All Fissure Fistula

Can a Fissure Turn into a Fistula?

Two prevalent disorders that affect the anal region and cause discomfort and misery to people are fissure and fistula. Despite their similar sounds, these are two different illnesses with different causes, symptoms, and modes of treatment. There is a link between the two, though, which that raises the question: Is it possible for a fissure to become a fistula? To fully understand this, we need to know more about the traits of these illnesses, how they relate to one another, and their potential causes. As the best proctologist in Delhi NCR, Dr. Ravinder Sharma can offer you a thorough diagnosis and treatment for these ailments. In addition, he may address any query you might have regarding the connection between fissure and fistula.

Understanding Anal Fissure

An anal fissure is a tiny tear or cut in the lining of the anus that is usually brought on by trauma during bowel motions. All ages are affected by this widespread ailment, although adults are more likely to have it. The most common symptom of anal fissure is pain during or after bowel motions. Consequently, bright red blood frequently appears in the stool or on toilet paper. Itching, burning, or discomfort in the anal area are possible additional symptoms.

An anal fissure may occur suddenly or gradually. When given the right care and attention, acute fissure typically heals on their own in a few weeks, but Chronic fissure lasts longer and may require medical care.

Anal Fissure Causes

Anal fissure are caused by several factors:

  • Constipation: One condition that can lead to anal fissure is constipation, which induces straining during bowel movements.
  • Diarrhea: Prolonged diarrhea can irritate the vulnerable anus tissues, increasing the risk of fissure.
  • Trauma: Anal injuries, such as those sustained during childbirth or anal sex, can result in fissure.
  • Inflammatory Bowel Disease (IBD): Because of inflammation and damage to the intestinal lining, conditions including Crohn’s disease and ulcerative colitis can cause anal fissure.

Anal Fissure Treatment

The objectives of anal fissure treatment are to reduce discomfort, encourage healing, and stop recurrence. It might consist of:

  • Dietary changes: Eating more fiber and drinking enough of liquids will soften stool, facilitating easier bowel movements and lessening anorectal strain.
  • Topical medications: lidocaine-containing over-the-counter lotions or ointments/ other soothing ointments help lessen inflammation and pain. 
  • Sitz baths: The sphincter muscles can be relaxed and blood flow to the area enhanced by bathing the anal area several times a day in warm water for 10 to 15 minutes. This aids in the healing process. 
  • Medication: To aid with healing and relaxing the anal sphincter, a fissure specialist doctor may prescribe medications such as calcium channel blockers and nitroglycerin ointments. 
  • Surgical intervention: Injections to paralyse internal sphincter or a lateral internal sphincterotomy are two surgical procedures that may be explored if conservative methods are ineffective in treating persistent fissure. 
  • Kshar Karma Treatment for Fissure: When Fissure-in-Ano is in its acute stage, the recommended course of treatment is Kshar Karma and manual dilation of the sphincter muscles (preferably done by the patient; if it fails to relieve the spasm, then by an expert proctologist). Be extremely careful when performing this procedure to prevent overstretching the sphincter muscles. Kshar Karma is applying Kshar, a specific type of Ayurvedic medication, to the area of the fissure. This medication promotes healing and debrides the fissure.
  • Ksharsutra Treatment for Fissure: When the sentinel tag develops and Fissure-in-Ano has become more chronic, an Ayurvedic proctologist recommends Ksharsutra therapy. The ligation of a specialized medicated thread, called Ksharsutra, at the sentinel tag’s root is the treatment. Within a week or ten days, the sentinel tag sheds as a result of the blood supply being cut off. The patient can go home the same day following treatment since this is an OPD procedure. Typically, the patient can do his regular activities as usual during treatment without the need for hospitalization or bed rest.

Understanding Anal Fistula

An irregular tunnel or route that develops between the skin around the anus and the anal canal is called an anal fistula. It typically arises because of an anal abscess, a pus-filled mass in the tissues around the anus. A fistula may develop from a passage that does not heal properly following an abscess burst or is evacuated.

