The disease can mean pain as much as shame. This is especially so when it comes to anorectal diseases. Remedies are available in Allopathy but these are expensive and do not guarantee non-recurrence.

Piles free for five rupees….read the headline in a Malayalam daily recently. This claim was made not by an Allopath but by an Ayurveda practitioner in the Ksharasootra clinic of the Government Ayurveda Hospital in Chelakkara in Thrissur district.

The clinic and its head Dr Shahana A. K. have been attracting patients from different parts of the state and even from outside for treatment of anorectal diseases like fistula, hemorrhoids, anal fissures, and rectal prolapse. She treats them with an ancient method of ksharasootra which involves insertion of a medicated thread through the affected area or fistula.

The practice called Ksharasootra takes very little time and the patient need not even be admitted. The thread is replaced by fresh ones a few times till the patient is healed. It is simple, non-invasive, with no side effects, cost-effective, and leads to no recurrence of the problem unlike in surgery.

Dr Shahana doing a surgical procedure in her clinic

Sushruta is considered the "Father of Plastic Surgery" and lived in India sometime between 1000 and 800 BC. He is the author of the treatise The Suśrutasaṃhitā which includes unique chapters describing surgical training, instruments, and procedures in ancient India. One of the oldest Sushrutasamhita palm-leaf manuscripts is preserved at the Kaiser Library of Nepal.

Dr Shahana has been practicing this ancient Ayurvedic para-surgical process in the government clinic for the past few decades and her name has come to be attached to Ksharasootra. The success stories have been traveling through the state by sheer word of mouth, says the doctor. No one has tried to publicize it. People come here after hearing about it from people who have healed, she says.

Speaking of the recent item in a newspaper, she said: I want more people to know of the treatment so that they don’t fall victim to quacks, who spoil their cases forever and charge them huge sums.

 After her BAMS (Bachelor of Ayurvedic Medicine and Surgery) she went on to do her master's in surgery or Shalya tantra which had just three seats in the state colleges then.  In Ayurveda surgery has many para-surgical procedures including Ksharasootra, rakthamoksham, ksharakarmamand so on.

Ksharasootra though devised by the father of Ayurveda Susruta centuries ago, the procedure has evolved over the years, she points out to this scribe.

As for why she opted for Ksharasootra, she says, "I wanted to use my education to help the maximum number of people."

The world of anorectal diseases is a dark, quiet, and obscure one where patients suffer silently in fear and shame to disclose their suffering as it concerns their private parts. If the patients are women, then it is even more shameful to discuss this with doctors.

Chelakkara Gram Panchayat Government Ayurveda Hospital in Thrissur

Patients do get treatment in Allopathy and go through multiple surgeries as the piles or fissures recur. So they are drained of money by the time they turn to Ayurveda with a recurrent condition, she says.

"When I started working quacks ruled the roost, as they promoted themselves as experts in this ancient method and offered treatment for piles, fissures, and fistula without surgery. Patients still fall for their hype and lose a lot of money and their health,” she says.

The treatment for diseases like piles, fistula, or fissures is free in her clinic, while other government Ayurveda hospitals in Kerala charge a token fee. In private Ayurveda clinics, it can cost a lot.

The main advantage she says it does not cause incontinence. Since it is a treatment in the anal region, patients often lose control over their bowel movements after surgery in Allopathy.

The profile of patients suffering anorectal disorders has been changing dramatically she says. “Earlier there were mostly middle-aged people. Today there is no age difference. They come from every age group including youth and children. Poor toilet habits, stress, junk food, and lack of physical activity all lead to anorectal diseases in children even below the age of ten,” she says.

Dr. Shahana spreading awareness about rectal disease

These diseases are also occurring in pregnant women mainly because of the traditional food supplements they take for a healthy child. These days, women don’t have the digestive capacity and are still given meat supplements. So women who are already suffering from constipation get even worse and develop anorectal complications and come here,” she says.

Patients cut across caste and community and ironically every religious festival leads to a spike in the number of patients in her clinic.

Onam, Easter, Christmas, and Eid all cause a spurt in cases and aggravate of old cases. During the fasting month of Ramzan, patients suffer a lot as they eat very spicy and oily food to break a day’s fast. It aggravates these disorders, she says. In some festivals drinking of alcohol leads to a spike. 

Her clinic is gearing up to observe World Piles Day on November 20 with awareness camps and posters. “We are trying our best to reach out to more and more people so that they are saved from quacks, she says. Often people go for self-medication, to avoid medical examination of their private parts. Or they go to quacks to avoid surgery. They don’t realize that often rectal cancer and piles show the same symptoms which only a good doctor can detect,” she says.

A bust of Sage Sushrut

The Ksharasootra clinic run single-handedly by her for the past few decades is to be declared a centre of excellence by the Kerala Government. This would mean more doctors and more funds. ``Of course, I would have retired by then but the treatment facilities would improve,’’ she says.

Asked if there was a stigma attached to practicing Ksharasootra she agrees that the number of Ksharasootra practitioners is very few in the state. But she feels it is because very few seats are available for surgery or Shalyatantra. “Not everyone who does the course may get the opportunity or have the mental willingness to pursue this line. It’s not possible for everyone,” she adds quoting Susruta on the qualities required by a surgeon…   shauryamashukriyataishyam…. meaning courage, fast and unfearing while being insightful of the patient’s condition.…

"As for me, I feel it is an opportunity to do some good. People come to me after two or three allopathic surgeries. Just recently I had a patient who had been operated on for piles and fistula eight times. He was mentally and physically shattered and hopeless. I’m able to bring these people, many of whom are on the verge of suicide,  back to hope and normalcy, ‘’ she says.

She says her religion Islam or her gender does not discourage the work she is doing.

"Being a woman has been an advantage I feel as I can empathise with their suffering and approach patients with maternal affection and concern.  As a Muslim the work I do is considered equivalent to devotion. Islam considers all good deeds done with good intentions as ibadat or devotion. These are considered superior to prayers or reading of scriptures,’’ she says.

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Dr Shahana believes that if one has a job that allows doing good to the masses then one should do the maximum possible. “That is my policy. Often people ask me why I take so much trouble to reach out to these patients. I feel that for anyone like doctors or politicians who are in a position to do work for the wellbeing of the public and do not do it, then it is not appropriate for them to be in that position.”

The author is a former social-editor of Business Standard and is teaching in a alternative school in Andhra Pradesh