In this disease usually one will not have any problem in the anus. Patient will have small pimple like swelling, pus/blood/watery type discharge from an opening, near anus region. This may or may not associate with pain. This type of swelling may occur repeatedly in same region. (However other disorders are also to be ruled out).
An anal fistula, almost always the result of a previous abscess, is a small tunnel connecting the anal gland from which the abscess arose to the skin of the buttocks outside the anus.
There are some glands surrounding the anal canal. It communicates with the anal canal with small ducts or channels. When infection spreads to this gland through these channels, glands get infects. This leads to collection of pus. Collected pus makes its own path to come out of the region. Therefore it may open anywhere near anus through skin. As it gets chronic or old there is less chance of healing, which makes a permanent path. This tract made by pus to come out of the body is called fistula. Once pus drained out, pain and other difficulties may reduce. However there will be persistence of the fistulous tract. Whenever pus again collects, pain, fever etc may start. Therefore this story continues in some patients for years.
Diagnosis is by examination, either in an outpatient setting or under anaesthesia. The examination can be an anoscopy. Possible findings:
It should be understand that mere oral medication definitely would not cure the disease. Therefore it should be treated by surgically. Surgery includes complete cutting of the tract with surrounding tissue. Fistula-in-ano disease is difficult to treat surgically because of severe pain, high rate of recurrence (is up to 30%) complex anatomy of the region, involvement of sphincters and severe complications like incontinence. Ksharasutra chikitsa in Bhagandara (mentioned in the SushrutaSamhita) has got advantages than surgery. Medicated (kshara) thread (sutra) passing through the tracts which cuts the tissues gradually simultaneous healing occur from opposite side therefore no loss of tissues or sphincter damage.
Initially an ordinary thread is inserted in to the tract with help of malleable probes, and to be taken out of the anus (with or without anesthesia). After a week it should be replaced by the ksharasutra. Kshara cuts the tract slowly (0.5mm/ week) and simultaneous healing also occurs.