Diseases

Fistula is defined to be an abnormal connection between two epithelialized surfaces such as blood vessels, intestines etc. Fistula in ano or Anal Fistula is a chronic clinical condition in which an abnormal pathway is formed between the epithelialized surface of anal canal and the perianal skin.

Cause

Fistula may cause due to an infection or inflammation, or after complication of an injury or a surgery. Fistula in ano occurs in people who have a history of anal abscess.  It also shows a hereditary predisposition.

Pathophysology

Anal glands which are located in between internal and external sphincters become blocked due to some infection or inflammation, they become abscess which mostly untreated or neglected and result in fistula. This also happens even if the abscess is treated improperly and abscess reccur which mightn’t have an opening that will accumulate pus in between the routes of sphincters and can form a tunnel like pathway which finally opens either both ends or at an end. Usually these fistula forms a connecting tunnel as such between the surface of perianal area and the anal canal.

Types

There are generally five types of anal fistula namely; Extrasphincteric fistulae ( begins from rectum or sigmoid colon to perianal area passing through Levator ani muscle), Suprasphincteric fistulae (begin between external and internal sphincters to the perianal area passing through in between Levator ani and Puborectalis muscles), Transphincteric fistulae ( begin between external and internal sphincter behind the anus passing through external sphincter giving it a U-shaped tunnel and open up in perianal area), Intersphincteric fistulae ( begin in between the sphincters passing through internal sphincter and open nearby anus) and Submucosal fistulae(which passes superficially beneath the submucosa and do not cross any sphincters).

Signs & Symptoms

Fistula forms externally a skin maceration which secretes pus, serous fluid or rarely faeces discharge. Sometimes the discharge may be bloody or purulent. Itching may be caused due to pruritis ani. Severe purulent and bloody fistula produces pain, swelling, tenderness, fever or unpleasant smell.

Ayurveda Treatment for Fistula

In Ayurveda, Fistula is considered as caused by digestive impairment. Hence the first protocol is to enhance digestion. Internal ayurvedic medicines will be started as soon as soon possible along with external Avagahana Treament to pacify the soreness of perianal area.

 After analaysed by the Ayurveda doctor, either Panchakarma Treatment or Ksarasutra Treatment or both will be given. Panchakarma will pacify the inflammation spread over the area and enhance the blood circulation. Ksharasutra therapy even though painful, complete management is assured and it doesn’t reccur in future.

Prevention has an important role in person with family history. The main factor for prevention is dietary regulations. The diet regime is advised to the patients after discharge to prevent the reccurrence.