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Anal Fissure Tips

What Is Fistula? What Causes It?

Dr. Vivekanand Rai Rai 90% (10 ratings)
MS - General Surgery, MBBS
General Surgeon, Varanasi
What Is Fistula? What Causes It?

A fistula is an abnormal connection between two hollow spaces (epithelial surfaces), such as blood vessels, intestines, or other hollow organs. Fistulas are usually caused by injuries or surgeries resulting in infection or inflammation. Also sometimes fistulae are created for therapeutic purpose.

Types of fistulas include:

  1. Blind - with only one open end. Also known as sinus tracts
  2. Complete - with both external and internal openings
  3. Incomplete - a fistula with an external skin opening, which does not connect to any internal organ

Location:

  1. Eye, adnexa, ear, and mastoid process: Lacrimal fistula, carotid cavernous fistula, mastoid fistula, craniosinus fistula, labyrinthine fistula, perilymph fistula, and preauricular fistula
  2. Circulatory system: Coronary arteriovenous fistula, arteriovenous fistula of pulmonary vessels, pulmonary arteriovenous fistula, cerebral arteriovenous fistula, arteriovenous fistula, and fistula of artery
  3. Respiratory system: Pyothorax with fistula and tracheoesophageal fistula
  4. Digestive system: Duodeno biliary fistula, salivary gland fistula, fistula of stomach and duodenum,  gastrocolic fistula, gastrojejunocolic fistula, enterocutaneous fistula, gastric fistula, fistula of appendix, anal and rectal fissures and fistulas, anal fistula, anorectal fistula, fistula of intestine, enteroentral fistula, fistula of gallbladder, biliary fistula, and pancreatic fistula
  5. Musculoskeletal system and connective tissue: Fistula of joint
  6. Urogenital system: Vesicointestinal fistula, urethral fistula, vesicovaginal fistula, cervical fistula, enterovaginal fistula, and rectovaginal
  7. Congenital malformations, deformations and chromosomal abnormalities: Congenital preauricular fistula, Portal vein-hepatic artery fistula, congenital fistula of lip, Congenital fistula of salivary gland, congenital absence, atresia and stenosis of the rectum with fistula, congenital fistula of rectum and anus, congenital fistulae between uterus and digestive tract, and congenital rectovaginal fistula

Causes:

  1. Inflammatory bowel disease causes of anorectal, enteroenteral, and enterocutaneous fistulas.
  2. Complications from gallbladder surgery can lead to biliary fistula.
  3. Radiation therapy, obstructed labor can lead to vesicovaginal and rectovaginal fistulas. Also, vesicovaginal and rectovaginal fistulas may also be caused by rape with foreign objects.
  4. Obstetric fistula develops when the blood supply to the tissues of the vagina, bladder (and/or rectum) is cut off during prolonged obstructed labor.
  5. Head trauma can lead to perilymph fistulas.
  6. Trauma to other parts of the body can cause arteriovenous fistulas.
  7. External causes include traumatic arteriovenous fistula and persistent postoperative fistula.

Physical examination: to determine the extent and pathway of the fistula

Treatment:

  1. Treatment for fistula depends on the cause and extent of the fistula.
  2. Surgery is often required to assure adequate drainage of the fistula. Surgical intervention combined with antibiotic therapy is usually required
  3. In some cases, fistula is temporarily covered e.g. cleft palate fistula is treated with a palatal obturator to delay the need for surgery to a more appropriate age.
  4. Surgical procedures commonly used are fistulotomy, placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining)
  5. Filling the fistula with fibrin glue

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

3222 people found this helpful

Piles & Fistula - How Kshar Sutra Therapy Can Help?

Dr. Nilesh Nigam 89% (49 ratings)
Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Lucknow
Piles & Fistula - How Kshar Sutra Therapy Can Help?

You would be surprised to know that half the population around the globe suffers from haemorrhoids, more commonly referred to as piles. What’s worse is, most of the sufferers do not want to acknowledge that they have this problem. Either they stay fearful of the surgery or do not want to face the social embarrassment of owning up to the fact or both. But before you steer clear of treatment, know that there is a natural way of curing all the anorectal disorders like fissure, fistula, pilonidal sinus and piles. The Kshar sutra therapy is one such Ayurvedic remedy that offers a comprehensive cure for these diseases through a minimally surgical process.

Kshar Sutra therapy is a standardized, sophisticated and modified version of an ancient treatment process that was described by ancient sages such as Vagbhata and Sushruta. Depending on the extent and severity of the disease, one may have to undergo several sessions of the Kshar Sutra therapy for desired results.

How are piles treated with the Kshar Sutra therapy?
First, the patient is anaesthetized to inhibit the sensation of pain. Then, the pile mass is taken out of the anal orifice with the help of forceps. Afterwards, the doctor makes an incision at the mucocutaneous junction and then it is transfixed with the help of kshar sutra at the base of the pile. This technique helps in local gangrene of the mass tissue of the haemorrhoids, and the mass sloughs off within a week or so. The entire affected area heals typically within two weeks.

