PILES

It is loss of elasticity of veins in the anal canal & lowermost part of rectum. It in seen in both the sexes, chances increases with the age. Piles are classified as

1. Internal piles ( arising in the upper two-thirds of anal canal )
2. External piles ( it is skin covered lower one-third of the canal or at anal opening)

Intenal piles occurs due to obstruction in venous return from that part. Other causes can be.Hereditery, anatomical , physiological factors,constipation, diarrhea straining at stool, Inadequate fibre diet etc. In this a young adult who develops boil ( with pus ) at the base of tail bone which bursts or opened by Doctor. Discharge of pus then ceases but reddish swelling ( Induration) persists ? boil reforms & cycle repeats.

Patient is advised to take high fibre diet.

• Injection Sclerotherapy: Injecting sclerosing agent in the pile mass.
• Cryosurgery : piles can be necrosed by freezing with a cryoprobe, using CO2 or N2O.
• IRC (Infra-red coagulation).
• Rubber band ligation.

These are called as Office procedure & usually done in OPD basis without anaesthesia,blood Loss & hospital stay also safe for Diabetics & pregnant woman. Patient can go to Piles clinic on any working day, no need to go with empty stomach & after Rx patient can go back home & do the routine work on same day.

If patient does not responds to above methods or suffering from III grade piles then advised to go for following methods:

• Ligation & Excision: Band is applied to the pile bearing & pile mass is excised.
• Submucosal Haemorroidectomy.
• Stappler Haemorroidectomy.
• MIPH ( Minimal Invasive procedure for Haemorroides ): It is newer modality available which shows lesser pain, minimal bleeding & shorter hospital stay, early return to work.
• Less discomfort after operation.

Above mentioned procedure routinely being done in Abhishek Day Care Centre. Patient can go home on the same day & must follow the instructions given by surgeon at the time of discharge.
After operation patient is advised to take Antibiotics, antiamoebics, analgesics & laxatives. Also advised to sit in plain luke warm water twice a day.

FISSURES IN ANO

It is crack in the skin-lined part of Anal canal.Usually seen in young or middle aged adults & common in both sexes.

Constipation, Injury to Anus during passage of large hard stools. It is seen in Proctocolitis, Crohn's Disease very rarely.Patient presents with pain & or swelling in the form of skin tag at anal region. He may get bleeding either in drops or streak of blood along with stools.

1. Intake of High fibre diet,green leafy veg, fruits, salads will help to prevent this complaint.
2. Stool softener should be given to avoid constipation.
3. Application of Lubricant & Local Analgesics ointments, sitting in hot water gives relief from the symptoms.

If above Rx fails to give relief then one should go to surgeon.

1. Fissurectomy: Excising the fissure usually resulted in healing ,sometimes resulted In seepage of stools, to prevent that closed fissurectomy is preferable.
2. Sphincterotomy:
   1. Open : Incision of the overlying anoderm & direct exposure of sphincter (muscular part)
   2. Closed:Fissurectomy with division of the sphincter with repair.

Above mentioned surgery can be easily done as day care surgery in Abhishek Day Care Centre, patient will be discharged on the same day. After surgery patient is advised to take pain killers, stool softners, antibiotics, ointment, sitz bath ( sitting in luke warm water).

FISTULA IN ANO

It is a track which connects the external opening on the perianal skin to an area in the depth of the anal canal or rectum. It mainly caused due to anorectal abscess which burst or it opened inadequately.
It may be seen in Tuberculosis & in association with Crohn's disease very rarely.
Patient will present with repeated episodes of painful swelling near anal verge, burst with pus discharge.

1. Fistulotomy:
   The fistula is incised from external to internal opening.The floor of the tract is scooped & wound heals by granulation.
2. Fistulectomy:
   Tract is excised from external to internal opening.
3. Sphincter saving fistulectomy :
   Tract is cored from the external to the internal opening protecting the damage to the sphincter.

1. After discharge patient is advised to take bath the wound for three to four times in a day.
2. The wound must be kept clean.
3. Once in a week patient must go to the surgeon for follow-up.
4. Patient is advised to take Laxatives to allow smooth passage of stools without straining which will help to reduce the pain.

Above mentioned surgery can be easily done as day care surgery in Abhishek Day Care Centre, patient will be discharged on the same day

PILONIDAL SINUS

It is a sinus (Tract which opens at one end only) situated a short distance behind anus (at the position of tail bone) & generally containing hairs. Other areas of occurance can be finger web in barber,under arm, between the thighs, umbilicus. In this a young adult who develops boil ( with pus ) at the base of tail bone which bursts or opened by Doctor. Discharge of pus then ceases but reddish swelling ( Induration) persists - boil reforms & cycle repeats.

There will be midline opening or multiple openings, may also find hairs projecting from opening.

1st step of treatment is Anti-inflammatory drugs, Antibiotics, Injections within the sinus. If the patient does not respond then may need a surgical treatment which can be done in Abhishek Day Care Centre. Surgical Rx (Excision of sinus) is lying open the tracks, removal of all debris & hairs & suturing laid open edges to the skin.

After surgery patient is advised to keep the wound clean, use a shower 2-3 times a day, directing the spray onto the wound. One can use hair-dryer to keep the wound dry. To prevent hairs entering into wound, skin edges should be shaved weekly.

Piles / Fissure

1) Tab. Bruhat Suran Vatak         2 tds

2) Tab. Trifala Guggul                1-2 tds

2) Tab. Nagkeshkar                   2 tds

Pnachkarma

Swedan - Avagaha Sweda

Basti                                      Kasisadi Tel
C/i before completion of 4 months of pregnancy