Tuesday, January 31, 2012

Fistula-in-ano and Ayurveda Kshar-sutra therapy


The history of medical literature available today very clearly speaks that the disease Fistula-in-Ano (Bhagandara) affects more reputations of surgeons who deals with it. There is a saying in medical world "the best way to take revenge of a surgeon is to refer him a patient of Fistula-in-Ano". Thus, it is a well known fact that in spite of the tremendous developments of modern medical science especially of surgery, the disease Fistula-in-Ano still remains a challenging problem to the medical world.
The ano-rectal disorders and their management has established a separate surgico-dynamic  speciality among the various surgical disorders. The ano-rectal disorders have been known form the very early period of evolution to the medical science. The disease Bhagandara (Fistula-in-Ano) is said to have existed about four thousand years according to Wilson (1963) as mentioned by Khurana et al (1972). Furstenbergh et al (1964) have mentioned the method of Apolinose by which Hippocratus, the Father of modern medicine (460 BC) treated Fistula-in-Ano.
The main limitation of treatment of Fistula-in-Ano by conventional surgery is that even after surgical excision of the tract the recurrence rate still remains between 20-30%. Hence this disease even today stands as a challenge in front of the medical world.
Susruta’s method of thread treatment is known as Kshara-sutra treatment as mentioned above and even today it is quite successful method in treating this difficult disease.  Hippocrates named the procedure of passing the ligature along the fistulous tract as Appolinose. Chandsi and Madrasi treatments are known by their names only and much detail are not known about them. However it was Prof. P. J. Deshpandey at Banaras Hindu University, who took the lead after ancient Acharyas for exploring the technique, and modified and standardized it with the help of modern science and technology. The treatment was put to clinical trials in patient of Bhagandara and many scientific papers published. Apart from that, at the Department of Shalya Shalakya, Gujrat Ayurved University, Jamnagar many works done on Kshara-sutra treatment for the disease Bhagandara under the guidance of Prof. Kulwant Singh. Later on various other places in India and abroad started Kshara-sutra treatment in Bhagandara (Fistula-in-Ano) and piles patients. The Kshara-sutra treatment is now a well accepted Ayurvedic technique for treating the ano-rectal diseases viz. Fistula-in-Ano, Arshas (Piles), Parikartika (Fissures with tags) etc.

APPLICATION OF KSHARA-SUTRA IN A PATIENT OF BHAGANDARA (FISTULA-IN-ANO):
Pre Kshara sutra (Pre-operative):
a.      The patient should be admitted in the hospital a day before operation.
b.      Laxative like Panchsakara churana is given at previous night
c.       Shave and part preparation done.
d.      Patient is kept fasting for at least 8 hours
e.      Consent of the patient in written
f.        Proctoclysis enema 2-4 hours before the procedure
g.      Inj. Xylocaine sensitivity test
h.      Inj. Tetenus toxoid 1 Amp. IM stat.

EQUIPMENTS AND OTHER REQUIREMENTS
Proctoscope
Probes of different sizes
Artery foreceps both Staight & curved
Sponge holding foreceps
Surgical gloves assorted size and pair
Scissiors
Towel clips
Syringes
Swabs
Linens
Kshara sutra
Jatyadi oil

POSITION: All the patients were given lithotomy position for the  procedure.

Kshara sutra threading procedure (Operative procedure):

  1. Spinal anesthesia is induced by the Anesthetist.
  2. The patient is made to lie on the operation table in Lithotomy position.
  3. The perianal area is cleaned with Savlon and spirit followed by Betadine painting.
  4. The outer area is covered with sterile cloth, leaving the anal area open.
  5. Digital examination done to locate any induration, internal opening and to exclude other lesions.
  6. Probing is done through a malleable probe to locate the internal opening with the index finger of other hand inside the anus. If internal opening is located, the probe is pushed out through the anal verge and the track is threaded loosely by Kshara sutra. However if internal opening couldn’t be located it is made inside the anal canal at a point which offer least resistance to the tip of the probe. Again Kshara sutra threading of the track is done loosely.
  7.  10 ml. of Jatyadi oil is pushed inside the rectum and sterilized gauze is applied on the anus covering the external opening.
  8.  T-bandage is tied to keep the dressing in proper position.
  9.  Thereafter the patient is shifted to the ward.

