FAQ (Frequently asked questions)

Q.1) WHAT IS PILES(HAEMORRHOIDES)

Haemorrhoides is an vascular engorgements of the haemorrhoidal plexuses in the submucosa of anal canal beneath the mucocutaneous lining.It is very common disease of anal canal,which affects the both sexes.

The incidences of the diseases is higher after the age of fifty and extremely rare below age of fourteen.The word haemorrhoides and piles both are used synonymously.Bleeding is the most prominent symptom of haemorrhoids in many of the patients.

Q.2) WHAT ARE THE CLINICAL FEATURES OF PILES?

Bleeding and prolapse are the two cardinal symptoms of piles,for which the patient consult the physician.Normally pain is absent in uncomplicated piles.Prolapsed piles are mild to moderate painful.The late symptoms of piles are discharge,anal itching,secondary anaemia and psychological disturbances.

Q.3) WHAT ARE THE COMPLICATIONS OF PILES?

There are several complications of Piles like

• Acute severe bleeding
• Strangulation
• Thrombosis
• Ulceration
• Gangrene
• Fibrosis
• Portal Pyaemia

Q.4) WHAT ARE THE TREATMENTS OF PILES?

Various forms of treatment for piles are available

• Medical therapy
• Sclerotherapy
• Operative
• Manual anal dilation
• Elastic band ligation
• Cryosurgery
• Photocoagulation
• Stapling haemorrhoidectomy

Q.5) WHAT ARE THE COMPLICATIONS OF PILES?

• Necrosis & Persistant ulcer
• Bleeding
• Diarrhoea & Fever
• Ischiorectal and submucosal abscess
• Prostatic abscess and Haematuria

Q.6) WHAT ARE THE TREATMENT AVAILABLE FOR PILES?

Five types of the treatment for Piles are described by the Sushruta.

• Aushadhi(medical Treatment)
• Kshar Karma (Chemical Cauterization)
• Agni Karma(thermal cauterization)
• Shastra karma(haemorrhoidectomy)
• Kshar Sutra(excision of piles by medicated thread)

Q.1) WHAT IS AN ANAL FISTULA?

Anal fistula, or fistula-in-ano, is an abnormal connection or channel like structure, between the surface of the anal canal and the exterior perianal skin.

Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.

Ancient Ayurveda surgeon, Susruta has described five types of Bhagandara(Sataponak, Ustragriwa, Parisrabi, Sambukawarta, Unmargi). They have been classified according to the vitiation of the three doshas and the shape & site of the fistula tract.

Q.2) WHAT ARE THE CAUSES OF FISTULA?

Anal fistulas commonly occur due to an anal abscess.

An abscess is a collection of pus and infected fluid. An anal abscess usually develops after a small gland, just inside the anus, becomes infected with bacteria.

A fistula may occur if an abscess has not completely healed, or if the infected fluid has not been entirely drained away.

An anal fistula may also develop as a result of:

• a growth or ulcer (painful sore)
• a complication from surgery
• a congenital abnormality (a health problem that you were born with)

Anal fistulae are also a common complication of conditions that result in inflammation of the intestines. Some of these conditions include:

• Irritable bowel syndrome (IBS): a chronic (long-term) disorder that affects the digestive system, causing abdominal pain, diarrhoea and constipation.
• Diverticulitis: the formation of small pouches that stick out of the side of the large intestine (colon), which become infected and inflamed.
• Ulcerative colitis: a chronic condition that causes the colon to become inflamed and can cause ulcers to form on the lining of the colon.
• Crohn’s disease: a chronic condition that causes inflammation of the lining of the digestive system.

Q.3) WHAT ARE THE SYMPTOMS OF FISTULA

Anal fistulae can present with many different symptoms such as:

• Pain
• Discharge – either bloody or purulent
• Pruritus ani– itching around the anus
• Systemic symptoms if abscess becomes infected

Q.4) WHAT WILL BE THE DIAGNOSIS OF FISTULA

Diagnosis is by examination, either in an outpatient setting or under anaesthesia. The examination can be an Anoscopy.

