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 2^nd 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?

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.