Role of Kshara Sutra in the treatment of Fistula in Ano

Anal fistula

An anal fistula is a disease that affects the anal canal and the area around it. It was considered an uncommon disease in the old days. But these days it is becoming more and more prevalent. The increasing prevalence of this disease is currently due to lifestyle changes.

What is a fistula in ano? 

An infected tunnel between the skin and the anal canal. The fistula tract forms in the area around the anorectal region and is usually felt as an elongated, hardened tube.

How does a fistula form?

Most anal fistulas result from an infection of the anal gland that connects to the skin. The main causes of anal fistulas are blockages of the anal glands and resultant anal abscesses. Improper treatment of this abscess leads to the formation of a tunnel between the skin and the anal canal. Other than that, there are conditions that can cause anal fistulas such as Crohn’s disease (an inflammatory disease of the intestines), radiation therapy for cancer, anal area injuries, sexually transmitted diseases, tuberculosis, diverticulitis (a disease in which small pockets form in the large intestine and become inflamed) and cancer.

How does the patient feel about the fistula?

Symptoms of an anal fistula may include:

Skin irritation around the anus. At first, there is a dull, vague pain in the anal area for a few days. After a few days, it may turn into a constant, throbbing pain that may get worse when you sit, move around, defecate, or cough.
Foul-smelling discharge near the anus. It can be spotty in nature or release pus or blood when the stool appears as well. You also feel swelling and redness around the anus and a high temperature if you also have an abscess.
The end of the fistula may be visible as a hole in the skin near the anus, although it may be difficult for you to see yourself.

How is a fistula diagnosed?

A doctor can usually diagnose an anal fistula by examining the area around the anus. He or she will look for an opening (fistula tract) on the skin. The doctor will then try to determine how deep the tract is and which direction it is going by probing the tract with an instrument called a fistula probe. In some cases, there may be suspicion regarding the branching of the tract and the type of fistula. In these cases, you may need to have additional tests such as an ultrasound or MRI of the anal area to get a better view of the fistula duct.


Is there a cure?.

This may require several procedures that your surgeon can discuss with you. There is no medication to fix the condition, so surgery is considered as the main line of treatment.
In allopathic treatment, surgeons usually recommend fistulectomy, that is, complete excision of the fistula duct or VAAFT – video-assisted anal fistula treatment. The most common “open” surgical approach to treat anal fistula has a high recurrence rate and anal incontinence (bowel passing without your knowledge due to injury to the anal muscles )
In Ayurveda, the Ksharasutra is considered to be the best treatment of Anal fistula. Treatment of anal fistula by Ksharasutra is simple, easy and safe. The chances of recurrence and anal incontinence are very low, and most importantly, the cost of treatment is very low. Since it is a ‘day care procedure, the patient can join their work very early.

How ksharasutra is done?

After the tract is identified by anorectal examination, Ksharsutra is placed in the tract with the help of a malleable probe. Since there is no soft tissue injury, only mild pain or no bleeding is expected after this treatment.
The patient can continue his routine activities as usual from the first day. The patient is advised to walk and avoid sitting for long periods. Ksharsutra thread is changed at weekly intervals. Fistulas usually heal 0.5 to 1 cm per session. It depends on the type of tissue involved and the length of the tract. Anal fistula, which is 4-6 cm long, usually heals in 8-10 sessions. After Ksharsutra treatment sphincter control remains normal and fistula heals completely.
The advantages of ksharasutra in fistula are, a simple, safe and foolproof treatment for anal fistula (95-98% success rate) and is a minimally invasive technique. The recurrence is minimal (3-5%). It can be performed at Minor O.T and it takes only 30 to 45 minutes for the procedure. The hospital stay is minimal (5-6 hours) and minimal bed rest is required after the procedure. There is practically no damage to the anal sphincter, and the chances of incontinence are almost zero. It is an ambulatory procedure, and does not require hospitalization.
Hence, the application of Ksharasutra is a better option not only because it is cost effective but also due to lesser postoperative complications.

Author : Dr Jishnu Chandran MS (Ayu) Associate Professor, Dept. of Shalya Tantra.