Post Kshara sutra threading management (Post operative):
1.       Nil orally for 4 hours
2.       Give liquid diet after that to avoid any type of inconvenience.
3.       Monitor the vitals
4. If operation is done under spinal anaesthesia, to avoid   complication give head-low position for 12 hours.
5.       Jatyadi oil P/R OD
6.       Hot sitz bath with panchvalkal kwath 8 hourly
7.       To avoid hard stool, give mild laxative to the patient
8.       If pain is excessive, urinary retention occurred, it is managed accordingly.


Post Kshara sutra threading complications:

1.   Retention of urine – it has been observed that within 8 to 10 hours after ligation, some of the patients complain of retention of urine which can be tackled by frequent sitz bath in lukewarm panchvalkala kwatha or simple warm water. Catheterization is seldom required.
2.  Local irritation – In some of the patients local i.e. perianal irritation is seen which needs frequent use of oil application and hot sitz bath etc.
3. Abscess formation – In some of the patients (especially who was suffered from interno-external piles), abscess formation takes place which was managed with local application of Dashang lepa with Goghrita.
4.  Haemorrhage – Alarming type of haemorrhage is not a rule with Kshara sutra treatment. However in some of the cases slight oozing may be seen which need no special care except the usual routine line of management, viz. avoidance of hard stool and much straining during defecation.

Weekly change of the sutra: - Kshara-sutra applied initially is kept for 7 days after which it is replaced by a fresh Kshara-sutra by Rail Road Technique. This procedure is repeated every week till the track completely cut through and if there is any unhealthy granulous tissue, it is scrapped-off during this weekly follow-up to promote a better healing.

Mode of action of Kshara sutra:
Kshara sutra works by pressure necrosis, chemical cauterization by kshar (alkali) and sloughing of the tissue of the walls of the fistulous track along with adequate drainage. It leads to an easy debridement of unhealthy tissue and pus etc. and thus providing a cleaner base for the wound healing of the fistulous track. The Kshara-sutra is changed weekly so that an average pace of cutting of about 0.5-0.8 cm/week is maintained along with healing from behind. Finally the whole track is cut through and the fistula gets healed up with minimal scarring and without any other major complication.

Pathya-apathya (Diet and routinely activities):
From the very first day of Kshara sutra threading procedure, light diet like Khichri is advised. Patient is also advised to take plenty of fluids, blend diet, green vegetables, salad and seasonal fruits. Patient is further advised to avoid spicy and fried food and not to strain during defecation.
Picture 1: A case of multiple Fistula-in-ano, with kshar-sutra threading done in all the 3 tracks separately.

Picture 2: A completely healed case of Fistula-in-ano after kshar sutra treatment. In this case there was done fistulectomy which was not successful and fistula recurred. Thereafter the threading of the track was done by kshar sutra and the fistula healed successfully in about 4 months without any recurrence. 

NOTE: The procedure can also be performed under local anaesthesia or without anaesthesia at all if the patient is co-operative. However  if the patient is sensitive (Vata dominant prakriti), spinal anaesthesia is the best choice.

68 comments:

  1. kindly give your valuable comments.... for further improvements... Thanks.

    ReplyDelete
  2. nice post Dr. Chauhan. please keep it up. Thanks

    ReplyDelete
    Replies
    1. Hi Doctor,

      Thank you so much for this informative blog. I am suffering from this disease and taking following medicines:
      Amlycure D.S.
      Amroid tabs (2 tabs twice a day)
      Amroid ointment.
      Polynzyme Plus.

      And I have to apply Jatyadi oil in Ano using the pipe and injection. Do you think that it might cure Fistula-in-ano without operation??

      Delete
  3. Would you recommend using Jatyadi Oil for piles as an at home treatment? I live in the US and have never hear of this before, but it sounds like something I'd like to try.

    ReplyDelete
  4. Yes you can use it at home for treatment of bleeding piles, anal fissure or any wound. It helps in healing the wound and arrests the piles bleeding by repairing the anal mucosa. Thanks.

    ReplyDelete
  5. One of my friend got ksharsutra done for fistula....Dr himself removed the thred saying that it is impossible to put thread any more...Is it correct?? Will it happen any time??

    ReplyDelete
    Replies
    1. There is a lot of variation seen in different cases of Fistula. So, may be Dr at that time thought of removing the thread.. Kindly mail the case with part pictures so that I can have a better idea of the case and can give appropriate suggestion. Pls Mail me at nchauhan.dr@gmail.com. Thanks.

