ANO RECTAL DISORDERS

 FISTULA – IN – ANO

Fistula in ano is a hallow tract lined with granulation tissue connecting a primary opening inside the anal canal
to a secondary opening in the perianal skin.

CAUSATIVE FACTORS :-

1.    Unhealthy and unhygienic diet, like junk foods, bakery items, non-veg etc.

2.    Habitual will full postponement of natural calls.

3.    Secondary to trauma, chrons disease, anal fissures, carcinoma, tuberculosis infections etc.

SYMPTOMS :-

1.     Pus discharge either bloody or purulent.

2.    Pruritis ani.

3.    Painfull abscess in anal area.

TYPES :-

1.    Simple fistula

2.    Complex fistula

  TREATMENT

MODERN :-  1. Fistulotmy.

                       2.seton placement.

 

AYURVEDA :- The choice of treatment is by kshara sutra.

 

 HAEMORRHOIDS

Def: Dilatation of the veins with in the anal mucosa.

Causes:

1.    Constipation(Prolonged straining)

2.    Dysentry

3.    Low  fibre diets

4.    Increased intra abdominal pressure

5.    Absence of valves within the hemorrhoidal veins and aging

           Symptoms:

1.Bright red colour Bleeding ( Splash in the pan)

2.Painless bleeding during defecation

3.Mucoid discharge

Types:

1.    Internal

2.    External

 

1.Internal : Those that originate above the dentate line.

Based on the degree of prolapsed

1.Grade 1: No prolapsed

2.Grade 2 : Prolapse upon bearing down but spontaneously reduce

3.Grade 3: Prolapse upon bearing down and requires manual reduction

4.Grade 4: Prolapsed and cannot be manually redused

 

3.    External piles:

Those that occur below the dentate line

They are covered proximally by anoderm and distally by skin.
 

Treatment: 

1.    Conservative:

-         Nutrition rich in dietary fiber

-         Uptake of oral fluids to maintain hydration

-         Nsaids

-         Sitz baths

2.    Surgical :

             1.Rubber band ligation

            2.Haemorrhoidectomy

            3. Sclerotherapy    

Ayurveda: 1.Transfixation with kshara sutra

  FISSURE IN ANO

 

An anal fissure is a break or tear in the skin of the anal canal.

Causes:

1.Constipation – passing of large , hard stools

2. Prolonged diarrhea

3. decreased blood flow to the area

4. childbirth trauma in women

5.chrons disease

Symptoms:

1. Pain during and after defecation

2. Strek like bleeding during defecation Types:

3. Chronic fissure: undermined edges with sentinile pile mass.

Types:

1.    Acute fissure

2.    Chronic fissure/ complicated fissure

 

Treatment:

Conservative:

1.    Avoiding straining when defecating.

2.    Warm water sitz bath with betadine solution/ Triphala kashaya

3.    Application of local anaesthetic cream or gel.

4.    Application of silver nitrate to promote healing

5.    High fiber diet

6.    Bulk laxatives

Surgical:

In case of Chronic fissure with sentinile pile mass fissurotomy with kshara sutra should be done.

Complicated fissure is treated with ksharasutra like FIA.

 

 

                                   PILONIDAL SINUS

A Pilonidal sinus is an infected tract under the skin between the buttocks (Natal cleft).

Pilonidal = Nest of hairs

 

Causes:

 Theory1: Congenital or hereditary abnormality in the skin of the natal cleft.(The hairs grow into the skin rather than outwards)

Theory2: Development of skin dimples in the skin of the natal cleft( Damaged hair follicles due to local pressure or friction)

-         Sedentary occupation

-         Obesity

-         A previous persistent irritation or injury to the affected area.

-         Having a hairy, deep natal cleft

-         A family his

 Symptoms:

      1. Acute: Pain and swelling in and around the sinus

     2. Chronic: Around 4 in 10 people have a recurrence of their pilonidal

        Sinus. Usually the sinus discharges pus.

Treatment:

1.    Excision of the sinus and application of kshara sutra.