What is an Anal Abscess or Fistula?

          An anal abscess is an infected cavity filled with pus generally found near the anus and rectum.

          Most of the abscesses are the result of acute infection in the internal anal glands of the anus.

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What are classifications?

          Anal abscesses are classified according to their location in relation to structures surrounding the anus and rectum( perianal, ischioanal, inetersphinteric, supralevator). Perianal is the commonest one and the supralevotor is the rarest one. If any of these abscesses spreads partially circumferentially around the anus and rectum, it is termed a horseshoe abscess.

 

What are Symptoms of Fissure?

           Anorectal pain, swelling, redness of the skin and fever are the most commonest symptoms.. occasionally rectal bleeding and difficulty in urination.

 

Diagnostic studies:

              Most anal abscesses and fistula-in-ano are diagnosed and managed on the basis of clinical findings. Occasionally, additional studies can assist with the diagnosis or delineation of the fistula tunnel. Today, both traditional two-dimensional and three-dimensional endoanal ultrasound are a very effective manner of diagnosing a deep perirectal abscess, identifying a horseshoe extension of the abscess, and delineating the path of a fistula tract. This may be combined with hydrogen peroxide injection into the fistula tract (via the external opening) to increase accuracy. A pelvic MRI has been shown to have an accuracy of up to 90% for mapping the fistula tract and identifying internal openings.​

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What are the Treatments available for anal abscess?

          The treatment of an abscess is surgical drainage under most circumstances. An incision is made in the skin near the anus to drain the infection. This can be done in a doctor’s office with local anesthetic or in an operating room under deeper anesthesia. Hospitalization may be required for patients prone to more significant infections, such as diabetics or patients with decreased immunity.

           Up to 50% of the time after an abscess has been drained, a tunnel (fistula) may persist, connecting the infected anal gland to the external skin. This typically will involve some type of drainage from the external opening. If the opening on the skin heals when a fistula is present, a recurrent abscess may develop. Until the fistula is eliminated, many patients will have recurring cycles of pain, swelling and drainage, with intervening periods of apparent healing.

 

About Ksharasutra Treatment

           Ksharasutra Therapy is an Ayurvedic Parasurgical Technique. Great Indian Surgeon Sushruta narrated in his teachings the use of Kshara for cure of fistula in ano and other anorectal diseases. The work of Sushruta was later compiled as “Sushrut Samhita” in the 5th century A.D. Acharya Chakrapani Datta (10-11 Century A.D.) and Acharya Bhav Mishra (16-18 century A.D.) have described in their classical Ayurvedic texts, the method of preparation and treatment of fistula in ano by use of Kshara Sutra (K.S.). It is being used for the successful treatment of Anorectal Diseases from many years.

             The presence of Kshar Sutra in the fistulous tract does not allow the cavity to close down from either ends and there is a continuous drainage of pus along the Kshar Sutra itself.

             The Kshar Sutra slowly and gradually cuts through the fistulous tract from apex to the periphery. There is an ideal simultaneous cutting and healing of the tract and no pocket of pus is allowed to stay back.

             The Kshara (Caustics) applied on the thread are anti-inflammatory, antislough agents and in addition, have property of chemical curetting. The Kshar Sutra remains in direct contact of the tract and therefore, it chemically curettes out the tract and sloughs out the epithelial lining, thereby allowing the fistulous tract to collapse and heal.

              The Kshar Sutra, due to its antibacterial property, does not allow bacteria to multiply in its presence.

              Though the technique is effective in the management of fistula in ano, the longer duration of treatment due to the slow cutting and healing process makes the treatment difficult, especially in complex fistulas.