Piles/Fissure/Fistula

Piles/Fissure/Fistula

Piles:

Piles may occur due to straining during bowel movement. It often occurs in the case of chronic constipation where increased pressure is required in order to make the bowels move out of the rectum and anal canal. Hard stools may also contribute to worsening the condition by exerting added pressure to the dilated veins. Piles may also develop during pregnancy due to the additional weight in the pelvic region or as a trauma during child birth. Cirrhosis of the liver may cause pooling of blood in the anal vessel also resulting in piles.

Dry piles are more painful, while bleeding piles render a person weaker. Pregnant ladies, elderly persons, sedentary persons who eat enormously and quite often but do no exercise, or the person taking above-mentioned dietary items, are more prone to piles. Persistent complaint may cause other complications also, such as fissures, cancerous growths, pain, swelling, smarting etc. Types of Piles : Dry piles( shushk arsh ) – In dry piles there is inflammation of the external piles, continuous pain and become unbearable while voiding the bowels. Bleeding piles(stavi arsh ) – In bleeding piles, the internal piles start bleeding and there may be excessive bleeding which lead to anaemia and consequent emaciation.

Fissure

Anal Fissure commonly called as Gubcheer is a longitudinal crack in the long axis of lower anal canal. Superficial anal fissures look like a paper cut, and generally get self-heal within a week. However, some anal fissures become chronic and deep and will not heal. The most common cause of non-healing is spasming of the internal anal sphincter muscle which results in impaired blood supply to the anal mucosa.

Main Features:
– Pain in anal area which increases after passing stools,
– Severe cutting pains, patient prefers to remain constipated rather than going through the agony of pain.
– Bleeding – stools are streaked with blood.
– Burning sensation at anal opening.
– Constipation – pain either initiated or aggrevated with passing stools sotendency to avoid going to stools so constipation.
– Swelling – a large sentinel tag causes painful external swelling.
– Urinary symptoms – some patients may develop urinary retention, painful urination, increased frequency.

Causes:
– Constipation – passing of large, hard stools,
– Prolonged diarrhoea,
– Child birth trauma in women,
– Poor toileting in young children.

Treatment – Treatment is given according to type of fissure.
– Different types of Internal medicines, medicated ghritas are given for healing of cuts.
– Ayurvedic stool softerners are given to avoid hardening of stools.
– Extenal medicinal sitz bath are provided for killing of pains and for healing of cuts.
– Fibre diet is suggested to improve bad toilet habits.

However, for recurrent Fissures occuring due to spasming of internal sphincter muscles called Anal Stricture, anal dilatation is suggested to relieve sphincter muscle spasm.

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.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. Anal fistulas commonly occur due to an anal abscess. A fistula may occur if an abscess has not completely healed, or if the infected fluid has not been entirely drained away. 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.

SYMPTOMS OF FISTULA
Pain
Discharge – either bloody or purulent
Pruritus ani– itching around the anus
Systemic symptoms if abscess becomes infected

AYURVEDA TREATMENT OF FISTULA
Kshara Sutra is utilized in the treatment of fistula in Ayurveda.

KSHARA SUTRA:

Kshara Sutra is a seton thread medicated with organic alkalis,like apamargakshara(Achyranthesaspera), Arkakshara(Caltropisgigantea) or Snuhikshara (Euphorbia lingularia). The alkali is repeatedly coated on the seton thread 15 – 21 times. Apart from this, natural antibiotic like haridra powder, guggulu, etc are also used to make Ksharasutra. The mechanical action of the threads and the chemical action of the drugs coated , collectively do the work of cutting, curetting, draining, and cleaning the fistulous track, thus promoting healing of the track/ wound. This also acts both as the antiseptic and fibrotic agent to induce healing. The process of healing starts from deeper tissues and moves towards the periphery. This can be applied and changed periodically till the thread cuts the fistulous tract. Since the sphincter heals by fibrosis, there is no incontinence. Under local anaesthesia, the kshara sutra is inserted into the tract and the two ends of the thread are tied forming a loop. The alkalis coated on the thread are continuously released throughout the length of the track there by cutting, curetting, draining cleansing and healing the track. This therapeutic action of the thread lasts for seven days. The old thread is then replaced with a new thread following the same procedure. Depending on the length of the tract and the extent of damage, the kshara sutra may be changed up to 5 times. The changing of the thread is a simple procedure taking about 1 to 2 minutes and requires no anaesthesia.

BENEFITS OF KSHARA SUTRA:
• The procedure does not require hospitalization for more than 4 to 5 hours
• The patient requires minimal bed rest and can resume daily activities within 12 – 24 hours
• No painful dressings required
• The drugs coated on the Kshar-Sutra are slowly and gradually released into the track and the wound, leaving no abscess overseen. These abscess are drained out by the action of the drugs.
• The sphincteric muscles are not dissected and hence the possibility of incontinence is ruled out.