A fistula in ano is an abnormal tract or tunnel communicating from the anus or rectum to the external skin surrounding the anus.
Anal fistula is generally caused by the infection of anal glands (which are situated around the anal wall in between sphincter muscles). Infection of the anal gland results in pus formation deep inside the skin around the anus and it collects in that space. It then swells up and bursts to the skin.
While the condition is painful and causes a lot of discomfort, it is generally not life threatening. Also, it is not cancer.
Anal fistula can lead to complications if the patient is undergoing treatment using an immuno suppressant, or has uncontrolled diabetes, or has a low nutritional status, etc.
Possible complications include:
The infection can spread to a larger area.
More pus collection may cause an fever.
Sometimes the patient can go into a septic shock.
The fistula may branch out to multiple fistulae.
The fistula can open into the rectum.
A person suffering from fistula will initially have an abscess that bursts open in the area surrounding the anus or buttocks. It will fail to heal and the boil will persist. Pus-mixed-watery-fluid or sometime blood oozes out of the opening. It will never close, instead it becomes dry sometimes and later again it starts oozing. These are the tell-tale symptoms of a fistula.
Yes, it is mentioned in the Ayurveda text, ‘Sushruta Samhita’ authored in 500 BC. Fistula is referred to as ‘Bhagandara’ in Sushruta Samhita.
Sushruta said it is a boil in perineum region, having continuous ooze and connecting to inside (anus).
In Sushruta Samhita the treatment mentioned are different types the excisions and Ksharasutra treatment.
Ksharasutra is a treatment for anal fistula mentioned in Ayurveda texts. It is a thread which is coated with Ayurveda medicine called ‘kshara’.
It is an alkali prepared out of various plants.
‘Guggulu’ based ‘Apamarga’ (plant) Ksharasutra is generally used. A thread is coated with kshara and Guggulu (Tree origin) and turmeric 21 times. So that thread holds medicament in its surroundings.
Ayurveda surgeons who are qualified as M.S. Shalyatatra (Master of surgery in Ayurveda, Institutionally qualified) use this method to treat anal fistula and pilonidal sinus.
The medicated thread (Ksharasutra) is placed into the anal fistula using malleable metal probe from external opening (skin) to internal opening (within anal canal). This is done under appropriate anesthesia. Gradually medication will dissolve in the tract and scoops or scrapes unhealthy tissue surrounding it. It enhances healing from inside to outward direction.
Ksharasutra, when performed by qualified professionals with great experience of handling of different complex anal fistula and close monitoring, appropriate wound care has a high success rate in the treatment of anal fistula.
No. Ksharasutra is good for crypto glandular fistula of anus. It is not used for any other fistula.
When a patient having fistula has Crohn’s, Ksharasutra can be used to treat the fistula when Crohn’s is in control (remission). However the fistula can reoccur in a different place or at same place. Also, in case of patients with Crohn’s, the Ksharasutra treatment may fail sometimes.
It is generally not recommended. Ideally after colostomy and ileostomy reversal, Ksharasutra may be attempted.
No. In case of anal fistula secondary to tuberculosis, Ksharasutra is generally not required. Anti-tubercular treatment for specific period cures anal fistula also.
Tubercular fistula is diagnosed by the treating surgeon by performing some tests.
Under anesthesia,the primary threading is done and the patient might have to stay in the hospital 4 hours to 24 hours depending on the type of anesthesia administered.
Lay open of anal fistula is fistulotomy.
Laying opening of part of fistula where there is no muscle is “Partial Fistulotomy” and applying seton to the muscle bundle is “Primary Threading”.
As the fat part of buttock is laid open it helps for adequate drainage of pus or collection. It also reduces the duration of treatment.
Yes. Ksharasutra cuts the sphincter muscle. Radiologically or sonography-wise it shows a loss of sphincter. Clinically and functionally there is no loss of anal function. Chance of incontinence is very less if done judiciously.
It cuts tissues gradually and heals simultaneously, therefore the scar tissue forms simultaneously. Part of the anal ring is replaced by fibrous ring at the end of Ksharasutra.