Possible findings:

• The opening of the fistula onto the skin may be seen
• The area may be painful on examination
• There may be redness
• A discharge may be seen
• It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the fistula

Q.5) WHAT IS THE AYURVEDIC TREATMENT OF FISTULA & WHAT IS ABOUT KSHAR SUTRA?

Kshara Sutra is utilized in the treatment of fistula in Ayurveda.

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 15 – 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 1 to 2 minutes and requires no anaesthesia.

Q.6) WHAT WILL BE THE BENEFITS OF KSHARA SUTRA, WHY I SHOULD GO FOR KSHAR SUTRA?

OR

WHAT ARE THE ADVANTAGES OF KSHAR SUTRA OVER THE ALLOPATHIC SURGERY?

• The procedure does not require hospitalization for more than 4 to 5 hours
• The patient requires minimal bed rest and can resume daily activities within 12 – 24 hours
• No painful dressings required
• The drugs coated on the Kshar-Sutra are slowly and gradually released into the track and the wound, leaving no abscess overseen. These abscess are drained out by the action of the drugs.
• The sphincteric muscles are not dissected and hence the possibility of incontinence is ruled out.

COMPLICATIONS OF FISTULA

Depending on the effectiveness of the treatment, fistula may result in infection or incontinence of stools.

RECURRENCE OF FISTULA

The reoccurrence rate of fistula treated with kshara sutra ligation procedure is less than 2%. This is because the medicines on the thread gradually and continually curate the payogenic membrane and fibrous tissue in the track and thus leave no pus pockets undrained.
In some cases, the fistula can reoccur despite having surgery. After having a fistulotomy, the reoccurrence rate rises to 21%. After an advancement flap procedure, the reoccurrence rate may be as high as 36%.

Q.1) What is a Anal fissure?

An anal fissure is a small tear in the skin that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. An anal fissure typically causes pain and bleeding with bowel movements.

Anal fissures most often affect people in middle age, but fissures also are the most common cause of rectal bleeding in infants. Most anal fissures heal within a few weeks with treatment for constipation, but some fissures may become chronic

Q.2) WHAT ARE THE COMMON CAUSES OF ANAL FISSURES

Anal fissures can be caused by trauma to the anus and anal canal. The cause of the trauma can be one or more of the following:

• Chronic constipation
• Straining to have a bowel movement, especially if the stool is large, hard, and/or dry
• Prolonged diarrhea
• Anal stretching
• Insertion of foreign objects into the anus

Other causes of anal fissures (other than trauma) include:

• Longstanding poor bowel habits
• Overly tight or spastic anal sphincter muscles (muscles that control the closing of the anus)
• Scarring in the anorectal area
• Presence of an underlying medical problem: such as Crohn’s disease and ulcerative colitis; anal cancer; leukemia; infectious diseases (such as tuberculosis); and sexually transmitted diseases (such as syphilis, gonorrhea, Chlamydia, chancroid, HIV)
• Decreased blood flow to the anorectal area

Q.3) WHAT ARE THE SYMPTOMS OF ANAL FISSURE?

Signs and symptoms include:

• Pain during, and even hours after, a bowel movement
• Constipation
• Blood on the outside surface of the stool
• Blood on toilet
• A visible crack or tear in the anus or anal canal
• Burning and itch that may be painful
• Discomfort when urinating, frequent urination, or inability to urinate
• Foul-smelling discharge

Q.4) WHAT ARE THE RISK FACTORS FOR ANAL FISSURES?

Factors that may increase your risk of developing an anal fissure include:

• Infancy. Many infants experience an anal fissure during their first year of life, although experts aren’t sure of the reason.
• Aging. Older adults may develop an anal fissure partly because of slowed circulation, resulting in decreased blood flow to the rectal area.
• Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing.
• Childbirth. Anal fissures are more common in women after they give birth.
• Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing

Q.5) WHAT ARE THE PREVENTION OF ANAL FISSURES?