Anal Fistula Symptoms : 

Anal fistula symptoms might differ in severity and location. Typical signs and symptoms include:

  • Chronic pain in the anus
  • Bulges or swelling close to the anus
  • Blood or pus oozing from the anus aperture
  • Recurrent lesions in the anus
  • Rashes or itching near the anal orifice

Anal fistula causes

An infection in the anal glands, which are tiny glands found inside the anal canal, is usually the cause of anal fistula. These glands have the potential to develop an abscess, which may ultimately result in a fistula if they get clogged or infected. Other elements that raise the possibility of an anal fistula are as follows:

  • Crohn’s disease: People who have Crohn’s disease are more likely to develop anal fistula because of their persistent inflammation and intestinal lining damage.
  • Previous anal surgery: Anal glands or surrounding tissues may sustain unintentional injury from surgical operations like hemorrhoidectomy or fistulotomy, which can result in fistula.
  • Trauma: Anal fistula risk can also be raised by injuries to the anal region, such as those sustained during childbirth or anal intercourse.

Anal Fistula Treatment

The location, degree of complexity, and underlying etiology of anal fistula determine the course of treatment. It may involve:

  • Antibiotics: Antibiotics may be administered to treat an infection if an anal fistula is linked to an abscess or infection.
  • Surgical intervention is used to treat anal fistula. To preserve sphincter function and reduce the chance of recurrence, surgery eliminates the fistula tract along with any related infected or damaged tissue. A variety of surgical methods, including advanced flap repair, fistulotomy, fistulectomy, and seton placement, may be used.
  • Ksharsutra Treatment for Fistula: A medicated thread called Ksharsutra is inserted into the fistula tract as part of this treatment, and it is replaced every week or ten days until the fistula heals fully. This procedure is performed by the Ksharsutra expert. Since this is an OPD treatment, bed rest or hospitalization is typically not necessary for the patient. The patient can go about his everyday activities as usual while receiving treatment. 

Fistula-in-Ano complications such as recurrence or stool incontinence are not observed in the Ksharsutra treatment. 

Can a Fissure Turn into a Fistula?

After discussing the characteristics of anal fissure and fistula, we can now answer the query: Is it possible for a fissure to develop into a fistula? Although anal fissure and fistula are two different disorders, there may be a relationship between them.

Small anal fissures seldom become anal fistula in the absence of any underlying issues. However, the likelihood of complications like abscess and fistula may rise in cases of persistent or untreated fissure, particularly those linked to underlying diseases like Crohn’s disease. Anal tissue damage and chronic inflammation can delay recovery and put people at risk for fistula.

Surgical procedures like lateral internal sphincterotomy for chronic anal fissure can also enhance the chances of the development of fistula. This emphasizes how crucial it is to properly assess and treat anal fissure to avoid complications and encourage healing. 


There may be a relationship between anal fissure and fistula, even though they are treated and caused differently. Anal fistula risk may be raised by untreated or chronic fissure, as well as by some underlying medical disorders. Adequate diagnosis, treatment, and aftercare are critical for the proper management of both disorders and the avoidance of complications. If you have symptoms of an anal fissure or fistula, it is highly recommended that you consult the best fistula doctor in Delhi NCR for an evaluation and appropriate treatment.

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Why Ksharsutra for Fistula-in-Ano

Ksharsutra Treatment is more convenient and more effective than surgery in patients suffering from Anal Fistula*
*Indian Council of Medical Research (ICMR)

कृशदुर्बलभीरूणां नाड़ी मर्माश्रिता च या |
क्षारसूत्रेण तां छिन्दयात् न तु शस्त्रेण बुद्धिमान् ||
An intelligent surgeon prefers Ksharsutra treatment over any surgical intervention to treat a patient suffering from Fistula/ sinus or other similar problem who is emaciated/ weak/ fearful/ timid/ whose fistula or sinus is in vulnerable area.
सुश्रुत संहिता चि. स्था . 17/29 (Sushruta Samhita Chi. Stha. 17/29)

Till date many treatment modalities have been tried to treat Fistula-in-Ano with varying rate of success. So for a patient suffering from Fistula-in-Ano; it becomes very difficult to decide which treat to adopt.

