Don’t Confuse Fissure with Piles

Don’t Confuse Fissure with Piles

For most of us any problem in the anal region is either piles or fissure, the self-diagnosis usually depending upon which of the two words is ingrained in our vocabulary. However, a goofed-up diagnosis not only adds to the misery but makes a simple problem complex. I have tried to explain the difference between the two in simple words here. When it comes to one’s health, its best to be well-informed and aware of the condition one is faced with.

What is the difference between piles and fissure?

Piles or hemorrhoids are swollen blood vessels near the anal opening whereas fissure is a tear in the delicate skin of the anal opening. Depending upon the severity of the disease, piles are graded from 1 to 4, grade 1 having just swollen vessels while grade 4 has a mass comes out of the opening.

What is the difference in symptoms?

The predominant symptom of a fissure is intense pain while defecating. The magnitude of the pain is such that one fears going to the toilet.
Piles are usually characterized by bleeding after passing stools. The blood is fresh and there is no pain. Sometimes one may feel a mass at the anal opening.

Which tests are needed for a diagnosis?

A history of symptoms and visual examination is enough to diagnose fissure. In addition to above, a simple painless technique called Proctoscopy is done in case of hemorrhoids, for a more accurate diagnosis and grading.

Can these conditions be permanently treated?

Modern medicine assures a reliable, quick and effective cure of anorectal problems. Medicines, dietary modifications and lifestyle changes (MCDPA) are enough to treat early piles and acute fissure. In case of chronic cases of fissure, Laser Sphincterotomy provides excellent results. Similarly, for higher grades of piles, Laser Hemorrhoidoplasty (LHP) or Stapler surgery (MIPH) provide a safe, minimally painful and efficient modality of treatment. The earlier techniques weren’t as developed and recurrences were a problem. But with these advanced procedures hemorrhoids can be cured for good.

À la carte or Buffet?

À la carte vs Buffet

There has always been a question of buffet Vs à la carte popped in too many times when asked for recommendations to eat out. We as Indians love a good spread of delicacies. After all, who does not want to have that extra helping of a dessert or a bit more of chicken curry. Thus , the major conundrum in taking decision is to stick to a buffet or go in for à la carte?

A buffet is an ultimate choice when heading out in large groups . It is simply cost effective, and everyone has a choice to stretch their hands and stock their plates with favourite food items.

A point in favour of buffet is it allows us to move while picking on food. But, little do we know that this movement is not helping burn calories as we are loading our plates with more food or simply making rounds to try each food.

When opting for à la carte and ordering at the table, we pick on the choices our mind is in a frame of eating. We know how palatable the food would be as compared to the ones on the buffet spread.

So, it is highly recommended nutritionally to focus eating from à la carte menu when ordering for individual or a small company.

Remember our small tuck pocket called stomach has certain capacity to fill in the load and so are our senses. It is commonly seen and reviewed, people enjoying the best scrumptious high end buffet  often do not get the taste of a particular food as their senses are delighted to multiple palates and more often leading to a situation where our bowel movements gets irritated.

Economically viewing, buffets stand out the best . Enjoying an unlimited array of food, you can refill anything and everything as much as you want. But , how many times, have you realised you could not make it to half the dishes on offer?

So, next time, sit back and enjoy the hot piped food direct from the kitchen onto your table. Order and relish and churn each bite to make it easier on the digestive system as well.  So if you are on a diet regime and you want a change on your taste buds ask your dietician for a guilt free eating day. I am sure she/he would recommend you the ideal choice from the à la carte.

To conclude, an à la carte meal can be most gratifying and although this  gastronomic journey might cost you a little more, but dear friends isn’t it much sensible to devour and digest one meal well rather than dumping in every possible food item and disturbing your gut?

How to Eat Carbs and Lose Weight

Carbs benefits

When trying to lose weight, many people cut out carbs. But this is a huge misconception. Thanks to diets like Atkins and Ketogenic diets, many of us have started to fear eating carbs. But the science behind carbohydrates is actually very complex, and demonizing an entire food group is not wise. Refined and complex carbs are very different, and it’s important to distinguish between the two.

It is possible to eat carbs and lose weight, you just need to know the trick:

1. Eat the right carbs

Let’s take for example potato, everyone’s favorite, this veggie gives you nutrition and has low energy density. On the other hand, French fries are deep fried and obviously an unhealthy way of cooking the potatoes. They should either be boiled or sautéed.

