Dr. Jeevagan

An anal fistula, is also called as fistula- in -ano, it is a small channel that develops between the end of the large intestine called the anal canal and the skin near the anus. This is a painful condition, especially when the patient is passing stools. It can also cause bleeding and discharge during defecation.

Genesis of fistula-in-ano
Almost all anal fistulae occur due to an anorectal abscess that begins as an infection in one of the anal glands. This infection spreads down to the skin around the anus causing fistula-in -ano. The anorectal abscess usually leads to pain and swelling around the anus, along with fever. Treatment for anorectal abscess involves incising the skin over the abscess to drain the pus. This is done usually under local anesthesia. A fistula-in-ano happens when there is failure of the anorectal abscess wound to heal completely. Almost 50% of patients with an abscess go on to develop a chronic fistula-in-ano.

Symptoms

1. Pain- Constant pain which gets worse when sitting down
2. Irritation around the anus, like swelling, redness and tenderness
3. Discharge of blood or pus
4. Constipation or pain while evacuation
5. Fever

Diagnosis
A clinical evaluation, including a digital rectal examination under anesthesia, is carried out to diagnose anal fistula. However, few patients may be advised screening for rectal cancer, sexually transmitted diseases and diverticular disease.

Treatment
The only cure for an anal fistula is surgery. The type of surgery will depend on the position of the anal fistula. Most patients are treated by simply laying open the fistula tract to flush out pus, called Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months.

1. Seton techniques: A seton is a piece of thread (silk, plastic) which is left in the fistula tract to treat anal fissures. This is used if a patient is at high risk of developing incontinence after fistulotomy.
2. Advancement flap procedures: When the fistula is considered complex, carrying a high risk of incontinence, then this advanced technique is used.

Other techniques like Fibrin glue and Bioprosthetic plug are also used to surgically treat anal fistulas. In the Fibrin glue technique, glue is injected into the fistula to seal the tract, after which the opening is stitch closed. Bioprosthetic plug is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. After this stitches are used to keep the plug in place. 

Whatever the surgical technique, one can experience minor changes in continence. Patients usually don’t require antibiotics after surgery but have to take pain medication. They may also have to use gauze to soak up drainage from anus. After surgery, patients should seek help if they have increased pain or swelling, heavy bleeding, difficulty in urination, high temperature, nausea or constipation.

In case you have a concern or query you can always consult an expert & get answers to your questions!

When you are pregnant, what you eat and drink affects not only you but your baby as well. An old wives tale suggests eating for two at this time. However, simply eating double your normal amount of food will not help. Instead, this will make you put on extra weight. Instead, you should focus on eating more nutritious food. Here are a few diet tips for you and the minerals your body needs most at this time.

Iron
Pregnant women need twice as much iron as compared to women who are not expecting. This amounts to 27grams a day. An iron deficiency will result in anemia, fatigue and make you more susceptible to infections. Iron is also necessary to supply the baby with oxygen. Iron-fortified cereals, peas, dried beans, poultry, meat, and fish are rich sources of iron. For better absorption, it is also advisable to consume vitamin C alongside the iron. The easiest way to do this is by drinking a glass of orange juice along with your meals.

Folic Acid
This is also known as folate. It is crucial to prevent birth defects in the baby’s spine and brain. Some foods that are rich in this mineral include enriched cereals, pasta, and bread. However, it may be difficult to consume the required amount of folic acid through food alone. The ideal amount of folic acid a pregnant woman should consume is around 600 micrograms a day. Hence, folic acid supplements are usually prescribed to pregnant women and should be taken regularly.

Calcium
Calcium helps build bones and teeth. If you do not consume enough calcium when pregnant, the body will start to use the calcium stored in your bones to build the baby’s bones. A pregnant woman needs over 1000 milligrams of calcium per day. Consuming milk, yogurt, calcium-fortified juices, cheeses, salmon, sardines and leafy vegetables like bok choy and kale can help your body get the required amount of calcium.

Proteins
Proteins are essential to build the muscles and organs of a baby’s body. Fish, poultry, eggs, nuts, tofu, peas and dried beans are rich sources of protein. When eating protein-rich foods it is essential to drink plenty of water to aid in its digestion.

To maximize nutrition, you must focus on fruits, vegetables, whole grains, dairy and lean proteins. You could also supplement this with prenatal vitamins. Caffeine should be limited to 200mg a day. Other foods such as unpasteurized foods like raw milk, certain types of cheese and store-bought deli salads, raw meat, raw eggs, fish with high levels of mercury such as swordfish and king mackerel should be avoided completely. In case you have a concern or query you can always consult an expert & get answers to your questions!