usually found to
be quite high after other methods is less than 2% after
Ksharsutra ligation procedure. This is because the medicines
on the thread gradually and continually curate the payogenic
membrane and fibrous tissue in the track and thus leave
no pus pockets un drained.
Chances of partial or complete incontinence
of flatus or / and faces (loss of control of passing stool
/ flatus) are always present in many types of fistula,
(especially in fistulae involving the sphincter muscles
after the conventional procedure. ( Fistulectomy Fistulotomy
). There are no chances of developing incontinence in
Ksharsutra ligation method.
How can i take care
of myself ?
Using stool softeners
Adding fiber to your diet
Drinking plenty of water, up to 8 eight-ounce glasses
Taking warm baths
Using clean, moist pads to wipe the area around the
anus, to remove irritating particles and fluid from the
Using special skin creams to soothe irritated tissue.
How can i help prevent an anal fistula?
Follow these guidelines to help prevent an anal fistula.
They help to keep the lower gastrointestinal tract healthy.
Eat food high in fiber.
Drink plenty of water each day (up to eight 8-ounce
Have regular physical exams to look for underlying diseases
of the rectum.
Be aware of the signs and symptoms of bowel disease,
and seek medical attention if any appear.
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