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Ayurvedic Treatment for Fistula

What are Fistula Diseases?

The literal meaning of Bhagandara (Fistula) is Darana, which means splitting or bursting up. This indicates that bursting of ripened) abscesses results into communicating track between anal region with surrounding perianal structures. Bhagandara is therefore correlated to the Fistula-in-Ano and is defined as “An inflammatory track which has an external opening in perianal skin and an internal opening in the anal canal or rectum, which is lined by unhealthy granulation and fibrous tissue”.

Fistula diseases, while not as common as some other medical conditions, can have a significant impact on a person’s quality of life.

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Types of Fistula Diseases

Fistula Diseases are categorized based on their location and severity:

Anal Fistula: This type of fistula occurs between the anal canal or rectum and the skin surrounding the anus.
Complex Fistula: These fistulas have multiple tracts, are deeper, or may involve other organs, making them more challenging to treat.

Causes of Fistula Diseases

Infection or Abscess: An untreated infection or abscess can lead to the development of a fistula as the infection tries to find a way to drain.
Inflammatory Bowel Diseases (IBD): Conditions like Crohn’s disease and ulcerative colitis can increase the risk of fistula formation due to chronic inflammation in the digestive tract.
Trauma or Injury: Severe injuries or surgical complications can sometimes result in the formation of a fistula.
Complications of Surgery: In some cases, surgical procedures in the abdomen or pelvic area can lead to fistula formation.
Radiation Therapy: Radiation treatment for cancer can cause tissue damage and, in rare cases, lead to the development of a fistula.

Symptoms of Fistula Diseases

Abnormal Discharge: Depending on the type and location of the fistula, patients may experience discharge of pus, stool, urine, or other fluids through an abnormal opening.
Pain or Discomfort: Pain may be present, particularly during bowel movements or urination, depending on the location of the fistula.
Recurrent Infections: Fistulas can lead to persistent infections due to the continuous flow of bodily fluids.
Skin Irritation: The skin around the fistula site may become red, swollen, and irritated.
Fever and Chills: In some cases, especially if there is an infection associated with the fistula, patients may experience systemic symptoms.

Prevention of Fistula Diseases

Preventive measures for Fistula Diseases may include:

Ensuring proper hygiene in the anal area to prevent infections.
Timely treatment of anal abscesses to avoid the development of fistulas.
Managing underlying health conditions like inflammatory bowel disease.
Following a high-fiber diet to maintain regular bowel movements and prevent constipation.

Treatment options

Medical Management: Depending on the type and severity of the fistula, certain medications may be prescribed to control symptoms and prevent infection.
Surgery: Surgical intervention is often necessary to close the fistula and repair any damaged tissues. The specific surgical approach will depend on the location and complexity of the fistula.
Seton Placement: A seton is a piece of material (such as a suture) that is passed through the fistula tract to promote drainage and prevent abscess formation.
Fistulotomy: In some cases, a surgical procedure called fistulotomy may be performed, which involves cutting open the fistula tract to allow it to heal from the inside out.
Fistula Plug: This involves inserting a biocompatible plug into the fistula tract to promote healing.
Laser Treatment: Certain types of fistulas, particularly those in the reproductive organs, may be treated with laser therapy.

Ayurvedic Treatment For Fistula Diseases

Fistula Treatment in Ayurveda will be discussed below as per different classics.

Sushrutha Samhitha:

Non-suppurative stage – treatment measures of vrana chikitsa (wound management) such as apatarpana (light diet) and virechana (purgation) have to be followed.
Suppurative stage – Snehana (oleation) and Avagaha swedana (sudation of immersing the part in medicated liquid in the tub) of the perianal region.
If the pitika (abscess) does not resolve, then exploration of the tract (fistulotomy) is to be done followed by Kshara application (medicated caustic paste) or Agnikarma (cauterization) should be done in the explored bed of uthe lcer. Postoperatively, irrigation of medicated oils (Yashtimadhu taila or Anu taila) over the ulcerative lesions and Sitz bath is advised for the patient.

In conditions where it is chronic, recurrent episodes, the tract is partially fibrosed and is not patent, or patients who are unwilling for surgery, irrigation of the tract with medicated oils (Bhagandara nashana taila) is advised.

Charaka Samhitha:

Charaka opines the treatment for the non-suppurative stage of fistula as mentioned above by Sushrutha and says to do raktamokshana (bloodletting) to prevent suppuration followed by Vata patradi lepa (medical paste poultice application) over the affected site.

In the suppurative stage, fistulotomy is done and then Kshara application or Agnikarma is to be performed.

Chakradatta, advises lepa or paste applications in the suppurative stage such as Rasanjanadi lepa or Kushtadi lepa; and also application of Snuhi dugdhadi varti.

Vagbhata advises Vamana (emesis), Virechana (purgation) ,and Raktamokshana (bloodletting) therapies when the abscess is in nthe on-suppurative phase. Once the abscess suppurates, incision and drainage (bhedana karma) followed by Kshaara application and Agnikarma procedures.

Ksharasutra ligation for fistula ablation is explained by Vagbhata in the context of “Parikshepi Bhagandara” (high anal complex fistula) and is the direct reference available.

Kshara Sutra Therapy For Fistula Diseases

Kshara Sutra is a seton thread medicated with organic alkalis, such as Apamargakshara(Achyranthesaspera), Arkakshara(Caltropisgigantea) or Snuhikshara (Euphorbia lingularia). The alkali is repeatedly coated on the seton thread 21 times. Apart from this, natural antibiotic like haridra powder, guggulu, etc are also used to make Ksharasutra. The mechanical action of the threads and the chemical action of the drugs coated, collectively do the work of cutting, curetting, draining, and cleaning the fistulous track, thus promoting healing of the track/ wound. This also acts both as the antiseptic and fibrotic agent to induce healing. The process of healing starts from deeper tissues and moves towards the periphery. This can be applied and changed periodically till the thread cuts the fistulous tract. Since the sphincter heals by fibrosis, there is no incontinence.

Under local anaesthesia, the kshara sutra is inserted into the tract and the two ends of the thread are tied forming a loop. The alkalis coated on the thread are continuously released throughout the length of the track there by cutting, curetting, draining cleansing and healing the track. This therapeutic action of the thread lasts for seven days. The old thread is then replaced with a new thread following the same procedure. Depending on the length of the tract and the extent of damage, the kshara sutra may be changed up to 5 times. The changing of the thread is a simple procedure taking about 10 to 12 minutes and requires no anaesthesia.

Our Treatment Philosphy

Every person is unique, hence treatment for the person’s disease must be unique too. Sandhya Medicity doctors take
the ayurveda approach, which includes: