Anal fissure

It is like a crack. It is a small linear crack or ulcer usually at the posterior part of the anus. Commonly seen in subjects with chronic constipation and after child birth. It leads to painful act of defecation and at times small bleeding per rectum. Thirty percent anal fissure that are shallow (not very deep and chronic) can be treated by treating constipation, avoiding strains at stool, frequent wash and certain oral and local medications Some patients have a very tight ring of anal opening called sphincter that stops the healing of anal fistula We perform a technically exacting surgery called ‘fissurectomy’ Fissurectomy is relieving the tight anal ring by dividing just the right amount of lower fibres of internal sphincter. The operation has over 95 percent success rate and is done as a single day procedure

Anal fistula is a consequence of a peri-anal abscess or boil. Our anal canal is studded with glands that produce mucous. Mucous lubricates and facilitates the passage of stool. Sometimes bacterial infection in the mucous glands can lead to infection and this abscess may burst outside or drain, may also have a small connecting tract or opening inside the anus. This is called anal fistula. It intermittently discharges pus. It harbours an abscess cavity where bacteria form a colony.

Such fistulas can be very high and its tract may be simple, straight or tortuous

Treatment : All deep anal fistula, multiple fistulae are treated with a mix-match of modern and Ayurvedic techniques. We generally do not perform MRI scanning. Instead, examination of fistula or probing and dye and bubble localization is done under a saddle block anesthesia. Tract is then identified and explored and kshar sÖÖtra is applied that is changed weekly depending upon the condition of fistula. Multiple changes are done for a month or so but the change is prolonged if the fistula is high. The part of fistula tract below the anal sphincter (the muscular ring that closes the anus) is excised and the cavity that is attached to the fistula is thoroughly cleansed (curettaged)

Kshar sÖÖtra acts like a wick, stops the fistula to close down intermittently. Its high alkaline pH curtails the infection. It cuts through painlessly and the tissue heals without causing anal incontinence. Leakage after fistula operation is a undesired problem and this hybrid method of treatment using part surgical excision and part kshar sÖÖtra cutting is a good compromise to save patient’s time without incontinence Benefit : Painless operation, early recovery to work. No dressing. Daily routine is advised ie walking, work, doing own work, cycling etc

A large number of people to the extent that almost all at least once in lifetime have fresh blood rectal bleeding. Piles are naturally occurring tortuous veins in the anus. Stagnation, high pressure and hard stool leads to bleeding often painless. These can grow as small grade I, large internal grade II and large external grade III. The blood in piles can get clotted called and the pile mass become very painful called thrombosed pile mass.

We undertake a full range of piles treatment. Simple internal first grade piles
are treated with injection therapy called sclerotherapy

There are a large number of options to treat piles both surgically and medically. The most effective is the most latest treatment called DG HAL – Doppler Guided Hemorrhoidal Artery Ligation. A large number of blood vessel make tortuous vascular malformation in the lower anus leading to pile masses. Most procedures tend to excise these tortuous vessel mass. DG HAL precisely localizes the feeding vessel higher up in the rectum and the feeding vessel is selectively ligated leading to shriveling of the pile mass. If there is a lot of flesh with this mass, plication is also done (RAR – Recto-Anal Repair).

All other types of pile treatment like rubber band ligation, kshar sÖÖtra ligation, infra red / radio frequency coagulation can be done in highly selective cases but not preferred by us Surgical excision of pile masses is undertaken of external piles, piles bearing fissure, skin tags etc.

Both young and elderly get anal prolapsed. All types of treatment, medical, injection sclerotherapy and surgery is undertaken.

There are several benign conditions of this region. These are commonly associated like anal itching or pruritus, fungal infection of this region, pilo-nidal sinus, anal warts, hydra-adenitis suppritiva, intermittent acute anal pain (proctalgia-fugax). These conditions are readily recognized by our trained eyes and easily treated

hydra-adenitis suppritiva

Pilo-nidal sinus being treated with kshar sÖÖtra

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Cancer rectum and anal canal

Sometimes what may be referred as piles or fissure may actually be a malignant mass in the rectum or anal canal. Proper endoscopic examination and biopsy is done. Patients are counseled. Surgical and chemotherapeutic treatment of malignant conditions are also undertaken.