Here we are listing few advantages with Ksharsutra treatment for Fistula-in-Ano over other treatments:

Predictably ZERO recurrence: Fistula-in-Ano is notorious enough to recur again and again even after being treated by the bestest of surgeon. Because of its high recurrence rate there is an idiom “If you want to defame a surgeon refer him a patient suffering from Fistula-in-Ano. Even the latest treatments like Laser/ VAAFT etc. have pretty high recurrence rate of 25-30% after treatment.
Whereas Ksharsutra treatment assures complete recovery from Fistula-in-Ano and usually recurrence of Fistula-in-Ano is not reported after Ksharsutra treatment. Ksharsutra treatment is found successful in complicated Fistula-in-Ano where multiple surgeries have failed.
Ayurved is the best to correct diet and lifestyle: unhealthy dietary habits and lifestyle is one of the main causative factor for Fistula-in-Ano and everybody is aware about the fact that Ayurved is the best health science when it comes about correcting unhealthy dietary habits and lifestyle.

No Complications: Due to damage to sphincter muscles partial or complete stool incontinence (difficulty or inability to hold stool) is observed after surgery for Fistula-in-Ano whereas sphincter muscles remain intact in Ksharsutra treatment for Fistula-in-Ano and complication of stool incontinence is not reported.

Done under local Anesthesia: Ksharsutra treatment is done under local anesthesia which is the safest route of anesthesia so complications associated to spinal/ general anesthesia like back ache/ head ache/ affected brain activities/ urine retention etc. are not seen in Ksharsutra treatment for Fistula-in-Ano.

No Hospitalization/ Bed rest: Ksharsutra treatment is an OPD treatment and done under local Anesthesia so usually hospitalization or bed rest is not required in Ksharsutra treatment for Fistula-in-Ano.
Minimal pain and other complications: Ksharsutra treatment for Fistula-in-Ano does not involve any cutting of tissue so complications like pain/ bleeding/ frequent infection etc. are not seen in Ksharsutra treatment for Fistula-in-Ano. A little bit of burning sensation or irritation is felt by some of the patients when ksharsutra is changed which is manageable by sitz bath (warm water tub bath)/ application of some anesthetic gel or taking painkiller medicines etc.

No frequent hospital visit: Surgery for fistula-in-Ano may require daily packing and dressing of the wound which requires frequent hospital visit. Whereas Ksharsutra treatment for Fistula-in-Ano involves replacing of older Ksharsutra by a new one at a week or 10 days interval. Patient is not expected to visit hospital in-between this time period.

Daily routine not affected: a patient can continue his normal routine activities as usual during Ksharsutra treatment for Fistula-in-Ano which is not possible in surgery for fistula-in-Ano.

Cost Effective: cost incurred in Ksharsutra Treatment for Fistula-in-Ano is always less than surgery for Fistula-in-Ano. One more thing; Ksharsutra treatment involves payment of small amount at intervals whereas surgery involves payment of big amount in single installment.

Keeping all above said points we can conclude that Ksharsutra treatment is the best treatment for Fistula-in-Ano available till date. So a patient suffering from Fistula-in-Ano should opt for Ksharsutra Treatment for complete recovery..

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Top 10 treatments for Fistula-in-Ano

Fistula-in-Ano is an inflammatory tract with an external (Secondary) opening in the area around the anus and an internal (Primary) opening in the anal canal/ rectum. This tract is lined by unhealthy tissue. To date ,different treatment options have been tried to treat Fistula-in-Ano with varying success rates.

