Fistula in Ano Question? and their Answers ::
What is an anal fistula?
- 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?
- 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.
- Itching, discharge 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 following procedures:
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 disease
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 x-ray
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.
Causes of anal fistula?
- In a few cases there is a previous history of ano-rectal abscess.
Some times a fissure in ano/ anal fissure gets infects & the infection travels down to form a track or a fistula.
- However in most cases there are no definite causes found.
- Possible contributing factors
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 anus.
Modes of treatments of anal fistula?
- Anal fistulas are almost never found to heal spontaneously. The inner wall of the fistula develops fibers tissue & payogenic membrane not allowing spontaneous healings.
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 )
The Ksharsutra / Ksharsootra ( Medicated Setone ) Ligation.
Laser Surgery ( Fistulectomy / fistulectomy by laser beam )
Laying open the fistula and applying a skin graft.
Laying open, excision of the fistulous track and suturing the wounds.
Coring out the fistulous track. ( link with core technique for fistula )
Sealing with fibrin glue.
Fistula Plug Management.
VAFT Technique for anal fistula.
Reconstruction with flap surgery for anal fistula.
- 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 / Ksharsootra?
- 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/ wound.
- A number of drugs like,
Apamarg kshar (see picture)
Kadali kshar (see picture)
Arka kshar (see picture)
Nimb kshar (see picture)
Snuhi ksheer (see picture)
Udumber ksheer (see picture)
Papaiya ksheer (see picture)
- 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.
- The drugs 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 no anesthesia.
- 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 in anal fistula?
- 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 anesthesia.
- 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 a day
- Taking warm baths
- Using clean, moist pads to wipe the area around the anus, to remove irritating particles and fluid from the fistula
- 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 glasses).
- 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.
Reimbursement and Cashless TPA Health Insurance for the Process Of Kshar Sutra is available now. In NCR, Ghaziabad and Noida
E-mail: firstname.lastname@example.org Ph:+91 – 9219434343, Mo:+91 – 9412637645,
Kshar chikitsa types of kshars and uses :
- Kshar chikitsa or alkaline therapy in has been in practice since 500 BC.
- Kshars or alkalis are the herbal extracts of plants like Euphorbia nerifolia,
- Cassia fistula, Holarrhena antidysentrica, Adhatoda vasica, Caltropis
- giganteo, Alstonia scholaris, Achyranthus aspera, and Sesamum indicum.
- An kshar can be a compound or mixture of many herbs or may be from
- single herb like Moolika kshar, Til kshar, Yavakshar etc.
TYPES of kshars
There are 2 types of kshars
- 1. Paniya kshar: kshar for internal use
- 2. Pratisarniya kshar: for external use only
The pratisarniya kshar is further divided into 3 types
- 1. Mridu: mild in action
- 2. Madhya or modest: stronger
- 3. Teevra: strongest in action
Ayurvedic doctors are using the paniya (drinkable) kshars to treat
many diseases like malaria, jaundice, urinary tract infections,
indigestion, obesity, tumors, inflammation, flatulence, infections
and cysts. Kshars have a very rapid action and safe to use.
The external or pratisarniya kshars are widely used to manage hemorrhoids,
warts, corns, fistulae, sinuses, polyps and many skin problems.
External kshars are a reliable and safe alternative to a number of
modern medical surgeries. Therefore they are the first choice of
Kshar sutra or the medicated thread and its role in hemorrhoids will
explain it further here. Let's see how it is made and used.