One week of rest is generally required but there is no need of bed rest. Patient can do normal household work, can sit, walk, etc.
It is generally long term treatment because of the gradual cutting and gradual healing process. On an average, it takes approximately 3 months for complete healing. The duration depends on the complexity of the fistula, from one technique to another.
The patient needs to place a cotton or gauze pad in the area and it to be changed once in 12 hours or more frequently depending on discharge. Also, if the patient is advised sitz bath, no sitz-bath should be done for 24 hours after a thread change. It is generally required to do the sitz bath for not more than 10 minutes at once.
In case of a simple fistula it is safe. The patient needs to consult with a qualified professional to determine feasibility and to understand any risks involved.
Yes, it can be changed as there are no such contraindications.
Yes, there are no contraindications.
After fistula treatment, especially in case of anterior fistula, vaginal delivery is not recommended.
The patient can have normal food. However, it is recommended to avoid spicy food, curry items, dishes that include chili and non-vegetarian dishes.
After one week,the patient can do yoga/exercise/walking/jogging/vehicle riding/swimming/gym and any other physical activity if there is no noticeable pain. However, it may vary in certain conditions and it is recommended to check with the doctor before taking up any activity.
During the course of the treatment, if the surgeon feels that the drainage is not adequate or that the original tract is not covered by thread completely or if residual tract was missed initially, then the procedures may be repeated.
It can happen at anytime of life, no specific duration.
Ksharasutra is generally not very painful. It depends on the technique adopted by surgeon. It varies between surgeons and between techniques. Changing of Ksharasutra is painful; however, it is temporary and lasts for about 5 minutes.
Uncontrolled diabetes, auto immune diseases, Crohn’s disease, usage of steroids, etc., can adversely affect the Ksharasutra treatment.
Sometimes painkillers may be required and need to be used judiciously. Long term consumption of painkillers is discouraged as it can be harmful to the body.
It takes maximum of 5 minutes to change Ksharasutra. It is an OPD procedure. No preparation is required from patient side. Patient should not be on empty stomach.
There is no need to worry if the thread slips off or is torn. The surgeon can re-insert a new thread in a few minutes.It is a simple procedure.
Discharge of pus/pus-mixed-blood/blood/serous/watery-fluid is normal throughout the treatment.
Yes
Peri-anus skin allergy due to discharge.
Lower back or thigh pain, muscle catch,due to altered walking posture, stiffness of body due to fear and anxiety.
Sometimes skin boils in buttocks due to hair roots infection.
Itching surrounding the anus.
Loose stools due to medications.
Passing of gas or stool particles from wound or external opening.
Ayurveda drugs to reduce infection, to prevent irritation and inflammation, for easy evacuation of stool, to improve digestion and liver function.
Yes, all are herbal or plant based.
Generally there are no such restrictions during treatment. After the completion of treatment,the patient can resume all normal work starting from the next day.
It can be normal and does not have any interference on outcome of treatment.
Yes, the patient can come alone and drive vehicle or ride a two wheeler. However, it is advised to rest by sitting comfortably on a chair for 15 minutes after changing the thread. Also, drinking water and having food before thread change is recommended.
There are no complications of a thread change.However, patients with a low threshold for pain may feel dizzy and need to rest for about 15 minutes in order to recover.
The fistulotomy wound heals in approximately 2 weeks after surgery. The patient can then travel to any place. However, for changing of Ksharasutra, the patient will need to come in on a weekly basis.
It is not compulsory to visit exactly on 7th day. It can be plus or minus one or two days.
The patient can come after 2 weeks also, no further complications expected. Duration of treatment may prolong those many days. Generally duration of treatment is estimated and conveyed to patient on the basis of weekly visits.
Nothing happens. The treatment can continue once the patient is back and ready for further treatment using Ksharasutra. The thread will remain in place till such time.
There will be discharge of serous fluid. It is normal.
Passing of gas or little quantity of stool without control is normal (in very few cases, unusual, depends on type of fistula). It will be gradually reduce and the patient will be comfortable.
There may be itching around anus for few days.
Hard feeling on scar.
Mild discomfort or pain on scar due to hardness of the tissue