  1. Seton: Seton is a non-absorbable nylon or silk suture that is placed in the fistula tract. The main purpose of seton is to keep the tract patent so that pus discharge is easy and the patient does not experience swelling and pain. Alternatively cutting seton is also used. Seton is tightened at regular intervals to cause pressure necrosis (death of tissue) in the belief that it will cut the intervening tissue and finally Fistula will be healed without surgery.
    • Pros of Seton: it provides easy passage for pus discharge by keeping the opening patent and the patient does not feel swelling and pain. In some cases, cutting seton is successful in treating Fistula-in-Ano specially
    • Cons of Seton: 100% persistence in seton treatments when it is draining seton[1]. Necrosis of tissue is the concept behind the working of cutting seton. It does not debride the unhealthy tissue so the success rate of seton in treating Fistula is not very good (about 20% failure), and long term incontinence may exceed 30% [2].
  2. Fistulotomy & Lay open technique: In this treatment; a probe is passed through the fistula tract and overlying tissue is divided by a knife. In this way; Fistula is laid open and it is treated as an open wound.
    • Pros of Fistulotomy & Lay open technique: it could be a good choice for simple fistulas i.e. a single no-recurrent fistula that crosses less than 30% of the external sphincter/ fistula is not anterior in women i.e. towards vagina/ there is no history of impaired continence
    • Cons of Fistulotomy & Lay open technique: incontinence (partial or complete loss of control over the passage of stool) in about 1/4 to 1/3 of patients i.e. 25-35% cases. [3]
  3. Fistulectomy with primary sphincter reconstruction: In this treatment; an incision is given from the internal opening to the anal verge. From there the external opening is excised i.e. cut out. Then fistula tract is excised till the external sphincter muscles.
    • Pros of Fistulectomy with primary sphincter reconstruction: No special wound care is employed, the wound can be showered starting on the first day after the operation, the patient can walk, and physical exercises should be restrained for 4–6 weeks.
    • Cons of Fistulectomy with primary sphincter reconstruction: Incontinence in approx. 23% cases [1]
  4. Fibrin Sealant: In this treatment; first of all; the tract is debrided. After debridement the tract i irrigated with saline or hydrogen peroxide to further cleanse the tract. The sealant is slowly injected at the internal opening and allowed to set. Once the clot stabilizes at the primary opening, the sealant is injected to obliterate the entire tract. The clot is allowed to solidify for 5–10 min.
    • Pros of Fibrin Sealant: Operative procedures are typically performed as an outpatient. Oral and/or intravenous antibiotics are not necessary for this procedure. Fibrin sealant injection carries essentially no risk of incontinence as there is no division of the sphincter muscle. Additionally, there is very little postoperative pain, the procedure is easily repeatable, and most importantly it does not preclude any further surgical options later in the patient’s treatment.
    • Cons of Fibrin Sealant: The total recurrence rate was 36.95% (17/46). The long-term overall success rate was 63.04% [4]
  5. Fistula Plug: Placement involves identifying the fistula tract with a standard fistula probe followed by curettage. Once the probe has been placed through the tract, the plug can be tied to the probe and pulled through the tract. The plug is trimmed at the level of the mucosa internally and sutured in place with an absorbable suture. The external end of the plug is also trimmed at the level of skin. It is advised that some space be left at the external opening to allow for drainage of the tract, and for this reason the plug is not sewn in distally. Depending upon the material used in plug it can be Biologic Fistula Plug or Synthetic Fistula Plug.
    • Pros of Fistula Plug: Plugs seem to be better therapeutic options because they do not require ligation of the fistula or division of the sphincters, so there is decreased risk of incontinence. Plug placement is not particularly technically demanding.
    • Cons of Fistula Plug: success rates varying from 24%-88%[5] i.e. to say Fistula plug fails in about 12-76% of cases and recurrence is reported.
  6. Advancement flap: In this treatment, the internal opening is visualized and the fistula tract is probed. Careful attention should be paid to identifying any additional tracts, as undrained tracts will contribute to failure of the flap. Beginning from below to the internal opening, a partial-thickness flap is raised. As the flap is developed, the width is gradually increase so that the base is at least twice the width of the apex of the flap to ensure adequate blood supply to the flap. Dissection of the flap continues until the flap crosses the internal opening without excessive tension. The fistula tract is curetted to remove granulation tissue and debris. The internal opening is closed. The tip of the flap, containing the internal opening, is excised. The flap is then sewn into place. It is an Endorectal advancement flap. When the skin is used as the flap and extended to the internal opening; it is termed a Dermal advancement flap.
    • Pros of Advancement flap: Endorectal flap can be used in special situations such as Crohn’s disease and rectovaginal fistulas. Dermal flap is particularly useful in the presence of coexisting anal pathology such as anal stenosis or Crohn’s disease.
    • Cons of Advancement flap: the reported success rate is widely variable, ranging from 24% to 100%.[5] The main problem with flap procedures is the high recurrence rate of 30 to 50% [1]
  7. Ligation of Intersphincteric Fistula Tract (LIFT): In this treatment; first of all; the Fistula probe is introduced through the tract. Then comes dissection of groove between two sphincter muscles and the identification of the fistula tract. Suture ligation of fistula tract is done above and below followed by division of the fistula tract; if the tract is quite long, a segment of the tract is excised. LIFT wound is closed loosely, and external opening of the tract is enlarged to facilitate drainage.
    • Pros of Ligation of Intersphincteric Fistula Tract (LIFT): The beauty of the LIFT is not only in its initial healing rates, but that the procedure itself, even when unsuccessful, may predispose a patient to subsequent healing without risk of incontinence.
    • Cons of Ligation of Intersphincteric Fistula Tract (LIFT):76.5% mean success rate [5] Successful fistula closure was achieved in 57% of the patients [6]
  8. Video Assisted Anal Fistula Treatment (VAAFT): VAAFT works on the principle of “putting an eye” on the probe and exploring the tract from the inside under direct vision. The fistula tract is cleaned/ the waste material removed and the internal opening closed.
    • Pros of Video Assisted Anal Fistula Treatment (VAAFT): VAAFT’s main innovation is the possibility to explore the fistula tract from the inside “under vision” evaluation that includes, in addition to the main tract, secondary tracts, and abscess cavities. The fistuloscopy minimizes the risk of rupture of the fistula and plays a fundamental role in understanding the course of a complex fistula.
    • Cons of Video Assisted Anal Fistula Treatment (VAAFT): Quite expensive  overall success rate of 73.5%. [5]
  9. Fistula Laser Closure(FiLaC): The FiLaC procedure is performed using a ceramic diode laser platform. The laser fiber is introduced into the fistula tract via the external orifice until the internal orifice is found. The fiber delivers laser energy causing shrinkage of the fistula tract around the fiber.
    • Pros of Fistula Laser Closure(FiLaC): Relatively low chances of incontinence.
    • Cons of Fistula Laser Closure(FiLaC): Quite expensive overall success of 81% which further decreases to 71% when Crohn’s disease is also there [5]
  10. Ksharsutra Treatment: First of all Fistula tract is defined by probing or MRI fistulogram. With the help of a probe with an eye; Ksharsutra is placed in the fistula tract. Medicine present in Ksharsutra debrides the fistula tract and induces healing from the inside. This medicine works for 5-7 days so the old ksharsutra is replaced by a new one at a week or 10-day time period until the fistula heals completely.
    • Pros of Ksharsutra Treatment: Complications like incontinence are not reported and the success rate of treatment is 96.77% in Ksharsutra treatment for Fistula-in-Ano. [7]
    • Cons of Ksharsutra Treatment: This treatment takes time. Out come of treatment largely depends on surgeon’s ability to define the tract.