      Delete
  6. Doctor I done kshar sutra 2 months before yesterday my thread is come out itself I consult my doctor and he told me need to do dressing for few days? is it fine? doctor put some bandage in my wound which I removed in the morning but this hurts while walking or sitting is it normal? does it lead to any further complications? any precaution you suggest during this period

    ReplyDelete
  7. Ya it's normal. You may need a few dressings. Precaution is to keep the area clean by taking Sitz bath with lukewarm water with some disinfectant added to it. And avoid diet which may cause bowel irregularities like spicy food, fast foods etc. Drink adequate water. Take a fibre rich diet. If Khsar sutra procedure was done correctly, you will heal completely within a few days. Thanks. If you have any problem you may email me at nchauhan.dr@gmail.com

    ReplyDelete
    Replies
    1. Thank You Doctor, I will definitely mail if I have any concern

      Delete
  8. I have stared treatment.inserting kshar sutra was done without anesthecia.it was very painful. while changing sutra second time it was broken into two picces.i have problem of high BP . Doctor fear to give anesthecia.
    Pl.Guide me
    J.S.Gaikwad Pune Mob.8625830958 Email Id jsgaikwad03@gmail.com
    Regards
    Gaikwad

    ReplyDelete
    Replies
    1. Dear Mr. Gaikwad ji,
      If kshar sutra is done by skilled doctor, the pain during changing of thread can be minimized. As far as anaesthesia is concerned, it is practically very much difficult (almost impossible)to give anaesthesia every time while changing the thread because the number of sittings of thread change are quite much. However when threading of fistulous track is done first time, local or spinal anaesthesia can be given for patient's convenience. It's all depends on surgeon's skill. If a surgeon is having a good experience, he can change the thread with minimum pain and inconvenience.
      You can talk to me directly at my cell no. 09536909883 if still have any query regarding your problem.
      Thanks and regards,
      Dr. Naveen Chauhan

      Delete
  9. I had twice kshar sutra at belgaum but it started once again. please advice what to do now.

    ReplyDelete
  10. please call me at my personal cell number 09536909883 on any working day b/w 10am to 6pm and if possible pls mail me your latest fistulogram report/image and image of part affected.

    ReplyDelete
  11. Doctor how long does it take to heal completely after ksharsutra , after ksharsutra the cutiing healed and broke twice but without any pus, my doc says there is no fistula recurrence but since i have a very mobile life which includes travelling and sitting for long timr,,,pls advice
    And precautions must one take

    ReplyDelete
  12. Hello Dr
    i have undergone arsh sutra surgery for anal fitsula and piles 4 days back .visited the dr once after that as per medication.i m having problem of urinating since yesterday ..as adviced by doc m taking hot water bath and urination medicine prescribed by doc but yet i am not able to urinate in one go.Dr please advice when would this get solved
    .

    ReplyDelete
  13. Hello Doctor,

    First of all thanks for sharing the knowledge.
    I have anal fissure as diagnosed by my GP (MD). I am using rectogesic cream for pain relief. The size of fissure is reduced but i have an intermittent discharge like pus associated with stool particles. I have a doubt if it is fistula. Could you please give your opinion? The fissure has not healed from 12 weeks.

    Thanks,
    Saggy

    ReplyDelete
    Replies
    1. Hello dear!
      There may be pus discharge in fissure too. But whether you have any fistula is a matter of examination. Anything can be said after a proper rectal examination. For fissure please call me at 09536909883 (MOn. to Friday 10am to 4pm).
      Regards,
      Dr. Naveen Chauhan

      Delete
  14. Hello Doctor,
    I had piles and later got a fissure
    i changed my food habits and tried my best to eliminate the constipation factor .
    Continiouly taking sitz bath.
    now there is a fistula.
    Dont want to undergo a surgery,as heard a lot about its failure.

    Please help me.

    and suggest any good doc .
    Also tell me how long it takes heal completely.

    ReplyDelete
    Replies
    1. Please call me at 09536909883 (Mon. to Friday 10am to 4pm) for the solution of your problem.
      Regards,
      Dr. Naveen Chauhan

      Delete
  15. Hello Doctor,

    I undergoing Ksharsutra treatment for anal fistula and want to know, what will happen if there is any delay in thread replacement(means if it is not changed on every 7th day), and also what precautions need to be taken if there is a chance of delay in thread change.

    Thanks in Advance and Appreciate your response.

