Kshara Sutra Therapy in the treatment of Pilonidal Sinus

‘Kshara Sutra Therapy’ in the treatment of ‘Pilonidal Sinus

‘Pilonidal Sinus’ 

‘Pilus’ = Hair and ‘nidus’ = nest; Pilonidal sinus means ‘sinus with nest of hair.’

• This condition is commonly occurs in hairy men.
• This is an acquired condition.
• When a person sits, buttocks take maximum pressure. As they rub against clothing etc. hairs break off and get collected between cleft of the buttocks. These gradually penetrate the skin or enter the openings of sweat glands, forming a sinus. Gradually more hairs are sucked into the sinus forming a bunch of hairs, so it looks like a nest of hairs, thus it is called ‘Pilonidal Sinus’.
• As this condition is common in jeep drivers, this condition is also called ‘jeep bottom’ disease.
• In Ayurveda, ‘Pilonidal Sinus’ is a type of ‘Naadi Vrana’.

Symptoms of Pilonidal Sinus:

• Chronic or recurring sinus in the midline, between buttocks.
• A tuft of hair projects from its opening.
• Discharge from the sinus is blood stained, foul smelling and contains hairs.
• Secondary openings may be found in the midline or in the buttocks and there is an indurated track connecting the openings.
• Generally the patient is a hairy, male and 20 to 40 yrs. of age.
• There may be pain and swelling locally.
• Generally, it does not penetrate the bone.
• There may be history of repeated abscess in the region, which may have resolved spontaneously or may have been incised open.

Treatment of Pilonidal Sinus:
Conservative management of Pilonidal Sinus:

• Clean the track.
• Removing hairs from the track and a considerable area surrounding the track.
• Avoid occupations which involve long hours of sitting e.g. driving vehicles etc.

These measures have given encouraging results in those with mild symptoms.

When an abscess has been formed (acute stage):

• Incision and drainage (I & D) has to be done.
• The abscess cavity has to be cleaned well to remove hairs and unhealthy granulation tissue to prevent recurrence.
• Care should be taken as in a patient of abscess.

Excision (Surgical removal) of Pilonidal Sinus:

• Operation has to be carried out after the signs of inflammation have subsided.
• Patient is place in prone position.
• Methylene blue dye can be injected into the opening to colour and thus identify the tracks.
• The track once identified, has to be surgically laid open, hairs and debris removed and the edges sutured. But this is associated with risk of recurrence.
• Hence, once all the tracks have been excised, and perfect haemostasis maintained, the area is packed with gauze dipped in Betadine. Next day the dressing is removed, and patient is advised daily hip baths and a dressing till the wound has healed completely by secondary intention.

‘Kshara Sutra Therapy’ in the treatment of ‘Pilonidal Sinus’:
Kshara Sutra, an alkaline herbal medicated thread which is one of the most successful among all the therapies available for the treatment of Naadi Vrana (Pilonidal Sinus) and Bhagandara (Fistula-in-ano) from ancient time to the present era.

How to apply Kshara Sutra in Pilonidal Sinus: 

• Patient is placed in prone position.
• Under aseptic measures and under proper anaesthesia, track should be identifying with the help of a probe.
• After cleaning the track, Kshara Sutra (An alkaline herbal medicated thread) has to be passed in the track and make it fix over there.
• As we discussed above that due to its proteolytic enzymes and hygroscopic action, the Kshara produced debridement of sluggish tissue.
• The Kshara Sutra has power to cut and heal the sinus track simultaneously.
• After every week, the Kshara Sutra has to be changed with the previous one.
• After every week of Kshara-sutra change, the track cleans-up and simultaenous healing occurs, thus the length of track and the kshara sutra goes on decreasing on subsequent visits. Finally the whole track gets cut off (cut through) by the action of Kshara-sutra and the disease cures completely.

Principle behind ‘Kshara Sutra Therapy’:
Cutting and healing of the track (Sinus) simultaneously.
The idea has been to preserve the actions of all the three ingredients, i.e. the proteolytic action of the latex, the hygroscopic nature and caustic action of the Kshara and the antiseptic action of Haridra (Turmeric) powder. Due to its proteolytic enzymes and hygroscopic  and penetrating action, the Kshara sutra produce debridement of sluggish tissue, which leads to cleaning and thus a good healing.

Thanks for patiently reading this article. I hope people will be more familiar to this disease, after reading this article. If however, you still have any query/doubt, you can e-mail me at consult@ayurvedapilescure.com

Author: Dr. Naveen Chauhan

Consultant Ayurveda Physician and  Proctologist

SHRI DHANWANTARI CLINIC, GHAZIABAD