All ‘Low Carb’ diets are not Ketogenic. Low carb diets should target 150-200gm carbs per day. These carbs should come from complex sugars like fibrous fruits and veggies. As against this, a Ketogenic diet provides around 20-50gms carbs per day only and most of the energy is obtained from a high content of fat. It leads to a state of ketosis which is highly beneficial for people with certain diseases like epilepsy, diabetes, metabolic syndrome, or obesity. However, this extreme form of carb-restriction is not the only way to do a ‘low-carb’ diet.

2. Not all carbs are unhealthy sugar

There are many different types of sugars. Simple sugars include glucose, fructose, and galactose. Starch contained in grains and veggies gets broken down into glucose in the digestive tract. However, the sugar in a vegetable is not the same as that of a candy bar which contains sucrose (glucose+fructose). Thus, where as table sugar contains half glucose-half fructose, starch is only glucose. A balanced diet with portion control and complex carbohydrates can work well for weight loss.

3. Low Carbs diet can lead to weight gain

When following a low-carb diet, many people turn to foods that are high in fat and calories – even the good fat in too large a portion can cause a problem with weight gain. Portion sizes are primarily important no matter what diet you follow. Many low-carb foods can be fattening, especially for people who are prone to binge eating and have a history of fad diets.

4. Combo of energy and fibre

Carbs also contain fibre which our bodies can’t digest – Deeply understand; Fibre actually gets to the bacteria in the intestine, which has the enzymes to digest it and can turn it into beneficial compounds. That means fibre is essential for a healthy gut, which has been linked to maintaining a healthy weight. Some studies have even shown that fibre, especially soluble fibre (like those found in oats), can lead to weight loss and improved cholesterol

Aim for a mix of vegetables and whole grains in your diet to boost fibre consumption and drink plenty of water.

5. Carbs make you happy

It is commonly seen that people staying away from carbs have mood swings, trouble in concentrating and get easily frustrated. The simple answer is carbs help in creating a happy hormone called Serotonin. Tryptophan is an important amino acid and is the precursor of Serotonin. It cannot cross the brain’s blood barrier and needs carbs to help it cross over. Also, Tryptophan converts to serotonin and serotonin to melatonin, which is involved in our sleep cycle. Therefore, carbs make you happy and help you sleep, both of which are important factors for weight loss.

6. Cutting carbs is not sustainable

People observe some amount of weight loss in the initial phase of carb restriction. The question however is, can you do without it for lifetime? The answer is a big no. We need to be sensible enough to pick on the habit of clean eating and adapting lifestyle changes.

If you want to lose weight, look at portion control, a diet that is tailored to your needs, and up your exercise so that as a simple equation you’re burning off more calories that you eat.

Fisher Disease : A Painful Misnomer

Fisher Disease

Anal Fissure or Fissure-in-ano is a small crack or tear in the opening and lining of the anus. Written as ‘fisher’ by many because of an error in spelling, this rather painful condition has taken the name of ‘Fisher disease’ among many Indians.

An anal fissure occurs because of various reasons that include:

A) Passing hard stools – Lack of high-fibre diet , low water intake, constipation are the possible reasons that can cause hard stools.

B) Straining during childbirth – trauma to the skin between the posterior vagina and the anus medically known as perineum can potentially cause a tear in the delicate skin of the anus.

C) Repeated episodes of diarrhoea – Repeated perks of diarrhoea can also lead to anal fissure.

D) Due to medical procedures : The insertion or various medical devices for diagnosis eg: Endoscope, Rectal Thermometer, enema tip can result in a trauma causing fissure .

Types of Anal Fissure: There are two types of anal fissures

1. Acute Anal Fissure : Acute anal fissures occur suddenly and potentially heal within a time span of 2 weeks. They are associated with tremendous pain. These type of anal fissured can be treated with medicines and cream .

2. Chronic Anal Fissure : Chronic anal fissure generally fail to heal within the time span of 8 to 9 weeks and can worsen the case by reducing the diameter of the anal opening by half centimetre (½ cm) due to which there are chances of recurrence of the fissure every time the patient passes out the stools.

Signs and Symptoms of anal fissure :

Usually the diagnosis of anal fissure can be really easy just by asking your self few of the following questions –
1. Do I have a burning sensation or a sensation which makes me feel as if a sharp subject is pricking me ?
You will have burning pain when you pass stools because of the tear.

