Kshara karma, a safe effective alternative of to surgery in the management of Fissure

            Kshara is a caustic, alkaline in nature obtained from the ashes of medicinal plants. It is a milder procedure compared to surgery and thermal cautery. It is the superior most among the sharp and subsidiary instruments because of performing excision, incision, and scraping. It is versatile because even such places that are difficult in approach by ordinary measures can be treated by Kshara Karma. Kshara Karma is used as the substitute for surgical instruments because they can be used safely on the patients who are afraid of surgery.

Types:

• On the basis of Administration –   External application, Internal administration

• On the basis of Concentration – Mild, Moderate and Highly

Utility / Properties of Kshara

• Prepared Kshara, being a composite of many drugs, alleviates three doshas.
• As it is made of drugs having pungent, hot, sharp, digestive property, it does cauterize, digesting and splitting actions.
• If used in excess it can result in impotency.
• Externally it has: Cleansing, Heating, Absorbent and Scraping properties
• Internally it destroys Worms, Ama dosha, Kapha dosha, Skin diseases, Poison and Obesity.

Indications of external application of Kshara in anorectal diseases -

• Internal Haemorrhoids
• a fissure in Ano
• Rectal prolapse
• After excision of pilonidal sinus

Fissure in Ano (anal fissure)

The anal fissure is a tear in the skin of anal canal, which causes severe pain before and after defecation, bright red blood seen on the stool surface. The incidence of the fissure in ano is same in both men and women. Pain and burning sensation in the anal canal will be so severe where the patient may stay away from defecation for days, which can again cause constipation and deteriorate the condition. Due to the burning sensation and pain patient unable to focus on his daily activities and so, it is upsetting and weakening.

Causes for fissure:-

1. Constipation: fissures are usually due to passage hard stool.
2. Sedentary lifestyle: No physical exercise may cause hard stools which in turn leads to the fissure.
3. Irregular food habits: Improper and untimely food.
4. In females usually happens during pregnancy and childbirth.
5. Crohn’s disease.
6. Ulcerative colitis
7. Low dietary fiber intake and less intake of liquid.

How can fissure be prevented?

The primary cause of anal fissures is constipation. So, one has to develop habits by which constipation can be prevented. A few measures can be;

1. Taking adequate dietary fibers. Eat more vegetables, fruits, and salad.
2. Drink plenty of water and fluids but avoid much coffee and tea.
3. Avoid straining during defecation.
4. Avoid excessive chilies and spices in food items.
5. Avoid much of non-veg. food. Try to be vegetarian.
6. Use of buttermilk (Lassi without butter) with a pinch of cumin powder and black salt.

Treatment options

               Taking only oral medications may help in some patients if fissure is of recent origin. A final and permanent remedy for this is again kshara karma. Under local 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.

Advantages of Kshara Therapy

• Postoperative pain is mild in intensity
• No bleeding
• Minimum hospitalization – day care procedure
• No scope for recurrence
• Even in Some Systemic diseases where surgery has avoided this procedure can be done.
• No surgical complications like incontinence, stenosis, and stricture.

Dr. Shyam Prasad. BAMS and MS Shalya from SDM Ayurveda college Udupi. Associate professor in the dept. of Shalya Tantra.