    ReplyDelete
  16. If the thread not changed at time there will be delayed healing of fistula. Average time of complete cure will increase.
    Regards,
    Dr. Naveen Chauhan

    ReplyDelete
  17. hello doctor
    i have undergone ksharsutra treatment for fistula from 30/12 to 29/1 . on 29 the thread broke itself and when i consulted my doctor he said my fistula is healed giving me a blue colored powder to apply for 3 days and then betadine for 1 week . but now i feel discharge of blood and burning sensation at the site sometimes .
    plz tell me what to do

    ReplyDelete
    Replies
    1. An examination (check-up)is needed to understand your case properly. Please call me at 09536909883 if still have any doubt.
      Thanks,
      Dr. Naveen Chauhan

      Delete
  18. Dr.Chauhan,
    I have undergone two surgery for Fistulo in Ano. Both the surgeries have done by Fistulectomy method. after surgeries still Pus is discharging. My Dr.told me to do MRI, so I deed it. It is found that I have multiple fistula "Y" shape type at 6 oclock position. Then he advise me to go with ksharsutra Method.I visited Aurvedic Doctor for same.My main problem is that I don't have external opening for the Ksharsutra .So he has given me some power to apply externally. Now he told me we will do artificial hole for applying ksharsutra in the Y shape track.Please give me your advise for artifical preparation of hole and it's consequences.

    ReplyDelete
  19. Dr,
    I have done ksharsutra for fissure and fistula in ano on 09/02/2013.My first thread change was on 15/02/2013 and my Dr. told there will be more pain. But inspite of taking pain killer prescribed by my Dr. I am having unbearable pain for last 2 days and there is no symptom of pain reduction, I am regularly taking sitz bath also. Please advise how to reduce the pain and the precautions and dietary advise for the fast cure.

    Thanks
    Nagarajah

    ReplyDelete
  20. Dear sir one month back I gone anal fisttulla around 10cm effected as of now three threads changed the problem is while changing thread unbearable pain even though given local anesthesia really that's unbearable pain and after changing thread first four days I can not bear that pain even though using pain killer injection sir please suggest me the way for pain free please sir

    ReplyDelete
    Replies
    1. This comment has been removed by the author.

      Delete
  21. Dear Mr. Radhakrishna ji,
    If kshar sutra is done by skilled doctor, the pain during changing of thread can be minimized. As far as anaesthesia is concerned, it is practically very much difficult (almost impossible)to give anaesthesia every time while changing the thread because the number of sittings of thread change are quite much. However when threading of fistulous track is done first time, local or spinal anaesthesia can be given for patient's convenience. It's all depends on surgeon's skill. If a surgeon is having a good experience, he can change the thread with minimum pain and inconvenience.
    You can talk to me directly at my cell no. 09536909883 if still have any query regarding your problem.
    Thanks and regards,
    Dr. Naveen Chauhan

    ReplyDelete
  22. Dear Dr Chauhan I was diagnosed with Peri anal abscess and operated upon as the pain was unbearable. This was done under general anaesthesia by giving Ketamin i/v. It gives a death like experience and do not like to have it again. Now a painful swelling and slight discharge has started near that site. Surgeon without exam told me it could be fistula in ano. I do not wish to go for surgical the allopatic Tt. Suggest me will it be Fistula in ano and can i have it operated under local Xylocaine by kharsutra seton. Kindly advise me.

    ReplyDelete
  23. Dear sir,
    Yes, it can be fisutla in ano, but it can be diagnosed after examination (check-up). If your location is near Delhi, you can visit to me for examination and kshar sutra treatment if needed. Otherwise you may go to some kshara sutra specialist Ayurvedic doctor.
    Thanks,
    Dr. Naveen Chauhan
    Ghaziabad

    ReplyDelete
  24. Hello Doctor,

    I am Suffering from anal fistula from past three months, pimple has formed near 10cm to anal. Its draining frequently,I have consulted patanjali aurvedic doctor, he recommended some medicines. Does this fistula need surgery compulsorly or it can be cure with medicines?

    ReplyDelete
    Replies
    1. This comment has been removed by a blog administrator.

