Fistula treatment delhi

Fistula in Ano is an inflammatory track which has an external opening in the perianal skin and an internal opening in the anal canal or rectum. This track is lined by unhealthy granulation tissue and fibrous tissue.

IN AYURVEDA:-FISTULA (BHAGANDER) has been included in ashta mahagada(eight most dangerous diseases) by ACHARYA SUSHRUTA. Even today when the modern surgery is at its peak fistula in ano is still a challenge to the surgeons for its incidence of recurrence and postoperative complications.

CAUSES :-

• PERIANAL ABSCESS (most common) • Ulcerative colitis • Crohn's disease • Tuberculosis • Cancer of rectum

TYPES:-

• LOW LEVEL FISTULA- Fistula open into the anal canal below the anorectal ring • HIGH LEVEL FISTULA- Fistula open into the anal canal at or above the anorectal ring • SINGLE OR MULTIPLE- Depending upon the number of external openings fistula may be single or multiple.

SYMPTOMS:-

• History of perianal abscess • Discharge • Formation and rupture of abscess with pus discharge in early stage and continuous discharge in later stage.

DIAGNOSIS:- Clinical examination and probing by an experienced and qualified doctor can make the diagnosis in most of the cases. However fistulogram and MRI may be required in some cases to establish the track, branching pattern and internal opening.

TREATMENT:-

AYURVEDIC KSHAR SUTRA:- A multicentric clinical trial of kshar sutra in management of fistula in ano has been conducted by  "INDIAN COUNCIL OF MEDICAL RESEARCH"  Research wing of "MEDICAL COUNCIL OF INDIA" in 1991 in AIIMS & PGI Chandigarh, which says that kshar sutra offers effective, less traumatic, ambulatory and safe alternative treatment for fistula in ano with excellent success rate. it avoids hospitalization and saves man hours for the doctor and patient & is BETTER THAN SURGERY.

HOW IT ACTS:-It acts by virtue of chemical cauterization it destroys the infected tissue present in fistula and makes the wound free of infection, eradicates infected anal glands. It heals the wound drastically and the complete eradication of disease ensured by complete eradication of infection.

ADVANTAGES OF KSHAR SUTRA OVER SURGERY:-

• No need of hospitalization • No operation • Back to routine life in 48 to 72 hrs • No chance of INCONTINENCE(Loss of control on stool) • No relapse Fissure-in-Ano: Ayurveda approach.गुदा विदार का आयुर्वेदिक समाधान । Linear ulceration in anterior or posterior aspect of Anal canal is called as Fissure in Ano. Most of the times seen in posterior aspect because this part is backed by bony hard part. The main cause for this condition is chronic constipation with hard stools, where this hard stool by constant erosion produces linear ulcer most of the times over post aspect of Anal canal (6 o’ clock position). The other common causes are chronic Amoebiasis, IBS, Inflammatory bowel disease like Crohn’s disease, Ulcerative colitis etc. Main symptoms are Painful defecation Pain usually persists for 30 min to 2 hours after defecation and abruptly disappears. If bleeding occurs, seen as a red line on stool. If not treated for long time a flap of skin will cover the fissure which is called as sentinile pile which looks like piles but really not, just a flap of skin to protect the fissure. Many people due to the fear of pain avoid passing stool regularly, they hold it and passes stool whenever they feel relaxed, usually during weekends. This indicates how painful and irritable this condition is. Treatment. 1. Conservative 2. Surgery Conservative Management: Specific indication for Conservative management 1.The fissure should be of recent onset 2.There shouldn’t be development of hard granulation tissues over the fissure which prevents normal healing. Aim of treatment. Difficulty in treatment is because, Every time when patient passes stool formation of new abrasion every time is likely which prevents healing Acute spasm of anal sphincter due to which there will be poor blood supply to the fissure area, and because of poor blood supply there will be poor healing. There shouldn’t be formed hard indurated granulation tissue where normal healing is not possible, only by removing indurated portion we can expect healing. So here aim is 1.Laxatives (anulomana treatment) 2.Herbs which will make the tissues heal fast 3.Antispasmodics and Vedana hara drugs to reduce the sphincteric spasm. We prefer Abhayarista 20 ml bid, T Kankayana vati 400mg 1 bid, T Triphala guggulu 600mg, 1 tid, Avipattikara churna 1 tsp bid continuously for 3-6 months. Sitz bath with Triphala kwatha or just hot water. We have many success cases with these Rxs, strict diet has to be advised. Rich fiber food, should avoid all spicy and deep fried food. 2. Surgery Just Anal dilatation and removal of indurated tissue gives fast cure that is within 1 week. Really surgery gives complete recovery very fast. Ideal treatment in chronic case is definitely surgery, and recovery is comparatively very fast in surgery for all Fissure in cases. But most of the patients afraid to go for surgery, hence those eligible for conservative management can be treated successfully with medicines.