Kshara sutra therapy is considered as a minimal invasive Ayurvedic para-surgical procedure and time tested procedure within the management of various anorectal disorders like hemorrhoids, fistula & other skin related sinus diseases. Kshara Sutra is basically an Ayurvedic medicated thread coated with pure herbal alkaline drugs i.e. a caustic thread that destroys the devitalized tissue and improves healing action. Being considered superior to all surgical and Para surgical measures in Ayurveda classics as it is an amalgam of incision, puncture, and scarification to relieve derangements & uniformly affect the diseased part to which they are applied.
Indications of Kshara Sutra Therapy
Kshara sutra therapy is beneficial for patients with anorectal conditions like hemorrhoids, fistula, anal or rectal polyps, sentinel tags, pilonidal sinus etc;
- Haemorrhoids or piles:
The kshara sutra is ligated at the base of the sprouted piles mass under the minor surgical procedure and sterile dressing of the rectum with jatyadi oil dipped gauze pack to help soothe the irritation if any due to kshara thread. This actually shrinks the pile mass within 6-7 days to get dry & fall off as the blood supply gets reduced due to strangulation of the vessels and heals the wound within 10-15 days after weekly sterile dressing.
The kshara thread is passed through the fistula or the tract under local anesthesia that helps to gradually curette, draining & healing the tissue by removing the unhealthy tissue from the affected region. The thread is changed weekly and it usually takes 3-4 weeks for proper healing.
- Pilonidal sinus:
This technique along with leech application is highly beneficial in treating pilonidal sinus as the thread is passed through the opening of the sinus to the skin that gradually cuts and heals by removing the unhealthy tissue and promotes quick healing within 3 to 4 weeks.
- Anal warts or Anal polyps:
The sprouted anal outgrowth is tied & ligated with kshara thread that results in the cessation of the blood supply to the unhealthy tissue and making it dry and dead within 6 to 7 days.
Contraindications of Kshara Sutra Therapy
Kshara sutra technique is preferably avoided in conditions such as;
- Severe systemic ailments like Fever, nasal bleeding, appendicitis, inflammatory bowel disease, urethral stricture etc.
- Malignancies like Tuberculosis of the abdominal wall, venereal diseases, carcinoma in the rectum, hepatitis, leprosy.
- Diseases of heart, liver, anaemia
- Digestive conditions like diarrhoea, anorexia, indigestion
- Female conditions like the menstrual cycle, pregnancy, displacement of the vagina or prolapsed uterus
- Infants, children, old aged people
- Application of kshara is contraindicated over vital parts such as all marma sites.
What is Kshara Sutra & How It is Prepared?
Kshara material is obtained from the ashes of the drugs of animal origin such as shankha, kapardika, pravala etc., minerals like tankan and herbal origin like apamarga, snuhi, arka, etc. The alkaline portion required is extracted from the ashes of these substances & chosen according to their properties required for various diseases. The local application of kshara results in chemical cauterization that usually has better results than electric cauterization.
- Materials Used
- Thread: The model thread used is a surgical linen thread of size 20 since it possesses a sufficient strength to hold the 21 coatings of all the herbal ingredients throughout the therapy.
- Kshara or Alkali: The type of caustic agent or kshara used must be fine, dry & white coloured powder for effective chemical cauterization.
- Ksheera or Latex: The kshara does not have an adhesive property. Thus for adhesive action, Ksheera or latex of snuhi, papaya, udumbara, arka, guggulu etc. is used as binding material for the preparation of different types of kshara sutra.
- Haridra or Turmeric: The excessive hygroscopic nature of the kshara makes it useless when it gets exposed to the atmosphere. Therefore, the turmeric coating prevents the direct contact of Kshara with the atmosphere, & preserves it for a longer period sustaining its antiseptic & antihistaminic properties.
- Method of Preparation
- Collection of latex or ksheera: Linear cuts are made on the stem of the plant and latex is collected in a clean bowl. After collection of adequate amount of latex devoid of any pieces of the bark of the plant & dust, it is transferred to a glass container. The Latex should be used immediately to avoid its hardening.
- Preparation of kshara: Ash is collected by burning the whole plant along with tila nala. Then it is mixed with six times water or gomutra and filtered thoroughly. The filtrate is boiled to evaporate the water and dry powder is obtained. Store the powder in an airtight bottle like it catches moisture very easily due to its hygroscopic nature.
