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DEFINITIONS : PiloNidal sinusis a conditionfound in acongenitalcleftontheelongatedcoccyx.(coccyx)Consists of one or more central openings with a fibrous groove containing loosehairsin the lumen.
MODE OF ORIGIN : In a sitting position, the buttocks bear the weight of the body and move independently or together. Hair that breaks from friction with clothing and short hair tends to accumulate in natural crevices. The act of cutting the butt, which is increased by sitting in a hard chair. Loose hairs fall down to the interstitial area to penetrate the skin.
Men affected moreHairy men is more affected.
The simple treatment of hairy sinuses is to clean, wash, and remove all hairs and passages.
An Anal fissure is a small crack or tear or ulcer (open sore) in your skin in ano-rectal region. Fissures are characterized by extreme Pain, Burning sensation & needle pricking sensation during defecation & in extreme cases throughout the day also. Sometimes fissure causes bleeding also. About one in 10 people get an anal fissure at some point in their life. Anal fissures usually develop at the part of your anus towards your back – in line with the cleft of your buttock or in front of your anus, or even both together. An anal fissure will usually heal within five to six weeks, and it’s called an acute anal fissure. If it lasts for longer than this it’s known as a chronic anal fissure. Anal fissure can come at any age, but it’s most common in people aged 20 to 50.
☛ A sharp, searing or burning pain in, or around, your bottom, which can last for a couple of hours after you go to the toilet. Some people describe the pain of an anal fissure as like passing broken glass.
☛ Spasms in anus.
☛ Sometimes small Bleeding during defecation.
☛ A sentinel pile. This is a tag of skin that can develop on the edge of your anus below the fissure. This can develop after you get the fissure.
These symptoms may be caused by something other than an anal fissure. One condition they’re often confused with is piles (haemorrhoids), for example. If you have any of these symptoms, contact your Doctor.
Generally an anal fissure will heal within few weeks without any treatment. An anal fissure usually heals if you make some dietary & lifestyle changes along with medicines, or use creams. If it doesn’t get better, generally Doctors advice for surgery.
Fissures Surgery
Surgery may be needed if medicine fails to heal a fissure in the anus. The preferred procedure is an internal anal sphincterotomy. In this procedure Surgeon makes a small incision in the internal anal sphincter, one of two muscles that control the bowels or opening or closing of anus. This will be done under local or general anaesthesia. The internal anal sphincter is always under tension, also known as resting pressure. If that pressure becomes too high, a fissure may form or an existing one may not heal. The incision reduces the resting pressure, allowing the fissure to heal. Even with surgery, an anal fissure must heal on its own. A sphincterotomy involves operating on the sphincter muscles, not closing the actual fissure.
Lateral internal sphincterotomy highly preferred treatment of fissure due to its high success rate (~95%) & easier process. In this treatment the internal anal sphincter is partially divided in order to reduce spasms and thus improve the blood supply to the perianal area.This treatment of fissure improvement in the blood supply helps to heal the fissure.This is a single day &simple surgery. However, this have a number of potential side effects like problems in incision healing and also loss of stool holding capacity and sometimes loss of urination senses also
Anal dilation or stretching of the anal canal also known as Lord’s operation is one of the older treatment of fissure, which is not very common, primarily due to the unacceptably high incidence of fecal incontinence & flatus incontinence.
Haemorrhoids, generally known as Piles, is a very common disease affecting almost 70% of the population because of lifestyle changes and unhealthy food style(junk foods)
Piles is nothing but swollen and inflamed veins in the anus or the lower rectum. The actual cause is not known however the main causes of piles are believed to be
• Long standing
• Chronic diarrhoea or constipation
• Straining while defecation
• Obesity
• Pregnancy(can cause before and after delivery)
• Weakening of muscles due to ageing etc
• Hereditary tendencies
Haemorrhoids / Piles are mainly classified in to two types based on location.
External Haemorrhoids or pile mass occur below the dentate line which are usually very painful in nature causing irritation and itching around the anus.
They may be thrombosed sometimes (Thrombosed Piles) with pool of blood forming a clot resulting in inflammation and severe pain.
Internal Haemorrhoids or Pile mass occur above the dentate line and are usually painless but present with severe bleeding per rectum during or after defecation.
As per the stages of the disease, they can be classified in to four.
• First Degree Haemorrhoids – Pile mass projects slightly into the lumen of the anal canal during defecation due to congestion of the veins.
• Second Degree Haemorrhoids – Pile mass projects out of the anal canal while defecation but returns in to the anal canal spontaneously after defecation.
• Third Degree Haemorrhoids – Pile mass protrude outside of the anus during defecation and remain protruded until manually reduced within the anus.
• Fourth Degree Haemorrhoids – Large Pile mass always remain protruded outside and cannot be manually reduced in to the anal canal.
About 40% of people suffering from Haemorrhoids show no significant symptoms. However, the common symptoms include
– Bleeding per rectum (Prolonged or severe bleeding may lead to anaemia)
– Discomfort especially during defecation and sitting
– Itching
– Swelling
Fistula is nothing but a hollow tube or sinus or a track (generally defined as an abnormal passage between two epithelium). Fistula in ano is more common in males to females, the ratio is believed to be 7:2.
Fistula in Ano is a granulated track communicating between perianal skin superficially to anal canal or rectum.
Fistula in Ano can be Cryptoglandular resulting from inflammation of proctodeal glands or Non-cryptoglandular resulting from Tuberculosis, Crohn’s disease, Ulcerative colitis, Hydradenitis Suppuritiva, Injury, Iatrogenic cause or Carcinoma.
Fistula in Ano is classified (Park’s Classification) in to four, based on the location of the track
• Inter Sphincteric Anal Fistula
• Trans Sphincteric Anal Fistula
• Supra Sphincteric Anal Fistula
• Extra Sphincteric Anal Fistula
Another classification is based on the location of internal opening of the Fistula Track
• Low Level Anal Fistula – They open into the anal canal below the Anorectal ring.
• High Level Anal Fistula – They open into the anal canal at or above the Anorectal ring.
Common symptoms of anal fistula include
– History of Anorectal abscess
– perianal discharge ( purulent / bloody discharge )
– Pain
– Swelling / Lump
– Skin excoriation
– Itching
– No fecal incontinence
– This is ‘surgery without knife’
– Huge wound can be avoided
– Short stay at Hospital
– Much economical
– Can do everyday activities
– Negligible recurrence
A special formulated thread / seton known as Kshara sutra prepared as mentioned in Sushruth Samhita. It is prepared by coating surgical thread with various medicinal plants such as Snuhi (Euphorbia nerifolia), Apamarga (Achyranthes aspera), Haridra (Curcuma longum) etc.This alkaline thread is tied around the fistulous track which cuts, curettes, drains and heals the fistulous track.
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