      Delete
  25. Hello
    This is a fact that Fistula in ano is a 100% surgically curable disease, and among surgery options Kshara sutra is the best one. For more information please visit the following link http://www.ayurvedapilescure.com/blog/?cat=61
    You may call me at 09536909883 if still have any doubt.
    Thanks and regards,
    Dr. Naveen Chauhan
    ghaziabad

    ReplyDelete
  26. Hi Dr.Naveen

    Thanks for sharing valuable information. Im suffering from Fistula. As you said in previous post it needs surgery, how many days patient need to take bed rest after operation. Does it curable with in one month.The job im doing have to seat for long hours.Can you please tell me how many day/months need to take bed rest after kshara sutra operation.

    ReplyDelete
  27. Hello,
    After kshara sutra threading procedure for Fistula-in-ano one never needs any bed rest even for a single day. Patient can resume his normal work and go to job right from the next day. As far as duration of treatment is concerned, it can be predicted only after proper examination of the case.
    If still you have any doubt kindly copy and paste the following link in your browser; http://www.ayurvedapilescure.com/blog/?cat=61
    you will find many articles on this disease.
    Thanks,
    Dr. Naveen Chauhan

    ReplyDelete
  28. dear sir,
    my wife is suffering from fistula from last two years.As i studied about kshar sutra i consulted with a ayurvedic doctor.He told me to wait for some time till the complete formation of track takes place.And so i did. Now on 24/2/13 first time ksharsutra was done.Till the date ie on 28/4/13 he changed 5th thread.Normally how much thread replacement is required.During the thread changing pain is too much so local anesthesia is given to her every time. is it very harm full.there is no formation of pus but wound is not completely heeled. sir pls help me i m too frustated with this fistula....

    ReplyDelete
    Replies
    1. Some pain may occur during the thread change but if thread is changed by skilled doctor, there is no need of any anesthesia during the procedure. As far as the duration of treatment is concerned, it can be predicted only after examining the case. If you still have any doubt you can call me at 09818969989.
      Thanks,
      Dr. Naveen Chauhan
      Consultant Proctologist and Kshara sutra surgeon
      Ghaziabad

      Delete
  29. dear sir,
    what are the chances of infection in kshar sutra treatment ? if thread is not changed for one month, can there be infection .sir from last one month my thread is not changed and it is smelling now.And one more thing if wound is not heeling should be go for surgeon ? sir please give me your valuable suggestion i will be thankful to you.

    ReplyDelete
  30. Why the thread left unchanged for one month? As far as infection is concerned, the fistulous track is always infected, kshara sutra helps in draining the infected material (pus etc.) thus leading to a clean base for better healing. You should immediately contact your kshara sutra specialist doctor, who after examination can provide you the best possible solution. If you still have any doubt please call me at 09536909883.
    Thanks,
    Dr. Naveen Chauhan
    SDC, Ghaziabad

    ReplyDelete
  31. hello Doctor,
    i have problem of fistula in ano.is it possible that it can be rectify by ayurvedic medicine only & no need for any surgery.
    Rohit
    New Delhi

    ReplyDelete
    Replies
    1. Dear Mr. Rohit,
      Fistula in ano is a 100% surgically curable disease. It's not possible to cure only by Ayurvedic or any other kind of medicine. Kshara sutra is an excellent way to treat it effectively. If you still have any query left, you may call me at my cell at 09818069989.
      Thanks,
      Dr. Naveen Chauhan
      Consultant Ayurveda Proctologist
      Shri Dhanwantari Clinic, Ghaziabad

      Delete
  32. dear sir
    my sixth thread broke itself and still there is little wound.Wound now is very close to anus .
    the problem is some abscesses is still discharging( very little concentrated yellow color) in 2 or 3 days.Is it a problem? Should be go for one more thread or it will heeled it self.sir please suggest....

    ReplyDelete
    Replies
    1. Hello sir,
      Warm greetings from Shri Dhanwantari Clinic, Ghaziabad.
      In your case I feel you should go to your doctor who can tell you what to do. Any advice can be given only after proper Check-up of the patient. Since your doctor has been treating you from a long time, you must consult him to get a permanent solution of your problem. If you want to consult me, you are most welcome at SDC, Ghaziabad. If still there is any query left in your mind, you can call me at my cell at 09818069989
      Thanks,
      Dr. Naveen Chauhan
      Director and consultant Ayurveda Proctologist,
      SDC, Ghaziabad

      Delete
  33. Dear sir
    What are causes for fistula? why it happens? what are the precautions to avoid fistula ? sir i suffered from fissure, now it is heeled? but i m very afraid that it will cause future problems like fistula? sir pls suggest