- Application of alkali & latex coating to the thread
- The surgical linen thread is spread & tied to the hanger of the Ksharsutra Cabinet.
- The latex soaked gauze pieces are used to smear the equally & uniformly all around.
- The coatings to be done until the desired tensile strength of the thread is obtained. After examining the desired tensile strength of the thread, the hangers are placed in the Ksharsutra cabinet for drying.
- After 11 such coatings with the latex, the 12th coating of the ksheera is done and the wet thread is then passed through a stack of finely powdered kshara immediately & then shaken gently allowing the excess particles of kshar to fall.
- The same process is repeated till 7 coatings of latex and the alkali is achieved, thus completing 18 coatings on the thread.
- The remaining last 3 coatings are performed with latex and fine powder of turmeric that disallows the moisture to penetrate and make the Kshara watery, whence, the loss of tensile strength.
- Maintaining a sterile atmosphere right from the first day of the coating is a must.
- The threads of a uniform length around 30-32 cm are cut for packing.
The definite purpose of the sequence and number of coatings is as follows:
- 11 coatings of latex: The initial few coatings get neutralized by the application of Kshara, but innermost coatings remain protected with the proteolytic action that aids in the debridement of the tissues.
- 7 coatings of latex & Kshara: The latex acts as an adhesive material for powdered Kshara particles thus maintaining the adequate concentration of Kshara for its effective caustic action.
- 3 coatings of latex & Haridra: The turmeric coating help in the preservation of caustic thread from the hygroscopic nature of kshara, thus aids in prolonged preservation of it.
What is The Mode of Action of Kshara Sutra Therapy?
Kshara sutra has the potentiality to execute incision with excision slowly by the integrity of its controlled chemical cauterization. The sclerosing effect of kshara by its protein coagulation property aids in ceasing the bleeding if any during the cutting effect, reducing the chances of infection due to sustained action of anti-infective action of kshara.
- The corrosive action of the kshara aids in invading the affected cells of lesion resulting in engorged tissue destruction
- The proteolytic action of the latex helps to dissolve the tissue at its base.
- The bactericidal & healing action of turmeric powder increases the speed of recovery.
All these three drugs support their actions by an equal and desirable effect. The ligation of the thread creates a mechanical strangulation effect on the blood vessels of the affected region resulting in the necrosis of the sprouted mass and swelling due to its pressure effect.
Post – Procedure Instructions
After Kshara Sutra treatment of anorectal disorders like hemorrhoids or piles, fistula etc, healthy diet & lifestyle changes are required for proper healing such as:
- Dietary changes
- Don’t take spicy and fried foods.
- Take a light and easily digestible diet enriched with fruits and vegetables.
- Take foods rich in fibre content.
- Drink plenty of water.
- Avoid constipation, take Isabgol husk or other natural mild laxatives.
- Lifestyle changes
- Stay active most of the time of the day.
- Avoid sitting, standing, travelling and driving for a longer period.
- Keep good hygiene of the anorectal area and clean it properly.
What are the Side-effects of Kshara Sutra Technique?
The kshara sutra technique advent is like a boon for the anorectal conditions like piles, recurrent fistula etc with no side effect except a very mild post-procedural pain that may include itching, swelling, redness for the time during the procedure and reduces subsequently.
There are zero chances of any surgical complications that occur in modern conservative treatments like stenosis, stricture and incontinence and even the anesthesia does not have any side effect as it is usually a local one.
Benefits of Kshara Sutra Technique
Kshar sutra technique is a type of chemical fistulectomy for the management of hemorrhoids, fistula in ano, chronic fissure with tags, anal warts, pilonidal sinus, chronic sinuses, rectal polyps, anal papilloma, neoplastic pedunculated growths etc with advantages as follows;
- It usually takes 3 to 4 weeks for proper healing of piles, rectal polyps, fistula or any other anorectal conditions.
- Simple, safe and surely a minimum invasive technique for anorectal conditions with lower recurrence rate.
- Cost-effective management that can be performed in minor O.T. conditions.
- Minimal to no damage to anal opening due to simultaneous cutting and healing hence, no chance of incontinence.
- It’s an ambulatory procedure hence, no hospitalization required.
- Minimum scar formation at the site of the wound.
The paramedical Ayurvedic procedure of Kshar Sutra results in permanent and benign treatment for those suffering from hemorrhoids, fistula-in-ano, anal fissure, and pilonidal sinus, where modern surgery is unable to offer satisfactory treatment.