| Descriptions of the conditions commonly seen by specialists in anorectal disease are below. Hemorrhoids (Piles) Hemorrhoids exist in everyone, but are only sometimes symptomatic. This occurs when blood vessels located in the anorectal region become swollen or inflamed. Hemorrhoids may be internal (inside the anus) or external (outside the anus). Symptoms of Hemorrhoids Symptoms of external hemorrhoids may include painful swelling or a hard lump near the anus, which may be a blood clot. Symptoms of internal hemorrhoids include bleeding (bright red blood on stool or toilet paper), and itching. An internal hemorrhoid may protrude through the anus, and cause pain and irritation. Some individuals with hemorrhoids have no symptoms. Hemorrhoid symptoms can resemble other conditions, including fissures, fistula, abscesses, or irritation and itching, called pruritis ani. Constipation and diarrhea may exacerbate hemorrhoids, or cause similar symptoms. Consulting your physician when you have any of these symptoms, such as blood in stool, is important to determine the exact cause of your symptoms. Treatment for Hemorrhoids Treatment for hemorrhoids will depend on your age, health, your medical history, the extent of your condition, and your tolerance for certain treatments and medicines. Symptom relief usually includes taking warm sitz (tub) baths several times a day for 10-15 minutes to shrink blood vessels and soothe itching and irritation; using witch hazel wipes to reduce irritation; and using cream or suppository to help shrink hemorrhoids. Cortisone creams are not recommended. Ice packs can also help relieve inflammation. Relieving or preventing constipation is important if you have hemorrhoids. This means drinking at least 6-8 glasses of water a day and increasing your dietary fiber – whole grains, vegetables, and fruits – and taking a stool softener or fiber supplement if necessary to eliminate straining and reduce pressure on hemorrhoids. Fiber is helpful for both constipation and diarrhea. Infrequently, large or symptomatic hemorrhoids may need to be surgically removed. Our experts treat hemorrhoids using a number of techniques, including: Opening of acutely swollen external hemorrhoids. This is only helpful if performed in the first couple of days after the onset of symptoms. Rubber band ligation – placing a rubber band around the bottom of the hemorrhoid inside the rectum, which cuts off blood flow to the hemorrhoid, causing it to slowly shrink and degenerate within a few days. Sclerotherapy – injecting a chemical solution around the blood vessel to shrink the hemorrhoid. Electrical, laser or infrared photo coagulation – using different sources of heat to destroy the hemorrhoid. Hemorrhoidectomy – removing hemorrhoids surgically. A new technique of stapling hemorrhoids may be appropriate with multiple internal hemorrhoids. What is stapled hemorrhoidectomy? Stapled hemorrhoidectomy is the newest surgical technique for treating hemorrhoids, and it has rapidly become the treatment of choice for third-degree hemorrhoids. Stapled hemorrhoidectomy is a misnomer since the surgery does not remove the hemorrhoids but, rather, the abnormally lax and expanded hemorrhoidal supporting tissue that has allowed the hemorrhoids to prolapse downward. For stapled hemorrhoidectomy, a circular, hollow tube is inserted into the anal canal. Through this tube, a suture (a long thread) is placed, actually woven, circumferentially within the anal canal above the internal hemorrhoids. The ends of the suture are brought out of the anus through the hollow tube. The stapler (a disposable instrument with a circular stapling device at the end) is placed through the first hollow tube and the ends of the suture are pulled. Pulling the suture pulls the expanded hemorrhoidal supporting tissue into the jaws of the stapler. The hemorrhoidal cushions are pulled back up into their normal position within the anal canal. The stapler then is fired. When it fires, the stapler cuts off the circumferential ring of expanded hemorrhoidal tissue trapped within the stapler and at the same time staples together the upper and lower edges of the cut tissue. sh01Haemorrhoids (Piles) sh01Hollow Tube Inserted into the Anal Canal and Pushing up the Hemorrhoids sh01Suturing the Anal Canal through the Hollow Tube sh01Bringing Expanded Hemorrhoidal Supporting Tissue into the Hollow Tube sh01Hemorrhoids Pulled Back Above Anal Canal after Stapling and Removal of Hemorrhoidal Supporting Tissue Who is a candidate for stapled hemorrhoidectomy? Stapled hemorrhoidectomy, although it can be used to treat second degree hemorrhoids, usually is reserved for higher grades of hemorrhoids - third and fourth degree. If in addition to internal hemorrhoids there are small external hemorrhoids that are causing a problem, the external hemorrhoids may become less problematic after the stapled hemorrhoidectomy. Another alternative is to do a stapled hemorrhoidectomy and a simple excision of the external hemorrhoids. If the external hemorrhoids are large, a standard surgical hemorrhoidectomy may need to be done to remove both the internal and external hemorrhoids. Rubber Band Ligation In Rubber Band Ligation treatment, a small elastic band is placed around the base of a hemorrhoid (see bow above). The band causes the hemorrhoid to shrink and the surrounding tissue to scar as it heals, holding the hemorrhoid in place. It takes two to four procedures, done six to eight weeks apart, to completely eliminate the hemorrhoid. Complications, which are rare, include mild pain or tightness (usually relieved with a sitz bath), bleeding, and infection. Other procedures for haemorrhoids include laser or infrared coagulation, sclerotherapy, and cryosurgery. They all work on the same principle as rubber band ligation but are not quite as effective in preventing recurrence. Side effects and recurrence vary with the procedure, so consult your physician about what’s best for your situation. Fistula-in-ano What is Anal Fistula :- The