    ReplyDelete
    Replies
    1. Hello there!
      To get the answers of your queries kindly visit the following link; http://www.ayurvedapilescure.com/blog/?cat=141
      I hope your queries will be resolved. If still any query remains, you can call me at 09818069989
      Thanks,
      Dr. Naveen Chauhan
      Director and Consultant Ayurveda Proctologist
      SDC, Ghaziabad

      Delete
  34. Hello Doctor,

    I was diagnosed with internal peri-rectal abscess of a size of tennis ball in May 2010 in US and had surgery to drain it. In July 2010 after colonoscopy I was diagnosed with mild crohns colitis. In January 2011, I had another surgery to drain four to five small peri-rectal abscess that could only be detected by an MRI. By March 2011, I developed fistula near the anal area. My doctor is US who is a renowned pelvic floor surgeon had mentioned me that a fistula surgery could fail depending on how it heals after the surgery. We didn't do an MRI to see how the fistula is developing and I didn't go for surgery at that point in time. Given my health condition at that point in time, repeated surgeries, I decided to manage my crohns, take a little break, did lot of reading on nutrition and finally decided to change my lifestyle. I became primarily vegan and rarely sometimes consumed dairy. I started walking, jogging and basic yoga on non-regular basis. On weekdays, I started drinking vegetable and fruit juices for breakfast, ate large salad for lunch and cooked vegetables, rice with dals for dinner. On weekends, it would be my little break time from weekday routine. This helped me control of my crohns inflammation without medications. My fistula still remains but it doesn't affect my lifestyle and on any given day I have low to negligible to no discharge. I am right now visiting India and started taking Crohns medication as a precaution, Himalaya Liv 52 and chyawanprash since last 3 weeks. My fistula discharge has suddenly stopped completely. I also started Divya Arshkap vati since last 2 days. Given that I have fistula since last 2 years, I can feel my fistula healing.

    My question is right now should I opt for Kshara Sutra procedure or wait to see if the fistula is healing?

    Thanks much...

    ReplyDelete
  35. Hello sir,
    Anything can be commented only after proper examination. So, better you consult and get examined by a Kshara sutra specialist doctor who can tell you what exactly to do to heal it.

    Thanks,
    Dr. Naveen Chauhan
    Consultant Ayurveda Proctologist
    SDC, Ghaziabad

    ReplyDelete
  36. Hello sir,
    my last thread broken two month ago itself But now sir problem is that white thick pus is discharging daily.one month ago when i consulted to my doctor he said little pus may discharge for 15 to 30 days and gave few antibiotics. but pus is still discharging. Sir please suggest is it recurrence or anything due to which pus is discharging.

    ReplyDelete
    Replies
    1. It may be recurrence or may not be. If kshara sutra treatment is done correctly, pus doesn't come after treatment. A proper check-up is necessary to comment on your case.
      Thanks and regards,
      Dr. Naveen Chauhan
      Consultant Ayurveda Proctologist
      Ghaziabad

      Delete
  37. After fistula operation & changing ksar sutra for about 3 months,my Dr. told that track is ok but thread was not found. Next day broken thread came out and shown to Dr. who told it is okay and dressed would for about two weeks. Now Dr. says it is alright but now sir problem is that white thick pus of 1 or 2 drops daily is discharging. Dr. gave me anti bitic for 5 days but still pus is there. Sir please suggest test if fistula is okay or it is reoccuring.

    ReplyDelete
    Replies
    1. It may be incomplete treatment or recurrence. Anything can be said only after proper check-up of the patient.
      Thanks and regards,
      Dr. Naveen chauhan
      Director and Consultant Ayurveda Proctologist
      Shri Dhanwantari Clinic, Ghaziabad

      Delete
  38. Dear Sir,

    currently I am undergoing kshar sutra treatment for my ano fistula in bangalore, already 8 threading done and dr has advised 30 threadings to heal completely , i have only one opening that to just 4 cm away from anal region, can you comment your opinion on this.

    Regards
    Bharath

    ReplyDelete
    Replies
    1. Dear Mr. Bharath
      The average rate of cutting of track by kshara sutra is 0.5 cms/week. But it may sometimes vary depending on case to case. But 30 weeks (threads) for such a short track doesn't seems to be logical to your case as you are telling it is 4 cms away from anal verge. Ask your Dr. that what is the initial length of fistula track and thread (kshara sutra). However every case can be commented upon after a proper check-up (examination).
      Thanks,
      Dr. Naveen Chauhan
      Consultant Proctologist, SDC, Ghaziabad

      Delete
  39. Dear Sir

    Thanks for replying

    0.5 cm cutting internally muscle tissue or external skin and dr has advised to squeeze and remove pus during sitz bath every day for faster healing and how can we know initially thst dr has inserted thread in right tract and giving right treatment.

