The Kshara karma is one of the Anushastra karma, a minimally invasive para-surgical measure. Ksharsutra is the method of Ksharakarma mainly employed in fistula-in-ano (anal fistula) and hemorrhoids (piles). This unique method has many advantages over conventional surgical methods, as this is an ambulatory and cost-effective method.
What Is Anal Fistula?
Fistula-in-ano (anal fistula) is a disease of the anorectal region and the description of which could be traced from dates back to the ayurvedic treatise - Sushruta Samhita. It is prevalent and occupies the second position among all anorectal diseases after hemorrhoids. Fistula-in-ano is a track that opens deeply in the anal canal or rectum and superficially on the skin around the anus. Sometimes, the track may have a single opening, which is called a sinus. Generally, this track develops from an anorectal abscess (Bhagandara pidika) that bursts spontaneously or is drained inadequately.
An anal fistula may occur with or without symptoms. There may be intermittent swelling with pain, itching, discomfort, and discharge of pus in the perineal or perianal region. This track does not heal due to frequent discharge, the presence of unhealthy granulation, and lack of rest to the part. This is purely a surgical condition, and certain operative procedures are usually associated with complications like loss of gluteal cushion, infection, and recurrence and require prolonged hospitalization. Research studies on fistula-in-ano at various renowned medical institutions worldwide revealed a higher recurrence rate after surgery.
What Are the Causes of Anal Fistula?
Generally, anal fistulas develop after the occurrence of an anal abscess. Other less common causes include:
Crohn’s disease (a condition in which the digestive system is inflamed).
Infection with tuberculosis (TB) or HIV (human immunodeficiency virus).
Diverticulitis (infection of small protrusions sticking out of the large intestine).
A complication of surgery around the anus.
Hidradenitis suppurativa (skin disorder that causes scarring and abscesses).
What Are the Treatment Options for Anal Fistula?
Anal fistula often requires surgery as they seldom heal if left untreated. Various treatment modalities such as Seton treatment (chemical or cutting), fistulotomy or fistulectomy (cutting open the whole length of anal fistula, so it heals into a flat scar), chemical destruction of the fistula by corrosives, application of fistula glue or fistula plug are suggested for the management of anal fistula. These methods have prolonged hospital stays, high recurrence rates,
and anal incontinence (inability to control bowel movements). Alternatively, the application of ‘Ksharasutra’ medicated cotton thread coated with ayurvedic medicines is very easy, has minimal pain, requires a lesser hospital stay, and has minimal complications.
How to Manage Anal Fistula Through Ayurveda?
Medicated Ksharsutra is considered one of the best options for managing anal fistula. However, not everyone can go for this treatment. Patients who complain of perianal discharge (stool-like) can have this treatment. Patients with compromised cardiopulmonary status and those who are immunocompromised are excluded.
Ksharsutra - Ayurvedic Para Surgical Measure for Anal Fistula:
Ksharsutra is prepared by repeated smearing of the alkali of the Achyranthes Aspera plant, the latex of Euphorbia neriifolia, and turmeric powder on a surgical linen thread, which possesses proteolytic, caustic, and antiseptic properties and promotes simultaneous wound healing. The ksharsutra therapy provides cutting and healing processes simultaneously.
The ksharsutra is inserted into the fistulous tract under suitable anesthesia with the help of a specially designed probe and is replaced with a newer ksharasutra on every seventh day till the fistulous tract is completely healed up. While performing the procedure, care was taken not to create a false passage. Gradually, the thread cuts out of the anal tract with a healed wound.
For multiple anal fistulas in different quadrants, multiple medicated Ksharasutra were applied.
This measure was revived, developed, and standardized in the early seventies by eminent scientists. Considering the importance and unique nature, further validation was done by ICMR (Indian council of medical research) through randomized, double-blind, multi-centric clinical trials. These revealed that the recurrence rate in patients of fistula-in-ano treated with ksharsutra therapy was just four percent, while about 11 percent in patients treated with surgery. The research studies over the years added a scientific basis to this art as an effective, amble, and viable alternative to surgery with better compliance. Ksharsutra can also concomitantly be applied in patients suffering from fistula-in-ano or anorectal diseases associated with diabetes, hypertension, neurogenic disorders, cardiac diseases, and also in tuberculous or cancerous fistulae.
The central council for research in Ayurveda and Siddha (CCRAS) has standardized the method of preparation of ksharsutra and patented it. The efficacy studies at CCRAS institutes revealed a 93 % cure rate with minimal recurrence.
Management of anal fistula with Ksharasutra is the best option not only because it is simple and easy but also due to minimal post-operative complications. This treatment method has a minimal cost and a very low recurrence rate.
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