How is fistula treated with the Kshar Sutra therapy?
In the treatment, the patient is first anaesthetized with local anaesthesia. After that, a malleable probe is inserted into the external opening of the pilonidal sinus to the surface of the skin. It helps in separating the debris to avoid chances of any infection. Kshar Sutra therapy for fistula helps in destroying and removing unhealthy tissues and promotes healing of the fistula affected track through caustic action. It can cut through the affected tissues without causing any pain and discomfort and lays the track open gradually.

The primary benefit of the Kshar Sutra therapy is that the chances of recurrence of the disease after the treatment are practically nil. On the other hand, in surgical procedures such as fistulotomy, the risks of recurrence and complications are very high. In all these instances, the Kshar Sutra therapy works as an excellent alternative. But to make the treatment successful, it is essential to follow the instructions of the doctor strictly. It is critical to switch to a well-regulated diet rich in fibre, drink a lot of fluids, and refrain from straining the anal muscles at the time of defecation.

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

3427 people found this helpful

Is It Fissure Or Fistula? Don't Get Confused!

Dr. Sourabh Aggarwal 90% (70 ratings)
MS - General Surgery
General Surgeon, Sri Ganganagar
Is It Fissure Or Fistula? Don't Get Confused!

If you think fissure and fistula are the same, you are mistaken. While the term fissure refers to the tear of the skin, fistula refers to the abnormal tube-like passages or connections between organs. Fissures get cured with or without treatment in a few days to few weeks, and do not lead to complications. On the contrary, fistulas when left untreated may lead to complications.

So, read on further to know about the distinction, how to recognize the symptoms and avail treatment.

What is anal fissure?
An anal fissure can occur due to various reason, such as prolonged diarrhea, anal sex, vaginal childbirth, rectum cancer, etc. For majority of the cases, it is usually due to constant constipation or strained bowel movements, that tear down the muscles controlling the sphincters to the inner rectum or the anal canal.

What is anal fistula?
Anal fistulas are not tears but abnormal abscesses near the anus, filled with pus. In fistula, a tunnel is formed under the skin which connects these abscesses to the infected glands. Fistulas are usually the results of present or previous abscesses. If ignored or left untreated, one single fistula can lead to the development of a more complex fistula, where the single fistula tract ends up creating multiple openings.

Symptoms of anal fissure and anal fistula
Some of the common symptoms of an anal fissure are excruciating pain in the anal area every time the bowel movement occurs, constant itching or burning sensation in and around the anus, bloody stool and visible tears and cracks around the anus.

For anal fistula, some of the very common symptoms are a throbbing pain in the anus, which continues to increase, difficulty in sitting down for longer period, swelling and redness around the anus, accompanied by skin irritation, discharge of blood and pus, and at times fever.

Treatment options
To completely cure anal fissure and fistula, it is the various surgical options that are the most effective ones. However, when diagnosed in its earliest form, medications like antibiotics, analgesics, and antipyretics can often help. It is solely depending on the location, type, and size or severity of the fistula or fissure, the treatments may vary from person to person and so does the recovery time.

Though, these conditions cannot be cured with dietary changes or exercise, following a healthy diet can boost healthy bowel movement, reducing chances of constipation or diarrhea that results in fissures.
Prevention is always better than cure. Therefore, it is essential that you visit the nearest medical facilities once you notice any signs of fissure or fistula , to avail the right treatment and get relief from the symptoms quickly.

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

1804 people found this helpful

Anal Fistula - Can Surgery Be Of Help?

Dr. Ayush Agarwal 83% (31 ratings)
MBBS, MS - General Surgery
General Surgeon, Ghaziabad
Anal Fistula - Can Surgery Be Of Help?

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!

2522 people found this helpful

Perianal Abscess - How It Can Be Managed?

MBBS, MD - General Medicine, DM - Gastroenterology, Fellowship in Advanced Endoscopy
Gastroenterologist, Mumbai
Perianal Abscess - How It Can Be Managed?

The human body is an intricate mechanism that functions amazingly. And when there is any trouble it does not fail to show signs of trouble, and all we need to do is, to notice it and solve our problems. This is applicable to all types of health issue, including a perianal abscess.

What is perianal abscess?
The extremely painful condition of anal abscess occurs when one cavity in the anus starts getting filled up with pus. Very often it appears as a painful swelling similar to boil just near the anus. Usually, it appears red in color as well as slightly warm to touch. If the location of the anal abscesses is in the deeper tissue, then it might be less visible and it occurs in people suffering from inflammatory bowel disease.
The worst part is that in certain cases, anal abscesses might lead to more painful anal fistulas. Generally, fistulas occur only if the abscesses fail to heal and break open on the skin’s surface. Therefore, it is important that the abscess heals properly or else it may lead to intolerable pain and may even require surgery.