For fissures in adults:

• Keep the anorectal area dry
• Wipe the area with soft materials, a moistened cloth, or cotton pad; avoid rough and scented toilet paper
• Promptly treat all occurrences of constipation and diarrhea
• Avoid irritating the rectum

Q.6) WHAT IS THE AYURVEDIC TREATMENT FOR ANAL FISSURES?

Ayurveda advises internal medication as well as topical ointment application in the treatment of anal fissures. To avoid further irritation to the damaged tissue, medicines which soften the stools and promote healing of the tissues are utilized. Ointments which are natural anti-bacterial and anti-septic are used for topical application.

Q.7) WHAT ARE THE COMPLICATIONS OF ANAL FISSURES?

Complications of anal fissure can include:

• Anal fissure that fails to heal. An anal fissure that doesn’t heal can become chronic, meaning it lasts for more than six weeks.
• Anal fissure that recurs. If you’ve experienced anal fissure once, you have an increased risk of another anal fissure.
• A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter). This makes it more difficult for your anal fissure to heal. An unhealed fissure may trigger a cycle of discomfort that may require medications or surgery to reduce the pain and repair or remove the fissure.

 

Q.1) What is Panchkarma?
Panchkarma is fivefold measures of bio-purification or detoxification of each cell of the body. For healthy person it may be defined as servicing of whole body.

Q.2) What are the benefits of Panchkarma?
For healthy: It is a preventive measure for the preservation of durable health up to old age.
For patient: eradicates disease completely (Samool Rog Nash) and also cleanses the body and is appropriate for wellbeing during post-convalescence and recuperation from acute or chronic illness.

Q.3) Is there any specific season for Panchkarma?
For healthy: Panchkarma procedures done on the basis of prakriti and Season specific i.e.
In Basant Ritu (Spring Season) – Vamana (Medicated Emesis)
In Sharad Ritu (Autumn Season) – Virechana (Medicated Purgation)
In Varsha Ritu(Rainy Season) – Basti (Medicated Colonics/Enema)
For patient: depends upon the condition and stage of disease

Q.4) Panchkarma can be done without admission?
Most of the procedure can be done without admit but for better result in some procedure admission is must.

Q.5) What are the contraindications during Panchkarma treatment?
There is some dietary and life style modification during the regime according to the procedure undergone.

Q.6) Is there any treatment for removing glasses or improving eye sight?
Yes there are procedure like tarpan, nasya and Virechan one or all to improve eye sight, myopia, hypermytropia, presbyopia and computer eye syndrome.

Q.7) Is there any treatment for stress, insomnia and blood pressure?
Yes, there are procedure like nasya, shirodhara, yogic exercise and Virechan one or all to relax and improve quality of life.

Q.8) Which major diseases can be cured by Vamana (Medicated Emesis)?
In conditions with aggravated/utklishta kapha,Before all promotive and preventive therapies, All types of allergic disorders, Diabetes and other lifestyle disorders, Epilepsy, Obesity, Skin diseases like Psoriasis, Respiratory diseases including Asthma, psychological disorders.

Q.9) Which major diseases can be cured by Virechana (Medicated Purgation)?
Before all promotive and preventive therapies, Asthma, Skin disorders: urticaria, allergic disorders, Life style disorders, Hyperacidity, Hyper and hypothyriod, obesity, constipation, Heart diseases, Pigmentation disorders of skin, Abdominal disorders etc.

Q.10) Which major diseases can be cured by nasya?
Sinusitis, Ophthalmic disorders, Cervical spondylosis , Migraine or Headache, Convulsive disorder, facial palsy etc.

Q.11) Is it necessary to undergone whole Panchkarma in one stretch?
No, because it’s depend upon your prakriti or body type and season and second whole panchkarma requires at least three month.
Q.12) Is panchkarma a costly procedure?
It is one time investment for your body to remain healthy for long span of time on that accord it is not very costly.

Q.13) What are the panchkarma procedures for stress management?
It is ten day package included shirodhara and nasya and in some cases virechan.
Q.14) What is the minimum time required for Vaman, virechan and basti?
For each procedure minimum 15 days are required.