Everything about Fistula-in-Ano


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Fistula means a tube with two openings. In context to Fistula-in-Ano; one opening of fistula (external opening) lies in skin around the anal opening while the 2nd one (internal opening) lies inside the anal passage.

Symptoms of Fistula-in-Ano:

Patient suffering from Fistula-in-Ano complaints of

  • Intermittent pus discharge with or without bleeding from the external opening with
  • Off and on pain; and
  • Swelling near anal opening.

Causes of Fistula-in-Ano:

Exact pathology of fistula-in-Ano is still unknown but is for sure that Fistula-in-ano is the resultant of infection in anal glands. There are certain conditions which make a person prone to Fistula-in-Ano like history of:

  • Fissure-in-Ano
  • Uncontrolled Diabetes mellitus
  • Ulcerative colitis
  • Crohn’s disease
  • Tuberculosis
  • Trauma etc.

Types of Fistula-in-Ano:

There are two sphincter muscles in our anal passage internal and external anal sphincter. According to the position of fistula tract relative to these muscles; fistula-in-Ano is divided as under:

  • Intersphincteric fistula.
  • Transphincteric fistula.
  • Suprasphincteric fistula.
  • Extrasphincteric fistula.

How to diagnose Fistula-in-Ano?

Fistula-in-Ano is suspected when someone gives history of intermittent discharge from or around anal opening with off and on swelling. In fact; swelling disappears when accumulated pus discharges to come again when pus accumulates. Patient gives history of swelling — pus discharge —swelling—- pus discharge…. and so on.  On examination, an ano rectal specialist can visualize external opening in area around anal opening. An Anorectal specialist; will confirm the diagnosis after defining the tract by probing with malleable metallic probe. In very few cases; he may also advise for MRI Fistulogram.

Treatment for Fistula-in-Ano:

First thing it is for sure that Fistula-in-Ano can not be cured by medicines only – Homeopathic/ Allopathic or Ayurvedic…… what ever it may be. Different treatments have been tried to treat Fistula-in-Ano with variable success rates. Among these main treatment options are:

  • Seton:
  • Fistulotomy & lay open technique:
  • Fistulectomy with primary sphincter reconstruction:
  • Fibrin Sealant:
  • Fistula Plug:
  • Advancement flap:
  • Ligation of Intersphincteric Fistula Tract (LIFT):
  • Video Assisted Anal Fistula Treatment (VAAFT):
  • Fistula Laser Closure (FiLaC):

Recurrence of Fistula-in-Ano after treatment and varying degree of incontinence are the complications frequently faced in above said treatments. But there is ayurvedic treatment which assures complete treatment without any complication viz Ksharsutra Treatment. Ksharsutra treatment is explained in detail in Ayurvedic text books like Sushruta Samhita etc. more than 2000 years back and still relevant in treating Fistula-in-Ano.

  • Ksharsutra Treatment for Fistula-in-Ano:

This treatment involves defining the fistula tract by probing with a malleable probe or MRI Fistulogram. After defining the fistula tract precisely; Ksharsutra specialist ligates the medicated thread i.e. Ksharsutra in the tract which is replaced by a new one at a week or 10 days intervals until fistula heals completely. Usually, no hospitalization or bed rest is required in this treatment and in most cases; patient can continue his normal routine activities from the vary first day of treatment. Complications like recurrence of Fistula-in-Ano after treatment and incontinence are usually not seen in Ksharsutra treatment for Fistula-in-Ano.

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