Paschat Karma Of Ksharasutra – Post Operative measures

Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa, BAMS
Observation of signs of properly conducted and improperly conducted kshara sutra procedure –
There are some signs of perfection and imperfection which should be observed keenly and recorded.

This gives one an idea as to whether the treatment has been successfully accomplished or not. This also gives one an idea to manage complications arising out of the procedure if any. The symptoms are as below mentioned –

Samyak Lakshana

Symptoms of proper administration of Kshara Sutra –
Pakwa jambava asitam – the scar appears black, similar to the ripe fruit of Jambu (Jamun fruit)
Read related: Ksharasutra Purva Karma: Pre-Treatment Procedures

Ayoga Lakshana

Symptoms of improper administration of Kshara Sutra –
Tamra varna – coppery red colour
Toda – pricking pain
Kandu – itching
Read related: KsharaSutra Pradhana Karma – Main Procedure

Atiyoga Lakshana

Symptoms of excessive administration (burning) of kshara sutra –
Rakta srava – excessive bleeding
Murcha – fainting
Daaha – burning sensation
Jwara – fever
Guda daha – burning sensation of anal region or over burning of anal region producing obstruction for passing faeces and urine or their excess elimination
Pumstwa ghata – loss of sexual power (impotency)
Mamsa ghata – loss of muscular power, incontinence
Mrutyu – death

Management of complications

Management of bad effects or complications (excessive burning of anal region) caused by faulty administration of kshara sutra

• Amla seka – pouring of sour fluids or fluids prepared using sour medicines, sour is cold to touch; combining with alkali it quickly attains the properties of sweet taste. Hence the burn caused by alkali should be washed with sour substances.
• Madhu-ghrita-tila lepa – application of paste prepared from honey, ghee and sesame
• Vata pitthara cheshtaa – all activities or comforts which mitigate vitiated vata and pitta
• Vata-pitthara ahara – foods which alleviate vitiated vata and pitta
• Sarva shishira kriya – all cold comforts and foods

Discharge of the patient – Generally patients who have undergone kshara-sutra treatment shall be discharged the same day with suitable instructions related to diet and lifestyle. The procedure doesn’t need a long hospitalization. On the other hand, the patient may be kept as in-patient for couple of days as a part of follow up, until the patient or attendants of the patients are trained to handle things at home. Kshara sutra is a clean procedure, if everything is done well there will be no complications in the post operative period. It is thus easy to manage things at home.

Advices to the patient

• Ambulation – The patient is advised to stay ambulated (active life following walking etc)
• Easy digestible diet – The patient is advised to take easy digestible diet for couple of days after the procedure, especially liquid diet. Later, the patient is allowed to take normal food which is easily digestible.
• Food – To take normal food and to avoid irritant, spicy, too cold, too hot foods and foods which tend to cause constipation or diarrhoea
• Fibre rich diet – Patients are advised to take plenty of fibre rich foods and vegetables along with plenty of water to maintain hydration
• Bowel clearance – Patient is advised to keep the bowel movements clear. He is also prescribed with suitable and mild herbal laxatives for bowel clearance.
• Avoid – prolonged sitting, standing, long distance travelling, driving
• Maintenance of sterility and cleanliness – Patient is advised to take regular bath and keep the body clean, especially the anal region. He and his attendants are advised to dress the anal region (lesion) properly and on regular basis.
• Sitz Bath – This is an important follow-up measure in the post-operative management. The patient is advised to have a sitz bath at least thrice daily. For this the patient needs to sit in a tub filled with warm water added with salt or medicated decoction. Triphala kwatha or Pancha valkala kwatha are generally preferred for sitz bath. These decoctions will help in quick healing of wound, cure infection and cleanse the local area (anus). This procedure shall be followed for at least 3-4 weeks. This procedure shall be done from the second day or the day following the day of procedure.
• Matra Basti – Enema with herbal oil or ghee is given for 1-2 weeks with Jatyadi taila oil or Jatyadi ghrita. This is elective and depends strictly on the decision of the physician. This enema will help in quick healing of the wounds and clear the stools on regular basis. This shall not be given if laxatives are advised.
• Analgesics – In presence of moderate to severe pain, some herbal analgesics shall be prescribed. Triphala Guggulu with Triphala Churna or Haritaki Churna given with hot water at bed time shall solve the purpose.
• Disease modifying medicines – shall be advised in the follow-up period to hasten recovery. For this, the medicines advised for treating arshas (piles) and bhagandara (fistula) shall be prescribed.
• Reviewing and follow-up kshara sutra – The dressing shall be done daily or checked at least once in alternative day if the patient is at an accessible distance and can come over to the hospital or clinic for regular follow-up. The patient is advised to get the kshara sutra changed again in a space of 10 days or 2 weeks if the healing is slow. Changing kshara sutra and replacing it with new one will quicken the recovery.

Ayurvedic medicines

Medicines (disease modifying) which could be prescribed in the follow up period –
Certain medicines (formulations) help in quick recovery by modifying the disease and setting in the healing action in quick time. Some of the below mentioned medicines will be handy in the post-operative period. Combinations are strictly left to the skill and decision of the physician. These medicines include those indicated in treating the ano-rectal conditions.

Classical Ayurvedic medicines: 

• Dusparshakadi Kashayam
• Chiruvilwadi Kashayam
• Gandharvahastadi Kashayam
• Punarnavadi Kashayam
• Abhayarishta
• Mridwikarishta
• Vidangarishta
• Bahushala guda
• Kalyanaka guda
• Manibhadra guda
• Suranavaleha
• Vyaghryadi leham
• Saptavimshati Guggulu
• Triphala Guggulu
• Changeri Ghrita
• Avipattikara Churna
• Kasisadi Taila
• Arshoghna vati
• Kankayana Gutika Arsha
• Arshakutara Rasa etc

Proprietary Ayurvedic medicines: 

• Cap Arsol (BAN)
• Tab Arshonyt (Charak)
• Cap Balvac (BAL Vedics)
• Tab Kultab (Vasu)
• Tab Pilex and Ointment Pilex (Himalaya)
• Tab Pilocure (Alopa)
• Tab and Ointment Pilorid (Nagarjuna)
• Tab Pirrhoids (Baidyanath)
• Cap Pylapy (Capro)
• Tab Rectocare (Bacfo)
• Cap and ointment Sukhada (Ayulabs)
• Cap Sunarin (Phyto pharma) etc
• Click to consult Dr Raghuram MD (Ayu)