fistula in anus is formed by bursting an abscess in the region of peri-anal area. There is a boil or abnormal tract around anus through which pus comes on and off. Symptoms :- Patient develops a boil around the anus. Pus is formed and there is severe pain. The swelling increases and finally bursts. After bursting the pain subsides. This process recurs in the same way again and again. In some cases continuous discharge from the boil remains till the adequate treatment. The condition is known as Bhagandara or Fistula-in-ano or anal fistula. This disease should be adequately known by people because surgery is a frustrating experience in this disease. I know some of my patients underwent surgery for 10 to 20 times but of no avail. I treated them successfully by Chharsutra (Kshar-sutra). These Fistula are low anal (less complicated) and high anal (complicated). Causes :- Infection in a fissure (Common), Tuberculosis, Diabetes mellitus, Cancer, Ulcerative colitis etc. Treatment :- The best mode of treatment available is mainly by Kshar-sutra. Surgery is not beneficial. It carries many risks, the major risk is recurrence. Why surgery is a failure :- 1. Entire infected tract or area cannot be excised especially in higher fistula. 2. Presence of faeces may halt healing. 3. The infected anal gland (source of fistula formation) is not removed completely. 4. Extensive tissue is lost during operation which is not good for patients. 5. Chances of injury to those muscles who hold the faces are there in surgery. 6. Hospitalization is necessary. There is bleeding, extensive wound occur. The wound requires daily dressing. In spite of all these problems, the cure is not certain and there is every possibility of recurrence of disease, therefore choose option of Kshar-sutra. Why Kshar-sutra is beneficial :- 1. Minimum trauma and no tissue loss, so minimum scar. 2. Practically nil bleeding. 3. No need for hospitalization; procedure is carried out under local anaesthesia. 4. The patient may perform his daily routine during the therapy. 5. No chance of muscle damage or narrowing of anal orifice. Most importantly there is nil chance of recurrence. Recurrence is noted in those cases associated with tuberculosis, Diabetes, Cancer etc. Dr. Praveen Kumar Choudhary has successfully treated around a thousand of cases. Pilonidal sinus :- It is a sinus or abscess occurring in the middle of buttocks. It is due to excessive hair. The hair causes trauma in the skin and a sinus is formed. The hair is present in the sinus. Treatment :- Kshar-sutra is best of all the treatments. Other non-healing sinus :- Kshar-sutra therapy is the best therapy to treat different types of sinuses. These include stitch abscess, foreign body impaction, injection abscess, and other types of sinuses also. KSHAR SUTRA (Alkaline Thread) - Ideal & Effective Technique For Fistula & Sinus What is Kshar-sutra (Alkaline thread) :- A surgical thread is coated with 21 layers of Ayurvedic medicines such as Achyranthus aspera, turmeric, Euphorbia etc. It may also be prepared by using Guggul, Turmeric and some alkaline material. Kshar Sutra Kshar Sutra Kshar Sutra Kshar Sutra Treatment of Anorectal Diseases through Kshar Sutra How it acts :- It acts by virtue of chemical cauterization. It destroys the infected material presents in the sinus and makes the wound free of infection. The wound heals beautifully. It also eradicates infected anal glands. The complete eradication of infection ensures complete eradication of disease. When tied in Fissure and piles, it cuts the mass and eradicates infection. Therefore the wound heals without complication. It is natural; therefore, free of side effects. Duration of therapy :- Piles, Fissures: One time sitting (7 to 10 days). Fistula and Sinus: As per the length of track. Weekly changing of thread. May take one month to six seven months. Ayurvedic medicines :- Oil enema :- Jatyadi oil in Fissure and Fistula. Kasisadi oil in piles and prolapse. Bowel regulator :- Trifala, Panchasakar powder and Colosep powder. Antiseptic :- Trifala guggulu, Sepgon, Amebanil etc. Have information on anus and rectum disorders such as Bhagandar (Fistula), Fissure (badi bavasir), Bleeding Piles or Hemorrhoids (Khuni bavasir) etc; you may avoid life-long frustrations. Introduction Meinero's fistuloscope The VAAFT technique is performed for the surgical treatment of complex anal fistulas and their recurrences. Key points are the correct localization of the internal fistula opening under vision, the fistula treatment from inside, and the hermetic closure of the internal opening. This technique comprises two phases: a diagnostic one and an operative one. There is no need to know the fistula classification which obviously saves time and money. Moreover, surgical wounds in the perianal region are prevented and the risk of faecal incontinence is avoided because no sphincter damages are provoked. The advantages of the VAAFT technique are evident: no surgical wounds on the buttocks or in the perianal region are provoked, there is complete certainty in the localization of the internal fistula opening (a key point in all fistula surgical treatments), and the fistula can be completely destroyed from the inside. There is no requirement to know if the fistula is transphincteric, extrasphincteric or above sphincteric because operating from the inside no damage is caused to the anal sphincters. Therefore, no preoperative examination is necessary. The risk of postoperative faecal incontinence is excluded. Moreover, the patient doesn't need any medications and he can start working again after a few days since the VAAFT technique can be performed in day surgery. Anal Fissure Patients with anal fissures have severe pain and sometimes bleeding after passing a bowel motion. Generally, medical treatments can be prescribed in this condition. For cases which do not respond to this, a minor surgical procedure called fissurectomy can be performed under local anesthesia. |
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