  1. Seyfried S, Bussen D, Joos A, Galata C, Weiss C, Herold A. Fistulectomy with primary sphincter reconstruction. Int J Colorectal Dis. 2018 Jul;33(7):911-918. doi: 10.1007/s00384-018-3042-6. Epub 2018 Apr 12. PMID: 29651553.
  4. Maralcan G, Başkonuş I, Gökalp A, Borazan E, Balk A. Long-term results in the treatment of fistula-in-ano with fibrin glue: a prospective study. J Korean Surg Soc. 2011;81(3):169-175. doi:10.4174/jkss.2011.81.3.169
  5. Limura E, Giordano P. Modern management of anal fistula. World J Gastroenterol. 2015;21(1):12-20. doi:10.3748/wjg.v21.i1.12
  6. Bleier JI, Moloo H, Goldberg SM. Ligation of the intersphincteric fistula tract: an effective new technique for complex fistulas. Dis Colon Rectum. 2010 Jan;53(1):43-6. doi: 10.1007/DCR.0b013e3181bb869f. PMID: 20010349.
  7. Dr., P.S., & Prof., M.S. (2010). Efficacy of Kshar Sutra (medicated seton) therapy in the management of Fistula-in-Ano. World Journal of Colorectal surgery, 2, 6.
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Everything about Fistula-in-Ano

Fistula means a tube with two openings. In context to Fistula-in-Ano; one opening of fistula (external opening) lies in skin around the anal opening while the 2nd one (internal opening) lies inside the anal passage.

Symptoms of Fistula-in-Ano:

Patient suffering from Fistula-in-Ano complaints of

  • Intermittent pus discharge with or without bleeding from the external opening with
  • Off and on pain; and
  • Swelling near anal opening.