Diet Plan For Patients of Piles, Fistula, Fissures
- पेट की बीमारियां, कब्ज़, बवासीर, भगन्दर आदि रोगियों के लिये भोजन व्यवस्था
- नाश्ताः (प्रातः 7 बजे से 9 बजे तक)
- , अंकुरित चने, अंकुरित गेहूं, बेसन का चीला, वडा-सांभर, डोसा
- अच्छी क्वालिटी के, चपाती-सब्जी, बिना घी के सिंकी ब्राउन ब्रेड, अंकुरित मूंग
- दलिया, खिचडी मूंग दाल व पुराने चावल की, मलाई रहित दूध, चाय, टोस्ट/रस
- नोटः- पेठा मिठाई व घर के बने छेने की मिठाई विशेष लाभकारी है।
- दोपहर का भोजनः (दोपहर 12 बजे से 2 बजे तक)
- टमाटर, पपीता, मूली, शलजम, गाजर आदि।
- चपाती, हरी सब्जी या मिक्सवेज, दाल, पुराना चावल, छाछ, सलाद- प्याज़,
- (बिना नमक व कम मात्रा में) या सेब भूनकर/दूध में पकाकर ले सकते हैं।
- चाय, टोस्ट, बिस्कुट, बिना नमक मखाने, मखाने की खीर, सूखे मेवे
- शाम की चाय/अल्पाहारः (शाम 4 बजे से 5 बजे तक)
- रात्रि भोजनः (रात्रि 8 बजे से 9 बजे तक)
- चपाती, सब्जी, दाल, चावल, सलाद (रात्रि में दही या छाछ न लें।)
नोटः- रात्रि में हल्के गर्म दूध का सेवन करना लाभकारी है।
Fistula-in-ano Classification Symptoms Treatment
WHAT IS AN ANAL FISTULA? Anal fistula, or fistula-in-ano, is an abnormal connection or channel like structure, between the surface of the anal canal and the exterior perianal skin.
Fistula-in-ano: An Ayurvedic Perspective
Bhagandara (Fistula-in-ano): An Ayurvedic Perspective
Definition of Bhagandara (Fistula-in-ano):
(Bhaga= Vagina, Darana= tear, spitting)
ते तु भगगुदबस्ति प्रदेशदारणाश्च ‘भगंदरा’ इत्युच्यन्ते ।
अभिन्ना: पिडका:, भिन्नास्तु भगंदरा: ।। (Su. Ni. 4/3)
This creates a tear in the area of Bhaga (Vagina), Guda (Anal canal & rectum) and Basti (Urinary bladder), so this is called Bhagandara.
Particularly, in the earliar stage when this is not open, called ‘Pidakaa’ (furuncle). Later on it will get burst and forms the Bhagandara (Fistula-in-ano).
Probable Causative Factors:
- Heavy diet
- Suppression of natural urges
- Unhygienic condition
- Infection of the anal glands
- Worm infestation
- Ingestion of foreign bodies
- Excessive horse riding or bicycle riding
- Abrasion by stone, cloth and ground
- Excessive drinking of alcohol
- Excessive coitus
- According to Dosha Involvement:
- Ayurvedic classical texts have classified Bhagandara mainly in eight entities according to doshik involvement.
- शतपोनक भगंदर (Shatponak Bhagandara)- Vāta dosha dominance
- उष्ट्रग्रीव भगंदर (Ushtragriva Bhagandara)- Pitta dosha dominance
- परिस्रावी भगंदर (Parisravi Bhagandara)- Kafa dosha dominance
- शम्बूकावर्त भगंदर (Shambukavarta Bhagandara)- Tridosha dominance
- उन्मार्गी भगंदर (Unmargi Bhagandara)- Aāgantuja /Traumatic
- परिक्षेपी भगंदर (Parikshepi Bhagandara)- Vāta Pitta dosha dominance
- ऋजु भगंदर (Rhiju Bhagandara)- Vāta Kafa dosha dominance
- अर्शो भगंदर (Arsho Bhagandara)- Pitta Kafa dosha dominance
According to opening:
- Sushruta (School of Ayurvedic Surgery) again classified each type of Bhagandara according to its opening whether presents externally or internally. He used the terms,
- पराचीन (Parachina) or बहिर्मुखम् (Bahirmukham) – blind external and,
- अवाचीन (Avachina) or अंतर्मुखम् (Antarmukham) – blind internal.
According to modern contrive:
- According to modern texts, fistula-in-ano can be divided in two groups broadly, on whether the internal opening is below or above the ano-rectal ring respectively.
- Low level fistula
- High level fistula
- Low level fistula can be further subdivided into subcutaneous type, submucous type, intersphincteric type, trans-sphincteric type and supra- sphincteric type.
- High level fistula can be further subdivided into extrasphencteric or supralevator type, trans-sphencteric type and pelvi-rectal fistula.
Symptoms of Bhagandara (Fistula-in-ano):
- The main symptoms are boil around the anus, anal discharge and pain in anal region.