2. Am I bleeding from the bottom ? Is the blood bright red in colour?
The bleeding may be caused due to the tear in the anal canal due to which the blood may be fresh blood streak on the stools or on the tissue paper.

3. Do you feel like itching around the anus (medically termed as pruritus ani) ?
You may have an itchy feeling and this is one of the commonest symptoms associated with a fissure.

If you think you have a fissure you can try some of the following tips and preventive measures :

1. Use some Vaseline jelly or liquid paraffin before you go to pass your stools .

2. Try using some laxative.

3. Have a high fibre diet and increase you water intake to a min of 3 litres and reduce intake of spicy food.

4. You can use some stool softeners. I would recommend Constac powder which contains all natural laxatives which are digestive in nature with no side effects.

5. If you have a lot of itching, try Anoac cream which is very effective on fissures.

6. Ignore using tissue and replace it with a shower or gently dab with wet wipes. The reason we suggest not to use a tissue is because it is abrasive and rough on the skin.

7. When you are passing stools , take it easy and go slow , as in many situations letting it go fast can aggravate the fissure.

These above tips can help you in taking care of an acute fissure. However, in case of a chronic fissure or an acute fissure that shows no signs of healing, it is wise to visit a Proctologist and avail good treatment at the earliest.

For an appointment with leading Proctologist, Dr Ashwin Porwal click here .

For more information and treatment for fissures you can click here

Have Piles? Shed the Shame

Our culture has a huge impact on how we think, what we choose to speak about and what we leave unsaid. It’s little wonder then, that most of us, especially women are shy when it comes to speaking about certain conditions like piles, constipation or prolapse that involve private parts. We choose to suffer in silence rather than coming forth and seeking help. Being the wife of a Proctologist, I often get to hear stories of how women have remained closemouthed for years until the disease has flared up to alarming complications.

Although we have tried to spread awareness and encourage women to shed their inhibitions, we have observed that there are quite a few who are still reluctant to come to us for a consultation, despite Healing Hands Clinic being the most advanced Proctology (branch of medicine that deals with diseases of the rectum and anal canal like piles, prolapse, constipation, fissure, fistula etc.) center.

Women often want a female doctor to consult with, especially for such conditions. Being a doctor myself, and having been brought up in a very ‘Indian’ culture, I understand both sides of the coin. However, all the wisdom in me reiterates that it is far more important to go to the doctor with the best knowledge of the disease, rather than settle for a doctor of a particular sex just because my mindset and culture conforms to it. Having said that, we ensure that no matter who the consulting doctor is, the presence of female assistants is a prerequisite for examination of female patients. EVERY FEMALE PATIENT IS MADE EXTREMELY COMFORTABLE DURING CONSULTATION, RESPECTING HER DIGNITY IS OUR TOPMOST PRIORITY DURING EXAMINATION. We have hundreds of happy female patients from every culture and every strata of society, and it is a matter of pride for us to have served them within their confines of decency.

This is to all you women out there; Leave behind the reticence, it’s your body, stand up for it. There is no shame in speaking to your doctor. Man or woman, we all have all sorts of health issues, and we all deserve the best care for it. So take the first step towards respecting your body and opt for the best medical care.
Like we urge to one and all; HAVE PILES? SPEAK UP.

At Healing Hands Clinic, we have best lady doctor for piles in Pune, Mumbai,
Nashik and Bengaluru centers.

Getting to the Bottom of Constipation

For most of us, a good beginning to the day would mean a satisfactory visit to the toilet. According to a survey, 14% of people in urban India suffer from


However, definition of constipation is quite subjective as bowel habits vary from person to person. While a daily evacuation could be a necessity for one, another could empty on alternate days, and both the individuals are equally healthy. Thus, before clicking the panic button, wouldn’t it be wise to understand how the bowel normally functions and what actually constitutes constipation?

The bowel or intestine is a tube-like organ that extends from the stomach to the anus. It is divided into two parts. The upper part called ‘small intestine’ begins from the stomach and along with it, is responsible for digestion of food. It is also here that absorption of nutrients takes place; whatever remains is passed further into the ‘large intestine’ as liquid faeces. The large intestine aka colon absorbs water back into the body causing the faeces to become more solid. When these faeces reach the rectum (the lowest part of the colon), one feels the urge to pass motion.