Causes of Fistula-in-Ano:

Exact pathology of fistula-in-Ano is still unknown but is for sure that Fistula-in-ano is the resultant of infection in anal glands. There are certain conditions which make a person prone to Fistula-in-Ano like history of:

  • Fissure-in-Ano
  • Uncontrolled Diabetes mellitus
  • Ulcerative colitis
  • Crohn’s disease
  • Tuberculosis
  • Trauma etc.

Types of Fistula-in-Ano:

There are two sphincter muscles in our anal passage internal and external anal sphincter. According to the position of fistula tract relative to these muscles; fistula-in-Ano is divided as under:

  • Intersphincteric fistula.
  • Transphincteric fistula.
  • Suprasphincteric fistula.
  • Extrasphincteric fistula.

How to diagnose Fistula-in-Ano?

Fistula-in-Ano is suspected when someone gives history of intermittent discharge from or around anal opening with off and on swelling. In fact; swelling disappears when accumulated pus discharges to come again when pus accumulates. Patient gives history of swelling — pus discharge —swelling—- pus discharge…. and so on.  On examination, an ano rectal specialist can visualize external opening in area around anal opening. An Anorectal specialist; will confirm the diagnosis after defining the tract by probing with malleable metallic probe. In very few cases; he may also advise for MRI Fistulogram.

Treatment for Fistula-in-Ano:

First thing it is for sure that Fistula-in-Ano can not be cured by medicines only – Homeopathic/ Allopathic or Ayurvedic…… what ever it may be. Different treatments have been tried to treat Fistula-in-Ano with variable success rates. Among these main treatment options are:

  • Seton:
  • Fistulotomy & lay open technique:
  • Fistulectomy with primary sphincter reconstruction:
  • Fibrin Sealant:
  • Fistula Plug:
  • Advancement flap:
  • Ligation of Intersphincteric Fistula Tract (LIFT):
  • Video Assisted Anal Fistula Treatment (VAAFT):
  • Fistula Laser Closure (FiLaC):

Recurrence of Fistula-in-Ano after treatment and varying degree of incontinence are the complications frequently faced in above said treatments. But there is ayurvedic treatment which assures complete treatment without any complication viz Ksharsutra Treatment. Ksharsutra treatment is explained in detail in Ayurvedic text books like Sushruta Samhita etc. more than 2000 years back and still relevant in treating Fistula-in-Ano.

  • Ksharsutra Treatment for Fistula-in-Ano:

This treatment involves defining the fistula tract by probing with a malleable probe or MRI Fistulogram. After defining the fistula tract precisely; Ksharsutra specialist ligates the medicated thread i.e. Ksharsutra in the tract which is replaced by a new one at a week or 10 days intervals until fistula heals completely. Usually, no hospitalization or bed rest is required in this treatment and in most cases; patient can continue his normal routine activities from the vary first day of treatment. Complications like recurrence of Fistula-in-Ano after treatment and incontinence are usually not seen in Ksharsutra treatment for Fistula-in-Ano.

For any other concern about the Fistula-in-Ano treatment you contact us through contact us page.

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Ksharsutra Treatment for Fistula- What you need to Know?

What is Ksharsutra Treatment for Fistula-in-Ano?

Ksharsutra comprises of two words namely Kshar (Specialized Ayurvedic medicine prepared from ashes of certain plants which is alkaline in nature) & Sutra (thread) so Ksharsutra is a specialized medicated thread having Kshar as medicine in it. In Ksharsutra Treatment for Fistula-in-Ano; your ano rectal will ligate this medicated thread in the fistula tract.

How to prepare a Ksharsutra?

A standardized Ksharsutra contains three medicines namely Apamarga Kshar (Specialized Alkaline medicine prepared from Achyranthus aspera), Snuhi Ksheer (Latex of Euphorbia nerrifolia) and Haridra (Curcuma longa). First 11 coatings of Snuhi Ksheer are applied repeatedly; then 7 coatings of Snuhi Ksheer & Apamarga Kshar and lastly 3 coatings of Snuhi Ksheer & Haridra are applied. In this way; there are a total of 21 coatings of medicines in a standardized Ksharsutra. Next coating is done only when the previous one has dried up. In last; this Ksharsutra is sterilized by ultra violet radiations. Now a days; Ksharsutra is prepared in specially manufactured Ksharsutra cabinets which has an arrangement for Ksharsutra hanging, source of heat, source of Ultraviolet radiations etc.