- Management (treatment) of Bhagandara (Fistula-in-ano):
- Local treatment:
- Aālepa (Paste of Ayurvedic herbal drugs)- for local application
- Upanāha (Warm poultice)- for local application
- Pariseka (Pouring of Ayurvedic decoctions)- for local application
- Swedana (Hot fomentation)- for local application
- Rakta vistravana (Blood letting)
- Varti application (Application of wick of cotton cloth mix with Ayurvedic herbal oils)
- General treatment:
- Follow the ‘Ayurvedic life style’ (look forward on the home page of this site)
- Apatarpana (Making the body thin by fasting)
- Vamana & Virechana (Ayurvedic Panchkarma Therapy/Ayurvedic Detoxification Programme)
- Kshāra- sutra Therapy (Application of Alkaline Herbal Seton)
- Rakta mokshan (Blood letting)
- Agni karma (Thermal cauterisation)
- Kshāra karma (Application of Ayurvedic herbal caustics)
- Bhedana karma- Fistulotomy
- Chhedan karma- Fistulectomy
Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.
Ancient Ayurveda surgeon, Susruta has described five types of Bhagandara(Sataponak, Ustragriwa, Parisrabi, Sambukawarta, Unmargi). They have been classified according to the vitiation of the three doshas and the shape & site of the fistula tract.
CAUSES OF FISTULA?
- Anal fistulas commonly occur due to an anal abscess.
- An abscess is a collection of pus and infected fluid. An anal abscess usually develops after a small gland, just inside the anus, becomes infected with bacteria.
- A fistula may occur if an abscess has not completely healed, or if the infected fluid has not been entirely drained away.
- An anal fistula may also develop as a result of:
- a growth or ulcer (painful sore)
- a complication from surgery
- a congenital abnormality (a health problem that you were born with)
- Anal fistulae are also a common complication of conditions that result in inflammation of the intestines. Some of these conditions include:
- Irritable bowel syndrome (IBS): a chronic (long-term) disorder that affects the digestive system, causing abdominal pain, diarrhoea and constipation.
- Diverticulitis: the formation of small pouches that stick out of the side of the large intestine (colon), which become infected and inflamed.
- Ulcerative colitis: a chronic condition that causes the colon to become inflamed and can cause ulcers to form on the lining of the colon.
- Crohn’s disease: a chronic condition that causes inflammation of the lining of the digestive system.
SYMPTOMS OF FISTULA
- Anal fistulae can present with many different symptoms such as:
- Discharge – either bloody or purulent
- Pruritus ani– itching around the anus
- Systemic symptoms if abscess becomes infected
DIAGNOSIS OF FISTULA
- Diagnosis is by examination, either in an outpatient setting or under anaesthesia. The examination can be an Anoscopy.
- Possible findings:
- The opening of the fistula onto the skin may be seen
- The area may be painful on examination
- There may be redness
- A discharge may be seen
- It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the fistula
Fistula is a deadly disease which occurs most commonly on the rectum.
A yellow liquid gets formed on the area which is very painful.
Bhagandara is the name by which fistula is known as in Ayurvedic practice. Three kinds of the disease are recognised with different treatments. One of the important therapies for curing fistula in Ayurveda is Kshar Sutra.
This involves cutting up some tissues and these take time to heal. Before performing this procedure, several herbs are given to the patient such as Kadali Kshar, Apamarg Kshar, Nimb Kshar, Papaiya Kshar and Snuhi Kshar.
Anal fistula is generally treated through surgery but it is known to recur after some time.
You need to be very conscious of this fact when looking to get your condition treated.
Ayurvedic remedies for fistula are known to cure the disorder for good. Several techniques and therapeutic procedures are available in Ayurveda that eliminate the problem from its root.
Although Kshar Sutra is a slow process on the whole but it is getting global recognition gradually as a very effective treatment for fistula. The great advantage in undergoing this treatment is that the patient does not need to be admitted to a hospital. He can carry on with his regular everyday work without any trouble.
and most of all 100% treatment without any recurrence.
Agnikarma is another treatment for fistula in Ayurveda. This involves use of hot iron or caustic agent for destroying the affected tissues.
Another Ayurvedic treatment for fistula is known as Enema. In this treatment, hot bath is given to the patient suffering from it. Lower body parts are involved in this therapy. A few other types of fomentation is also recommended. The patient needs to be constantly checked for any signs of suffering for diseases such as hypertension, diabetes, TB or any other.
The main reason for rise of this disease these days is the unhealthy lifestyle which people have started to lead. It is expected that with Ayurvedic remedies for fistula treatment becoming popular, the lifestyle recommended by the holistic system of medicine will also gain ground.