    Signs of a healthy bowel

  • Soft but well formed stools
  • Passing stools 1-3times/day to 3times/week
  • No need felt to strain excessively, no pain
  • Passing motion within about a minute of sitting at the toilet
  • Feeling of complete evacuation at the end of defecation, you don’t have to go back in some time to pass more
  • Absence of bloating, excessive flatulence

An unhealthy bowel is a doorway to constipation that can cause piles, fissure, prolapse and above all a diminished sense of well-being. At Healing Hands Clinic,

a Proctology centre

that specialises in diseases of the rectum and anal canal, constipation is tackled with a multi-pronged approach. For those with an occasional bout or looking for a detox, there is Colon Hydrotherapy, which is a drug-free, safe and effective way to cleanse the colon. If constipation is chronic (lasting >3months), a holistic treatment MCDPA provides excellent results. MCDPA is an amalgamation of modern science and Ayurveda and includes herbal laxatives, Biofeedback and Ayurvedic oil therapy.

Obstructed Defecation Syndrome (ODS), a type of

chronic constipation

more common in women, cannot be corrected with any amount of medicines as it is a structural problem of the rectum and needs a surgical correction. Recently Dr Ashwin Porwal published his research paper on

chronic constipation

titled ‘STARR Surgery: Highest case series of 500 patients at India’s largest Proctology clinic

  • Dr Ashwin Porwal
  • MBBS, D.N.B.(Surgery)
  • Dip. in Proctology (Italy)
  • Dip. in Laparoscopy (EITS-IRCAD, France)
  • Proctologist & Surgeon
  • For appointments visit/call:
  • Healing Hands Clinic,
  • Millennium Star Extension,
  • Dhole-Patil road.
  • Helpline: 8888288884
  • Website:
  • Email:

Don’t let varicose veins slow you down

Don’t Confuse Fissure with Piles

Varicose veins though often dismissed as a cosmetic problem, should not be ignored or taken lightly.If not investigated and treated correctly, varicose veins are likely to get worse. They are commonly found in those who have to sit/stand continuously for long hours. Heredity is another cause and varicose veinsare more common in females. These enlarged, bulging and twisted veins can get painful and unsightly. However, up to half of all

varicose veins

patients will show no overt signs of the condition until they cause a complication, as the troublesome veins remain hidden deeper under the skin. This leads to a lot of people ignoring them and accepting them, until a day that they reach an advanced stage and wake up the sufferer to a complication.

Common symptoms of varicose

veins are aching, discomfort and heaviness of the legs, which are usually worse at the end of the day. Sometimes the ankle can swell, too. Occasionally, high pressure in the veins causes damage to the skin around the ankle, leading to discoloration, rash (eczema) and in advanced cases, ulceration. Although diagnosis is straightforward, a test called Venous Colour Doppler is done for a detailed study regarding where the veins have come from, and helps in planning the line of treatment.

Compression stockings, worn regularly, are effective in controlling symptoms and preventing skin complications. When sleeping,it is beneficial to keep the legs elevated (about 9” above the ground) as this helps in emptying of the veins. Active treatment for varicose veins may not always be medically necessary especially in the earlier stages. However, a lot of patients, especially females, opt for treatment due to cosmetic reasons. Most of the older methods of treatment have a lot of side effects and high recurrence rates. This has led to the growing popularity of Endo-Venous Laser Ablation (EVLA), a highly advanced laser treatment which can be done with optimal precision with the aid of an ultrasound. The treatment takes approximately 30-45 minutes and is associated with minimal discomfort. One can return to his/her daily activities on the next day of the treatment.

Leonardo laser used for EVLA

was first introduced at

Healing Hands Clinic, Pune.


Constipation treatment

A good day obviously begins with a good morning which in turn relies a lot on our morning chores. Topping that list is a light tummy and how we wish it could be as easy as brushing teeth. Alas! It’s not the case with a lot of us, for whom every morning brings with it that big question – Will it be a smooth transit today? CONSTIPATION is becoming an increasingly growing menace in our lives, but in most cases, we have ourselves to blame. Faulty dietary habits, sedentary lifestyle, lack of exercise and stress are few common reasons to blame. However, wouldn’t it be wise to stop complaining at some point and take charge of our own health. That’s exactly what we want to encourage you to do.

Food habits/diet tips/home remedies for constipation

1) Water is an important constituent of the stools. Insufficient intake can lead to hardening of stools and delay the transit time. Drink at least 8 to 10 glasses (2.5 to 3 liters) of water per day. It is especially beneficial to have 1-2 glasses of warm water soon after waking up as it helps in initiating peristalsis.