    Regards
    Bharath

    ReplyDelete
  40. Dear Sir,

    Thanks for your kind reply

    0.5cm internally cutting of muscle tissue or external skin and dr has advised me to squeeze and remove pus during sitz bath where in lot of pus is coming out. Each time when I go for thread change it appears very loose and how will we know know that dr has inserted thread in righttract

    Regards
    Bharath

    ReplyDelete
  41. Respected Doctor,
    I am suffering from Anal fistula for last almost 2 years now. Initially there was only pus discharge, inflammation and swelling. But, since last year or so, initially there is pus mixed with blood (thick) and then some blood discharge enough to make the clean water in the commode red. One of the surgeons advised me surgery wherein the fistula track is removed and wound left open to heal. Our family physician advised me against it since the consequences are not good and it would cause more problems. Living with this fistula has been like a living hell. WOULD YOU SUGGEST KSHARASUTRA TREATMENT?

    ReplyDelete
    Replies
    1. Dear Mr. Junaidji,
      Yes, you can proceed for kshara sutra treatment for fistula in ano. Actual prognosis can be told only after proper examination.
      Thanks,
      Dr. Naveen Chauhan
      Consultant Proctologist
      SDC, Ghaziabad

      Delete
    2. hello Dr i have done fistulatomy done twice but thers is pus again now am going for kshar sutra what is the diet and post operative care and rest required.i have one track

      Delete
  42. Hello Doctor,
    Please tell your address of clinic and also the cost of ksutra therapy of fistula.

    ReplyDelete
  43. Hello Doctor,

    I am suffering from piles since many years. On 14th December I had undergone the Kshar Sutra treatment by a Chandsi Specialist. The procedure was quite painful in spite of the treatment under local anesthesia. The dressing was done and I was discharged from the clinic and was prescribed few medicines like pain-killers, antibiotics, vitamins, antacids etc. That very night after 9 hours from the treatment, I had a bad urge of defecation. I passed ample amount of blood with the stool and the pain was really impossible to bear. After talking to the doctor, I had taken two pain-killers at an interval of three hours along with a 500 mg sleeping pill. The next morning also, defecating was quite painful and i also passed blood. It 5 days now, and my condition has improved . I am not taking pain-killers now but the discomfort remains and every morning I am passing blood with stool. When I contacted the doctor , he said that it is quite normal during the first few days. Also, during my first dressing session, he observed and said that, the medicine has not worked properly that very night as it had to be left to work for 14-16 hrs but unfortunately I had to evacuate and it worked for only 9 hours. Next week, after observing my condition, he is planning to again inject some medicine. I am really at loss now, as if the whole procedure is repeated, the pain will be again unbearable. Please let me know if these things are normal, or is there anything serious. When will my wound heal and I can get back to lead my normal life?

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  44. Hi

    I got rectovaginal fistula due to childbirth. Are there any references in bangalore who would perform ksharsutra for rectovaginal fistula.

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    Replies
    1. Hello madam,
      You can visit any Govt. Ayurveda College's Shalya (Surgery) department for kshara sutra treatment. Or if possible visit our centre in Ghaziabad.
      Regards,
      Dr. Naveen Chauhan
      Director, Shri Dhanwantari Clinic,Ghaziabad

      Delete
  45. I had fistulaectomy and khasarsutra. Thread was changed after 5 days. Now pus is coming is it normal? ?

    ReplyDelete
    Replies
    1. Dear sir,
      The following links will be quite useful for you;

      PLEASE COPY AND PASTE THE FOLLOWING WEBADDRESS IN YOUR BROWSER
      http://www.ayurvedapilescure.com/blog/?cat=61

      DO'S AND DONT'S DURING KSHARA SUTRA TREATMENTS

      DIET AND OTHER PRECAUTIONS DURING KSHARA SUTRA THERAPY

      FREQUENTLY ASKED QUESTIONS ABOUT KSHARA SUTRA THERAPY

      Thanks and regards,
      Dr. Naveen Chauhan
      Director and Consultant Ayurveda Proctologist,
      Shri Dhanwantari Clinic, Ghaziabad

      Delete