Since when Ksharsutra treatment for Fistula-in-Ano is available?

Acharya Charaka has only mentioned the Ksharsutra treatment for fistula-in-ano while Acharya Sushruta have given detailed description of Ksharsutra treatment. He mentioned Ksharsutra in context of Nadi Vrana (Sinuses); Haemorrhoids and Fistula-in-Ano in 500 BC. While Acharya Chakradatta detailed the method of Ksharsutra preparation. Due to certain reasons (not relevant to discuss here) we did not get each and every detail about Ksharsutra preparation here also. So, Dr. Deshpande from Banaras Hindu University (BHU) did extensive research on Ksharsutra preparation. This is because of the efforts of Dr. Deshpande that there is standardized method of Ksharsutra preparation which is also validated and approved by Central Council for Research in Ayurvedic Sciences (CCRAS).

What is the process of Ksharsutra treatment for fistula-in-Ano?

First of all, your ano-rectal specialist will define the fistula tract with the help of soft malleable probe from external opening of fistula tract with special reference to depth direction & branching pattern of Fistula tract. If he is unable to define the fistula tract properly; he may also advise you to go for MRI Fistulogram. Once the Fistula tract has been defined precisely; your Ano-rectal expert will ligate the Ksharsutra in the tract. For ligation of Ksharsutra; he will attach the Ksharsutra to one end (with eye on its tip) of the probe. As he will withdraw the probe from internal opening; Ksharsutra will be placed in the fistula tract. Medicine present in the Ksharsutra debrides the fistula tract and induces healing. This medicine works for 5-10 days’ time period so your Ano-rectal specialist will advise to get old Ksharsutra replaced by a new one at an interval of a week or 10 days until fistula heals completely.

How much time it will take for your fistula to heal completely?

Time period required for complete healing of Fistula will depend on length, depth and branching pattern of your Fistula. It is observed that Fistula heals @ 0.5 to 1 cm per Ksharsutra change sitting. That is to say for complete healing of a 3 cm long Fistula tract; you may require 4-6 Ksharsutra change sittings at weekly intervals.

Is there any contraindication for Ksharsutra Treatment for Fistula-in-Ano?

While describing Ksharsutra treatment; Acharya Sushruta says:
कृशदुर्बलभीरूणां नाड़ी मर्माश्रिता च या | क्षारसूत्रेण तां छिन्दयात् न तु शस्त्रेण बुद्धिमान् || i.e. An intelligent surgeon prefers Ksharsutra treatment over any surgical intervention to treat a patient suffering from Fistula/ sinus or other similar problem who is emaciated/ weak/ fearful/ timid/ whose fistula or sinus is in vulnerable area. सुश्रुत संहिता चि. स्था . 17/29 (Sushruta Samhita Chi. Stha. 17/29)

That is to say Ksharsutra treatment is equally effective in treating Fistula-in-Ano in patients suffering from Sinus or Fistula where surgery is contra indicated otherwise. So as such there is no contraindications for Ksharsutra Treatment in treating Fistula-in-Ano.

Is Ksharsutra Treatment for Fistula-in-Ano very painful?

Medicines present in Ksharsutra are alkali in nature so you might experience some burning sensation or irritation during Ksharsutra treatment for Fistula-in-Ano. You may perceive these sensations as pain. Sitz bath (Warm water tub bath); application of some anaesthetic gel like lignocaine gel etc. or painkiller medicine can be taken to manage this pain.

What types of precaution; a patient should follow during Ksharsutra Treatment for Fistula-in-Ano?

  • Ensure normal regular bowel movement
  • Maintain local hygiene
  • Take sitz bath (warm water tub bath) at least twice daily and after every bowel movement.
  • Be active as much as possible
  • 3-4 Km. daily walk – It will help in pain management as well as fasten the healing process.

What is special in Ksharsutra Treatment in Fistula-in-Ano that almost 100% success rate is claimed for it?

