Sitz bath; a wonder remedy in anorectal problems

Sitz bath; a wonder remedy in anorectal problems
Sitz Bath:
The name is derived from the German verb ‘sitzen’ meaning ‘to sit.’
Definition:
A sitz bath (also called a hip bath) is a type of bath in which only the hips and buttocks are soaked in water or saline solution.
In Ayurveda it has been described as ‘Kati Snaana’
Equipment used for sitz baths:

Sitz bath apparatus

A sitz bath, in which only the hips and buttocks are soaked in water or saline solution, is used for patients who have had surgery in the rectal area or to ease discomfort from fissure, painful hemorrhoids, bladder, prostate, or vaginal infections etc.
Purpose:
A sitz bath is used for patients who either have had surgery in the area of the rectum, or to ease the pain of Anal fissure or an abscess in anal or perianal region or thrombosed/strangulated external hemorrhoids, uterine cramps, prostate infections, painful ovaries, and/or testicles. It is also used to ease discomfort from infections of the bladder, prostate, or vagina. Inflammatory bowel diseases are also treated with sitz baths.
Preparation
The bath should be filled with 3-4 in (8-10cm) of water. For most conditions, nothing else should be added (no bubble bath or oil).
Description
Warm sitz baths are one of the easiest and most effective ways to ease the pain of painful anorectal conditions like Fissure in ano, Thrombosed/strangulated haemorrhoids or an abscess in the anorectal region.
A brief, cool sitz bath helps ease inflammation, constipation, and vaginal discharge. It can be used to tone the muscles in cases of bladder or bowel incontinence.
How to take a sitz bath?

1. A sitz bath tub can be easily purchased at any general/plastic utensils’ store. Select the size that suits you. Sometimes you may also find them at hospital pharmacies or medical supply stores.
2. Prepare the items you will need so they are near at hand from where you will be using the sitz bath.
3. Place the sitz bath tub over the horizontal surface of bathroom, and fix it at its place.
4. Fill the sitz bath with warm water. Remember that the water temperature will feel cooler to your hands than it will to the rest of the body.
5. If your doctor has recommended it, add salt or alum powder to the water.
6. Sit in the sitz bath for 10-20 minutes, or as recommended by your doctor.
7. When finished, use a towel to gently pat the affected area dry.
8. Use your sitz bath as often as recommended by your doctor; generally several times a day as needed to ease discomfort.
9. Wash your sitz bath tub after each use and dry it thoroughly.

Precautions
Some patients may become dizzy when standing up after sitting in hot water; it is best to have someone else present when doing a sitz bath.
Aftercare
The area should be carefully patted dry and, if necessary, clean dressings should be applied.
Risks
Sitz baths pose almost no risk. On rare occasions, patients can feel dizzy or experience rapid heart beat because of blood vessel dilation.
Normal results
Swelling goes down; discomfort is eased; healing is promoted.

Thanks for patiently reading this article. I hope people will be more familiar to this simple but very effective remedy to relieve pain and discomfort in anorectal problems, 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

Free GI diseases, Piles, Fissure, Fistula Awareness and Treatment Campaign निःशुल्क बवासीर, फिशर, भगन्दर व उदर रोग जागरुकता एव्ं चिकित्सा अभियान

निःशुल्क बवासीर, फिशर, भगन्दर व उदर रोग जागरुकता एव्ं चिकित्सा अभियान
श्री धन्वन्तरि क्लीनिक, गाजियाबाद द्वारा आर्थिक रूप से निर्बल बवासीर, फिशर, भगन्दर, पाइलोनिडल साइनस के रोगियों के लिये एक ‘निःशुल्क बवासीर, फिशर, भगन्दर व उदर रोग जागरुकता एव्ं चिकित्सा अभियान’ का आयोजन किया जा रहा है। इस अभियान में;

1. गुदा व पेट की बीमारियों के बारे में जन-सामान्य को विभिन्न प्रचार माध्यमों द्वारा जागरूक किया जायेगा।
2. आर्थिक रूप से निर्बल बवासीर, फिशर, भगन्दर, पाइलोनिडल साइनस के रोगियों के लिये निःशुल्क आयुर्वेदिक औषधियों व क्षार-सूत्र चिकित्सा की व्यवस्था उपलब्ध रहेगी।
   

कॄपया हमारे इस अभियान में शामिल हों व अधिक से अधिक संख्या में लोगों को इसके बारे में बतायें तथा ऐसे रोगियों को निःशुल्क इलाज के लिये हमारे पास भेजें।

धन्यवाद!

डा० नवीन चौहान

श्री धन्वन्तरि क्लीनिक, गाजियाबाद

सम्पर्कः +91-9818069989, 9536909883

Email: info@ayurvedapilescure.com

Free GI diseases, Piles, Fissure, Fistula Awareness and Treatment Campaign

A campaign about anorectal diseases is being run by Shri Dhawantari Clinic, Ghaziabad to spread the awareness about the anorectal and GI diseases and to help the poor patients. Details of the campaign are;

1. Free educational and awareness programmes to be run in schools, colleges, villages, urban, slums, jhuggis about Piles (Bavaseer), Fissure, Fistula in ano (Bhagandar), Pilonidal sinus and Gastrointestinal problems etc.
2. Absolutely Free treatments of anorectal and Gastrointestinal diseases by Ayurvedic medicines and Kshara sutra therapy for economically weak patients.

Be a part of our campaign to help the poor. If you know any such patient who can’t afford the treatment, send him to us. We shall provide absolutely free treatment for him/her.

For more details and registeration/referral kindly call us at +91-9536909883 or email at info@ayurvedapilescure.com

Thanks,
Dr. Naveen Chauhan
Director and Chief Consultant
Shri Dhanwantari Clinic, Ghaziabad

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.