Kshara is a caustic chemical, 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. It is more effective than the other modalities of treatment, because they can be administered both internally and externally. Kshara Karma is useful as the substitute of surgical instruments, because they can be used safely on the patients who are afraid of surgery
Indications
- Internal Haemorrhoids
- After Fistulectomy
- Rectal prolapse
- After excision of pilonidal sinus
- After Incision and drainage of Anorectal abscess
Kshara Karma in Internal Haemerroids
- Pre-operative : First the required instruments like Proctoscopes, Kshara, Lemon juice, YastimadhuTaila, Allis tissue forceps, Artery forceps, etc. are kept ready with proper sterilization. The night prior to procedure, the patient is usually had light diet afterwards nil orally. The part is prepared well and gives soap water enema 2 to 4 hours prior to procedure.
- Operative procedure : The patient is in lithotomy position, the part is cleaned with aseptic solutions and draping was done after Local Anaesthesia / Spinal Anaesthesia. Lubricated Slit Proctoscope is to be introduced into the anus and internal piles bulges in. Then the pile mass should be rubbed and cleaned with cloth or a cotton swab with warm water. Then the Kshara applied over the pile mass and wait for 2 minutes or until the pile mass turns to the colour of Reddish black (PakwaJambuPhala Varna). After this process, the pile mass must be washed with Lemon juice to neutralize the Kshara after proper burning of piles. The same procedure should be followed in other piles also. Later the rectal pack with YashtimadhuTaila is applied and bandaging was done and shifted to the postoperative ward.
- Post operative : Patient is allowed to orally with sips of liquids and liquid diet after 4 to 6 hours of procedure. Later Patient is advised for PanchaValkalaKwatha / TriphalaKwathaSitz bath for 10- 15 minutes to relieve the pain and swelling. Triphala Guggulu & Gandhaka Rasayana 2 BDS for 10 days. Analgesics and Antibiotics if necessary. Histopathological examination of slough material in blackish brown discharge reveals the presence of necrosed haemorrhoidal tissue.
Mode of Action of Kshara in Internal Haemarroids
- It cauterizes the pile mass directly because of its corrosive nature.
- It coagulates protein in haemorrhoidal plexus. The coagulation of protein leads to disintegration of haemoglobin into haem and globin. Synergy of these actions results in decreasing the size of the pile mass. Further, necrosis of the tissue in the haemorrhoidal vein will occur. This necrosed tissue slough out as blackish brown discharge for 3 to 7 days. The haem present in the slough gives the discharge its colour. The tissue becomes fibrosed and scar formation seen. The haemorrhoidal vein obliterates permanently and there is no recurrence of haemorrhoids.
