Introduction:
The Kshara karma is one of the Anushastra karma, a minimally invasive para-surgical measure. Ksharsutra is the method of Ksharakarma mainly employed in fistula-in-ano (anal fistula) and hemorrhoids (piles). This unique method has many advantages over conventional surgical methods, as this is an ambulatory and cost-effective method.
What Is Anal Fistula?
Fistula-in-ano (anal fistula) is a disease of the anorectal region and the description of which could be traced from dates back to the ayurvedic treatise - Sushruta Samhita. It is prevalent and occupies the second position among all anorectal diseases after hemorrhoids. Fistula-in-ano is a track that opens deeply in the anal canal or rectum and superficially on the skin around the anus. Sometimes, the track may have a single opening, which is called a sinus. Generally, this track develops from an anorectal abscess (Bhagandara pidika) that bursts spontaneously or is drained inadequately.
An anal fistula may occur with or without symptoms. There may be intermittent swelling with pain, itching, discomfort, and discharge of pus in the perineal or perianal region. This track does not heal due to frequent discharge, the presence of unhealthy granulation, and lack of rest to the part. This is purely a surgical condition, and certain operative procedures are usually associated with complications like loss of gluteal cushion, infection, and recurrence and require prolonged hospitalization. Research studies on fistula-in-ano at various renowned medical institutions worldwide revealed a higher recurrence rate after surgery.
What Are the Causes of Anal Fistula?
Generally, anal fistulas develop after the occurrence of an anal abscess. Other less common causes include:
-
Crohn’s disease (a condition in which the digestive system is inflamed).
-
Infection with tuberculosis (TB) or HIV (human immunodeficiency virus).
-
Diverticulitis (infection of small protrusions sticking out of the large intestine).
-
A complication of surgery around the anus.
-
Hidradenitis suppurativa (skin disorder that causes scarring and abscesses).
What Are the Treatment Options for Anal Fistula?
Anal fistula often requires surgery as they seldom heal if left untreated. Various treatment modalities such as Seton treatment (chemical or cutting), fistulotomy or fistulectomy (cutting open the whole length of anal fistula, so it heals into a flat scar), chemical destruction of the fistula by corrosives, application of fistula glue or fistula plug are suggested for the management of anal fistula. These methods have prolonged hospital stays, high recurrence rates,
and anal incontinence (inability to control bowel movements). Alternatively, the application of ‘Ksharasutra’ medicated cotton thread coated with ayurvedic medicines is very easy, has minimal pain, requires a lesser hospital stay, and has minimal complications.
How to Manage Anal Fistula Through Ayurveda?
Medicated Ksharsutra is considered one of the best options for managing anal fistula. However, not everyone can go for this treatment. Patients who complain of perianal discharge (stool-like) can have this treatment. Patients with compromised cardiopulmonary status and those who are immunocompromised are excluded.
Ksharsutra - Ayurvedic Para Surgical Measure for Anal Fistula:
-
Though several operative procedures have been described for the treatment of fistula-in-ano, Ksharsutra (a unique minimal invasive ayurvedic para-surgical measure) has been advocated as a treatment of choice by ancient ayurvedic scholars.
Procedure:
-
Different alkalis employed in layering the seton thread include Apamargakshara, Snuhikshara, and Arkakshara.
-
These ayurvedic medicines or alkalis are applied multiple times onto the thread, typically ranging from 15 to 21 coatings.
-
Certain natural antibiotics are utilized for coating Ksharsutra, which may encompass substances like turmeric powder and Guggulu.
-
General or spinal anesthesia is administered to the patient for numbing before the procedure.
-
Using a flexible probe, the surgeon inserts it from the external opening of the fistula to the internal opening in the anal canal.
-
Afterward, the Ksharsutra is carefully drawn out along with the probe through the anal opening, and both ends of the thread are secured together.
-
The ayurvedic medications coated on the thread function by gradually releasing into the tract, aiding in its treatment as they take effect.
-
Consequently, the drugs assist in draining the abscess effectively.
-
Following one week, the Ayurvedic doctor replaces the thread.
-
The medicated thread, known as the Ksharsutra, both cuts and heals the tract. Eventually, the thread is removed, allowing the fistulous tract to heal.
-
For multiple anal fistulas in different quadrants, multiple medicated Ksharasutra were applied.
-
Application of ksharsutra in cases of fistula-in-ano is a minimally invasive, simple, cost-effective procedure.
-
This needs no hospitalization and can be carried out at OPD (outpatient department) levels.
This measure was revived, developed, and standardized in the early seventies by eminent scientists. Considering the importance and unique nature, further validation was done by ICMR (Indian council of medical research) through randomized, double-blind, multi-centric clinical trials. These revealed that the recurrence rate in patients of fistula-in-ano treated with ksharsutra therapy was just four percent, while about 11 percent in patients treated with surgery. The research studies over the years added a scientific basis to this art as an effective, amble, and viable alternative to surgery with better compliance. Ksharsutra can also concomitantly be applied in patients suffering from fistula-in-ano or anorectal diseases associated with diabetes, hypertension, neurogenic disorders, cardiac diseases, and also in tuberculous or cancerous fistulae.
The central council for research in Ayurveda and Siddha (CCRAS) has standardized the method of preparation of ksharsutra and patented it. The efficacy studies at CCRAS institutes revealed a 93 percent cure rate with minimal recurrence.
What Are the Benefits of Ksharsutra?
-
Straightforward procedure.
-
Requires hospitalization for no more than four- five hours.
-
Low likelihood of problem recurrence.
-
No loss of workdays.
-
Safe, reliable, and economical.
-
Minimally invasive.
-
Incontinence is not observed as no sphincter muscles are cut or dissected.
What Steps Can a Person Take To Care For Themselves?
-
Utilizing stool softening agents.
-
Incorporating fiber into the diet.
-
Consuming ample water, aiming for eight eight-ounce glasses daily.
-
Engaging in warm baths.
-
Utilizing clean, damp pads to cleanse the area surrounding the anus, removing irritating particles and fluid from the fistula.
-
Applying specialized skin creams to alleviate irritated tissue.
Conclusion:
Management of anal fistula with Ksharasutra is the best option not only because it is simple and easy but also due to minimal post-operative complications. This treatment method has a minimal cost and a very low recurrence rate.
Consult an ayurveda specialist online for queries regarding ayurvedic management of anal fistula --> https://www.icliniq.com/ask-a-doctor-online/ayurveda-specialist