Fistula is a Latin word which means ‘Reed’ or ‘Pipe’. In Medical use the term pertains to ‘Tract’ or ‘Tube’. It is usually inflammatory in origin and either end. In surgery, it implies a chronic granulation track communicating two epithelial lined surfaces. These Surface may be cutaneous or mucosa. Bailey & Love (1980) has stated that Fistula-in-ano is a tract lined by granulation tissue which opens deeply in the anal canal or rectum and superficially on the skin around the anus.
It is divided into two types-
Non Specific- Caused by Crypto Glandular Infection & Previous Anal Abscess.
Specific- A small number of fistulas may less frequently be caused by other processes such as Tuberculosis, Crohn’s disease, foreign, Ulcerative Colitis, Anal Fissure, Carcinoma, body sexually transmitted diseases, Pelvic inflammation, Radiation, Trauma, or diverticulitis.
The following may be symptoms or signs of an anal fistula,
- Recurrent anal abscesses.
- Pain and swelling around the anus.
- Pain with bowel movements.
- Bloody or foul-smelling drainage (pus) from an opening around the anus. The pain may decrease after the fistula drains.
- Irritation of the skin around the anus due to persistent drainage.
- Fever, chills, and a general feeling of fatigue. (However, these may be symptoms of many conditions.)
You should see your physician if you notice any of these symptoms.
Diagnosis is by examination, either in an outpatient setting or under anesthesia. The examination can be an Anoscopy.
- The opening of the fistula onto the skin may be seen
- The area may be painful on examination
- There may be redness
- A discharge may be seen
- It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the fistula.
Ayurvedic View: (Ksharsutra Therapy)
Kshara Sutra is utilized in the treatment of fistula in Ayurveda.
KsharaSutra is a seton thread medicated with organic alkalis,such as Apamargakshara (Achyranthesaspera), Arkakshara (Caltropisgigantea) or Snuhikshara (Euphorbia lingularia). The alkali is repeatedly coated on the seton thread 15 – 21 times. Apart from this, natural antibiotic like haridra powder, guggulu, etc are also used to make Ksharasutra. The mechanical action of the threads and the chemical action of the drugs coated , collectively do the work of cutting, curetting, draining, and cleaning the fistulous track, thus promoting healing of the track/ wound. This also acts both as the antiseptic and fibrotic agent to induce healing. The process of healing starts from deeper tissues and moves towards the periphery. This can be applied and changed periodically till the thread cuts the fistulous tract. Since the sphincter heals by fibrosis, there is no incontinence.
Under local anesthesia, the ksharsutra is inserted into the tract and the two ends of the thread are tied forming a loop. The alkalis coated on the thread are continuously released throughout the length of the track there by cutting, curetting, draining cleansing and healing the track. This therapeutic action of the thread lasts for seven days. The old thread is then replaced with a new thread following the same procedure. Depending on the length of the tract and the extent of damage, the ksharsutra may be changed up to 5 times. The changing of the thread is a simple procedure taking about 1 to 2 minutes and requires no anesthesia.