2) Include 5 to 6 servings of fruits and vegetables in the diet daily as they are an excellent source of fiber. Fiber, soluble as well as insoluble, is responsible for the bulk and binding of the stools. Whole fruit (not juiced) and raw vegetables in the form of salads are better. One should ensure sufficient water intake along with fiber intake on a daily basis to prevent constipation. Beans are also an excellent source of fiber.

3) Replace refined carbohydrates with whole grain cereals. Examples of refined carbohydrates are sugar, refined wheat flour and their products. Excess of these, disturbs the osmotic balance in the digestive system. Some good examples of whole grain cereals are oats, brown rice, whole wheat, etc. which contain fiber as well as B complex vitamins.

4) Probiotics are foods containing beneficial bacteria which are naturally present in the intestines. They help maintain a healthy gut environment. Consuming probiotic foods such as fresh curd/yogurt and buttermilk daily can help boost gut immunity and health and thus reduce risk of digestive disorders.

5) Go natural! Avoid processed, preserved, packaged food items as far as possible. Freshly prepared, home-made food items are the safest and most nutritious to consume. The traditional Indian diet (when cooked in minimal oil) is well balanced.

6) Super foods are foods which are especially beneficial for health and well-being. These foods contain unique substances which may have protective effect against various diseases. Some of the super foods for the digestive system are flax seeds, chia seeds, turmeric and cow’s ghee.These simple changes when combined with moderate exercise can help in common constipation. However, if constipation does not improve with these measures (lasts more than 6weeks) , it’s best to take an expert’s opinion. Conditions like Obstructed Defecation Syndrome can cause Chronic Constipation and need a Proctologist’s attention.

Potty Training : A Parenting Tool to Help Avoid Pediatric Constipation

During the growth period, a child has several milestones to meet. The child becomes increasingly capable and independent, given the right kind of environment and stimulus. Saying goodbye to diapers and nappies is one of the crucial milestones. Alas! It can be one of the most difficult tasks for the child as well as the parents.

It is essential for parents to pay proper attention to toilet training of their child as ignorance in this matter can lead to constipation. The worldwide prevalence of childhood constipation due to different causes in the general population ranges from 0.7% to 29.6%. In constipation a child may have fewer than 2 bowel movements a week or bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass.

Usually between 1 ½ to 2 years of age, children show readiness to be potty trained. Some signs can help the parent to identify the ideal time to begin potty training of their child, e.g. when they start telling when they have soiled their nappy, when they show interest in others using the toilet, when they keep their nappies dry for longer period owing to increased bowel and bladder control, etc.

Out dated and harsh methods could make toilet training a stressful experience for the child and he/she may try to hide. Children who hide are more likely to have stool toileting refusal, constipation, stool withholding, and later completion of training. Stool withholding involves the child doing physical maneuvers in an attempt to avoid defecation. The parents must be gentle, patient and understanding towards the child. The child may not know how to sit properly on the toilet. The “squatty potty” position should be taught to allow ease in passing stools.

Children tend to suppress the urge to pass stools or urine when they are focused in play or activity. They may forget to pay a visit to the toilet. Doing this frequently can also lead to hard stools. Hence, it is important to teach the child to visit the toilet whenever there is an urge. When the child is put into the habit of going to the toilet every morning and/or evening, their body clock gets set accordingly and they develop good toilet habits.

potty training

Small children may find it difficult to explain their discomfort. Painful defecation is the primary precipitant of constipation during early childhood. Parents need to be vigilant so that there can be quick intervention and the risk that their child will develop persistent constipation or fecal soiling can be reduced.

A nutritionally balanced, fiber rich diet and sufficient water intake can go a long way in avoiding constipation.

In order to get effective treatment for their child, the parents should seek the help of a Proctologist/Colorectal surgeon rather than a pediatrician in case of constipation and related complications.

Fistula-in- ano

Anal fistula or fistula-in- ano is an abnormal hollow tract or cavity between primary opening inside the anal canal to a secondary opening in the perianal skin; secondary tracts may be multiple and can extend from the same primary opening. Different types of anal fistulas are classified by their location. In order of most common to least common, the various types include:

Inter-sphincteric fistula : The tract begins in the space between the internal and external sphincter muscles and opens very close to the anal opening. It is a tract between two anal sphincters.

Anatomy of rectum anal canal

Transphincteric fistula : The tract begins in the space between the internal and external sphincter muscles or in the space behind the anus. It then crosses the external sphincter and opens an inch or two outside the anal opening. These can wrap around the body in a U shape, with external openings on both sides of the anus. It is also called as horseshoe fistula.

