What is this?

In this disease usually one will not have any problem in the anus. Patient will have small pimple like swelling, pus/blood/watery type discharge from an opening, near anus region. This may or may not associate with pain. This type of swelling may occur repeatedly in same region. (However other disorders are also to be ruled out).

Why and what happens here?

There are some glands surrounding the anal canal. It communicates with the anal canal with small ducts or channels. When infection spreads to this gland through these channels, glands get infects. This leads to collection of pus. Collected pus makes its own path to come out of the region. Therefore it may open anywhere near anus through skin. As it gets chronic or old there is less chance of healing, which makes a permanent path. This tract made by pus to come out of the body is called fistula. Once pus drained out, pain and other difficulties may reduce. However there will be persistence of the fistulous tract. Whenever pus again collects, pain, fever etc may start. Therefore this story continues in some patients for years.

What you have to do?

Clean the part daily. Sit in the hot water for 10 minstwo times a day without adding any medications. Press the region surrounding the swelling or opening during sitz bath. This helps in adequate drainage of pusfrom the tract. This reduces the pain and prevents progress of the disease. Then consult doctor.

What an Ayurveda surgeon does?

It should be understand that mere oral medication definitely would not cure the disease. Therefore it should be treated by surgically. Surgery includes complete cutting of the tract with surrounding tissue. Fistula-in-ano disease is difficult to treat surgically because of severe pain, high rate of recurrence (is up to 30%) complex anatomy of the region, involvement of sphincters and severe complications like incontinence. Ksharasutra chikitsa in Bhagandara (mentioned in the SushrutaSamhita) has got advantages than surgery. Medicated (kshara) thread (sutra) passing through the tracts which cuts the tissues gradually simultaneous healing occur from opposite side therefore no loss of tissues or sphincter damage.

Initially an ordinary thread is inserted in to the tract with help of malleable probes, and to be taken out of the anus (with or without anesthesia). After a week it should be replaced by the ksharasutra. Kshara cuts the tract slowly (0.5mm/ week) and simultaneous healing also occurs.

How this is advantageous?

No hospitalization, minimum pain, no tissue loss, less cost, no compromise in daily work of the patient, recurrence chances less (is only 1.5%), less discomfort. Commonly used kshara sutra is prepared out of Apamarga, applied to the cotton thread. In kshara sutra therapy patient should come for weekly follow-up for long duration.

Therefore this is important knowledge for general public to differentiate the disease. Simply consuming the drugs or commercial products with prefix or starts or end with ‘pile’ in their brand name, without consulting a surgeon may lead to complications. Medications have its own role and limitations. One should understand this and should take genuine treatment from qualified surgeons only. Beware of quacks in the treatment of piles and fistula. You loose health and money also!