As said above; your Ksharsutra specialist will define the fistula tract precisely before putting the Ksharsutra in tract. If by chance; some part of tract is not covered by the Ksharsutra; the medicine released from the Ksharsutra will take care of that part as it spreads all around the tract where ever it finds the passage. If the uncovered part of tract is small; it will be definitely debrided completely by the Ksharsutra already placed. If by chance; uncovered Fistula tract is big enough to be debrided completely; then the medicine of Ksharsutra will open up this part through some other external opening where Ksharsutra expert can put 2nd Ksharsutra. So, it is the debriding action of Ksharsutra medicine and the time; you give in Ksharsutra treatment which assure complete healing of Fistula-in-Ano without any recurrence.

What type of variation in result you should expect while taking Ksharsutra treatment for Fistula-in-Ano?

Healing rate of Fistula might differ between two persons. Even same person may notice the different rates in healing at two different times. This difference is because of the different consistency of the intervening tissues. When the involved part is softer like fatty tissue; healing will be fast while harder muscular tissue will take more time for healing.

Why Ksharsutra Treatment for Fistula-in-Ano is better than Surgery?

Surgery for Fistula-in-Ano Ksharsutra treatment for Fistula-in-Ano
1.   In all types of surgeries for Fistula-in-Ano; recurrence of fistula after treatment (in appox. 15-20% cases recurrence of fistula is reported after surgery) is the main complications. 1. Predictably; Ksharsutra treatment involves ZERO recurrence.
2.  Partial or complete stool incontinence is reported in Surgery for fistula-in-Ano. 2.   Patients taking Ksharsutra treatment do not complain of stool incontinence.
3.  Surgery requires spinal or general anaesthesia so obviously there will be anaesthesia related complications in surgery for Fistula-in-Ano like headache, light-headedness, temporary loss of memory, lower backache etc. 3.   Usually, Ksharsutra expert gives local anaesthesia while doing Ksharsutra treatment for Fistula-in-Ano; which is the safest form of giving anaesthesia.
4. Surgery involves cutting of fresh tissue so there might be plenty of bleeding in surgery for Fistula-in-Ano. 4. There is no fresh tissue injury in Ksharsutra treatment for Fistula-in-Ano so chances of too much bleeding are minimal in Ksharsutra treatment for Fistula-in-Ano.
5.   Surgery involves dressing of wound for a long time period so your surgeon may advise you long stay in hospital and/ bed rest at home. 5. Ksharsutra treatment for Fistula-in-Ano is a day care procedure and you can return home same day after taking few hours rest. Usually there is no need for hospitalization or bed rest in Ksharsutra treatment for Fistula-in-Ano.
6. It takes a lot of time for a patient to return back to his normal daily routine after surgery for Fistula-in-Ano. 6. In Ksharsutra treatment for Fistula-in-Ano; patient can continue his normal routine activities from the very 1st day of Ksharsutra treatment.
7. Financial burden is too much in Surgery for Fistula-in-Ano. 7. Ksharsutra treatment for Fistula-in-Ano is more economical. Patient needs to pay lesser amount and that too at weekly intervals over a span of time.
Comparison of Surgery for Fistula-in-Ano Ksharsutra Treatment for Fistula-in-Ano
So, we can conclude that Ksharsutra treatment for Fistula-in-Ano is better than any kind of surgery for Fistula-in-Ano.

Can recurrent Fistula-in-Ano after surgery be treated by Ksharsutra treatment for Fistula-in-Ano?

Ksharsutra works on fistula-in-Ano by its debriding action on Fistula tract. This action is equally effective in recurrent Fistula-in-Ano also. So Ksharsutra Treatment has got same success rate in treating recurrent Fistula-in-Ano also.

Why complication like stool incontinence is not there in Ksharsutra treatment for Fistula-in-Ano?

Ksharsutra treatment for Fistula-in-Ano works on the principle of debriding the tract, cutting the intervening tissue followed by healing. Here cutting of intervening tissue differs from the cutting of tissue in surgery in the sense that it is not in one shot but a slow process i.e., only few fibres are cut in a time (which is followed by reunion of these fibres) not the whole sphincter. This gives a chance to the sphincter muscle to remain patent. It is supported by the sphincter exercise which we use to advise to the patients. This is the reason; patients taking Ksharsutra treatment for Fistula-in-Ano do not complain of stool incontinence.

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