Fistula type 2

Suprasphincteric fistula : The tract begins in the space between the internal and external sphincter muscles and turns upward to a point above the puborectal muscle, crosses this muscle, then extends downward between the puborectal and levator ani muscle and opens an inch or two outside the anus

Fistula type 3

Extrasphincteric fistula : The tract begins at the rectum and extends downward, passes through the levator ani muscle and opens around the anus. These fistulas are usually caused by an appendiceal abscess, diverticular abscess or Crohn’s disease.

Fistula type 4

Cause of Fistula in ano – The most common cause of fistula is an anal abscess, though there are several other possible causes which may lead to fistula in ano which can be stated as follows:

1.Anal Abscess : An abscess is a collection of pus in an area of the body. An anal abscess develops when a small anal gland becomes infected with bacteria. It can be very painful and is one of the utmost reason which causes fistula. Approx 80% of cases having fistula are caused by abscess

2.Intestinal Inflammation : Intestinal inflammation which causes due Crohn’s disease which is a type of inflammatory bowel disease and Diverticulitis which is a condition which leads to inflammation of the small out pouching or diverticulitis which forms a number of tiny pockets from the side of the colon.

3.Malignancy in the an rectal area can lead to fistula in anal area.

4.Infections – Infection like Human Immunodeficiency Virus(HIV), Acquired Immunodeficiency Syndrome(AIDS),Tuberculosis etc are infections which leads to fistula

4.Iatrogenic – As a complication of a previous surgery in the region.
Symptoms of Fistula in Ano

Possible symptoms include:

1. Constant pain and discomfort which is throbbing and worsens when sitting down.

2. Skin irritation around the anus which includes swelling and tenderness.

3. Pus discharge

4. Constipation

5. Fever


Diagnosis of Fistula in Ano:

1. A brief history and required information is taken which is then followed by a clinical examination along with a digital rectal examination which is enough to diagnose an anal fistula

2. Proctoscopy – A small inspection of the rectum is done with a small tube like scope called as proctocopy to check for any concomitant condition in rectum area.

In certain conditions doctors may also take help of MRI Fistulogram if the fistula tract is difficult to diagnose.

Treatment for Fistula in ano (Anal Fistula)

There are two approaches to treatment of Anal Fistula viz. Traditional technique and Modern technique.

A)Traditional Technique include :

1. Fistulectomy : This process involves cutting open the whole length of the fistula in so that the surgeon can flush out all the content in the fistula. The fistula tract is removed and the groove which is formed is left behind to heal. This procedure comes with a risk of damaging the sphincter muscle which results in fecal incontinence and is usually used for treatment of complex anal fistula.

2. Ksharsutra : This technique has an Ayurvedic approach in which a thread of a special kind which is coated with ayurvedic medications is inserted into a fistula tract. This kind of treatment has no cuts and stitches but also needs to be done in multiple weekly sessions that is completed over a few months

B) Modern Technique include :

1. Video Assisted Anal Fistula Treatment : Also known as VAAFT is a technique used for a surgical treatment of complex fistula and is preformed with the help of a fistuloscope

2. Ligation of Intersphincteric Fistula tract : Also known as LIFT is a technique used to treat a complex or deep anal fistula. A seton is firstly placed in the tract which forces it to widen over a period of time. A few weeks later, the surgeon doctor removes the infected tissue and closes the internal fistula opening.

3. Fistula plug : A fistula plug is a plug that is 100% synthetic bio-absorbable scaffold. The fistula plug is placed in the fistula tract. Over a period of time the cells from the body migrate into the scaffold and new tissues are generated as the body absorbs the plug material which leaves no permanent material in the body.

4. Fistula-tract laser closure – Also known as Filac is done using Leonardo laser which was first introduced in India by Dr Ashwin Porwal at Healing Hands Clinic. This procedure helps in gently removing the fistula tract without damaging the sphincter muscle.

5. Distal Ligation Proximal laser – Known as DLPL aims not only at treating fistula but also to save the sphincter muscle which helps to prevent incontinence and to prevent recurrence, considering the nature of the fistula.In this treatment of fistula, firstly abscess cavity with internal opening is excised and then closing of distal tract is done. The proximal area of fistula tract is then sealed with the help of Leonardo laser which helps in complete closure of tract.

For more information on anal fistula you can click on the following link :

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