Ano-rectal-surgeries
Haemorrhoids
Commonly known as piles – are swollen blood vessels (veins) which develop inside and/or outside the anus. They are felt as lumps around and inside the anus . The lumps are formed by increased pressure on blood vessels in the area, causing them to enlarge and swell. If they become infected, they can cause bleeding, pain and discomfort and require medical attention.
Person suffering from piles usually will not have pain or burning sensation in the anus. Some soft mass or tissue comes out of the anus. It may go inside after the defecation. Sometimes have to push inside the anus after defecation. In chronic cases it lies or hangs outside the anus, which will not go inside at all. Another complaint in piles is bleeding. Hemorrhoids are painless (it may be painful if blood clotted inside the piles or if it is associated with other diseases like fissure-in-ano etc.)
Symptoms
Bright red blood spots in the toilet or on the toilet paper.
Heavy bleeding during defecation (During Passing Stools)
Itching and discomfort around the anus.
Feeling of a lump or mass near the anus which may be painful or painless.
Mucus discharge after passing a stool.
Discharge around the anus and soiling of clothes.
Feeling of incomplete evacuation of your bowels.
Pain while passing stools and after passing stools.
Causes
The exact cause of piles is not known. One theory is that it is due to weakness of the tissues that connects the anal cushions to the muscle layers underneath. Due to this weakness, the anal cushions slide out of their normal place and down the back passage.
Constipation – this is the most common cause which leads to straining during defecation. Straining leads to pressure on blood vessels causing them to swell, elongate and slide down the anal opening.
Low-fibre diet- Lack of dietary fibre can cause hard stools, constipation and straining.
Spend too much time in the toilet and holding the urge when you have to go.
Have long-lasting (chronic) diarrhoea.
Pregnant - due to the effect of hormones on the blood vessels, plus the increasing weight of the baby within your abdomen.
Have cancer or growths in your pelvis or bowel, which may put pressure on your abdomen.
Old age- Ageing reduces the efficiency of the circulation.
Lift heavy weights.
Have a family history of piles.
Are Overweight.
Treatment
This cannot be cured only by oral medications in some stages. However, immediate intervention also not required in all the cases of the piles, if it is not bleeding.
Sushruta, father of surgery wrote a book on surgical procedures in 500 B.C. in his treaties he mentioned about a disease and line of management. He broadly categorized to bheshaja (medicine), kshara Alkali application), Agni (cauterization), Shastra (surgical excision).This is a contribution by him in the management of piles to the Indian system of medicine. One among these treatment modalities is kshara karma. Ayurveda surgeons practice this procedure in hospital set-up.
Fissure
Fissures result from the stretching of your anal mucosa beyond its normal capacity. This often happens when stools are hard due to constipation. Once the tear happens, it leads to repeated injury. The exposed internal sphincter muscle beneath the tear goes into spasm. This causes severe pain.
Causes
- Chronic Constipation
- Decreased Blood Flow To The Anus
- Persistent Diarrhea
- Anal Intercourse
- Excessive Straining During Childbirth
- Excreting Hard Or Large Stools
- Feeling Constipated During Bowel Movements
Symptoms
- Anal Fissures Typically Cause Intense Pain During Bowel Movements, Which Can Last For Several Minutes When You Poop.
- You May Also See Blood On The Toilet Paper Or In The Toilet Bowl After Having A Bowel Movement.
- Anal Fissures Can Also Cause Itching, Discomfort, And Anal Bleeding. - If You Have An Anal Fissure, You May Notice A Small Lump Or Tag Of Skin Near The Tear. This Is Called A Sentinel Pile.
Treatment
Taking only oral medications may help in some patients if fissure is of recent origin. Final and permanent remedy for this is again kshara karma. Under Suitable Anesthesia application of kshara to fissure bed. This burns the part mildly without damaging much tissue. So that fresh wound is created which heals faster. Agni karma follows this, senile pile excised and sphincterotomy is adopted to prevent recurrence. Intermittent anal dilatation to be done after the procedure in further follows up.
Fistula in ano
An anal fistula — also called fistula-in-ano — is a tunnel that develops between the inside of the anus and the outside skin around 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).
An anal fistula, almost always the result of a previous abscess, is a small tunnel connecting the anal gland from which the abscess arose to the skin of the buttocks outside the anus.
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.
Symptoms
Pain (usually relieved after discharge of pus )
Discharge — either bloody or purulent
Systemic symptoms, if abscess becomes infected like Fever, weakness etc.
Itching
Diagnosis
The opening of the fistula onto the skin may be seen
The area may be painful on examination
There may be redness
An area of induration may be felt — thickening due to chronic infection
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
In complicated fistula some invasive investigations may be advised like Fistulography, Endo-Anal Ultrasound, MRI- Fistulogram etc.
A discharge may be seen
Treatment
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 Sushruta Samhita) 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.
Pilonidal sinus
A pilonidal sinus is a small hole or tunnel in the skin that can easily become infected. It typically forms in the cleft at the top of the buttocks.
When a pilonidal sinus becomes infected it can turn into an abscess or cyst. A pilonidal cyst usually contains hair, dirt, and debris. It can cause severe pain and may ooze pus and blood and have a strong odor.
A pilonidal sinus infection mostly affects men and is also common in young adults. It’s also more common in people who sit a lot, like cab drivers.
Causes
Ingrown hairs found in the crease of the buttocks result in a skin infection that causes a pilonidal cyst to form.
Activities that cause friction, like sitting, can force the hair growing in the area to burrow back under the skin. The body considers this hair foreign and launches an immune response against it, similar to how it would react when dealing with a splinter.
This immune response forms the cyst around your hair. Sometimes a person may have multiple sinuses that connect under the skin.
Symptoms
Symptoms of an infected cyst include
Pain,
Reddened skin or
Drainage of pus or blood.
Treatment
Excision and closure. This means taking out the section of skin which contains the sinus. This is done by cutting the skin either side of the sinus (to form an ellipse shape around the sinus), taking out the sinus, and stitching together the two sides of the ellipse. However, the risk of a recurrence, or of developing an infection of the wound after the operation, is higher than the above procedure. In some cases where the sinus recurs or is extensive, a plastic surgery technique may be advised to remove the sinus and refashion the nearby skin.
A simple treatment mentioned in a surgical text book of Indian system of medicine– Sushrutha Samhitha. The disease is called nadeevrana. Treatment is called Ksharasutra chikitsa
A malleable probe to be passed, its tracts to be identified carefully, and then a medicated thread to be inserted to tract. This is to be changed every week. This helps effective curettage and drainage facilitates healing withoutrecurrence.