How do you know if it is a perianal abscess?
The immediately noticeable and probably the most common anal abscess symptom is constant and throbbing pain around the anal area. Swelling accompanies the pain and its rate increases during bowel movements. Various other common signs include bleeding or rectal discharge, constipation, fatigue, etc. Besides swelling or tenderness, the affected individual might also suffer from skin irritation all around the anus.
Patients with deeper abscess might also show symptoms such as chills, fever, malaise, etc. Various reports state that certain people also feel a lump or nodule at their anus’s rim. Facing difficulty while urinating might also be experienced by some people affected by perianal abscess.

What to do if you suspect a perianal abscess?
One must immediately seek medical if they experience any of the above-mentioned signs or symptoms. Clinical evaluation along with digital rectal exam is sufficient for the proper diagnosis. But, in some cases, patients might need other tests to screen for rectal cancer, diverticular disease, inflammatory bowel disease and sexually transmitted infections. Your physician might also suggest for a CT scan, an MRI or an ultrasound.
Just after the diagnosis, a prompt surgical drainage would be carried out by the doctor before the abscess erupts. Deeper or larger abscess might require hospitalization as well as an anesthesiologist’s assistance. In most cases, patients are prescribed certain medications for pain relief just after the procedure. Antibiotics are mainly given to those people who have comparatively weaker immunity or suffer from diabetes.

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

3195 people found this helpful

How Fistula-in-Ano Can Be Treated With Surgery?

MBBS, MS - General Surgery, MCh - Cardio Thoracic Surgery
General Surgeon, Lucknow
How Fistula-in-Ano Can Be Treated With Surgery?

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!

2802 people found this helpful

Fistula In Ano - Success Rate In Ayurveda

Dr. Suchit Kumar Singh 89% (28 ratings)
B.A.M.S
Ayurveda, Gorakhpur
Fistula In Ano - Success Rate In Ayurveda

Fistula in ano or bhagandar is very much recurrent disease means, d first thing is when a person have anal fistula then it itself some times look like it is completely gone by time, but suddenly after few days, weeks, months or years it appears with all it's features. And a person with few medications like antibiotics or homoeopathic medications, if case is not taken properly, it again behaves the same. It's very recurrent even after surgeries. Now what I have learned in my practice and in my institutions, the kshar sutra method of ligation of fistula, completely cures the fistula in ano. And also it doesn't harm the rings of anus, so that it doesn't cause any incontinence.

3 people found this helpful

Piles, Fistula and Fissures - Know How Ayurveda Is Effective in Treating Them!

Dr. Khalid Bin Habib 86% (101 ratings)
B.U.M.S
Ayurveda, Etawah
Piles, Fistula and Fissures - Know How Ayurveda Is Effective in Treating Them!

Piles, fistula and fissures are the most common problems affecting the rectum and the anus. Both the rectum as well as the anus has a very rich vascular supply. There could be swelling of these blood vessels or tearing which can lead to the above conditions. Read on to know additional details about each of these conditions. 

Piles: In simple words, swollen blood vessels of the anal region are called piles. It can be internal or external, depending on how far it is from the anal canal. If it is located farther inside the anal canal, it is called internal piles.

Causes:

  • Chronic constipation, where the person has to strain to pass stools
  • Smoking and genetics can also lead to piles.

Symptoms: Starts off as painless bleeding, which happens in drops after bowel movement; the swelling happens much later. They can continue to grow and develop blood clots.

Treatment:

  • In the early stages, once identified, simple topical medications for symptom relief are sufficient.
  • Diet should be rich in fiber, with fruits and vegetables
  • Increased water consumption
  • Surgery if the disease has reached the stage of blood clots
  • Prevention is advised if there is a family history by consuming a fiber-rich diet and maintaining hydration

Fistula: When an infected anal gland bursts into the anal canal, it constantly discharges pus into the anal canal and becomes a fistula. Hygienic toilet habits can help in preventing fistulas.

Symptoms:

  • A constant wet feeling in the anal area, due to pus discharge.
  • This would be intermittent, and there would be periods with no discharge.
  • There could be a foul smell due to pus discharge.

Diagnosis and Treatment:

  • Identifying the exact location is important as surgery may be required.
  • An ultrasound scan or an MRI is usually done.
  • Newer techniques like Video Assisted Anal Fistula Treatment (VAAFT) are used. This locates the piles accurately and uses electric current to seal it with staples and surgical glue.
  • Conventional surgery is also used for economic or accessibility reasons.
  • Fissures: These cracks anywhere in the length of the anal canal are extremely common.

Symptoms

  • Very painful and the person may not want to go to the toilet
  • Rarely bleeding is also seen, maybe in very small amounts

Treatment:

  • Over 90% of the fissures do not require surgery
  • Switching to a high-fiber diet and improving hydration will help in managing these symptoms.
  • Topical relief can be provided by medications.
  • When they are recurrent, a procedure known as lateral sphincterotomy is done. This is an outpatient procedure and provides immediate relief.

Though one condition can lead to another, in most people, there is a strong genetic component, and working towards prevention is highly recommended.

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

2997 people found this helpful

Medication In Fistula In Ano

Dr. Suchit Kumar Singh 89% (28 ratings)
B.A.M.S
Ayurveda, Gorakhpur
Medication In Fistula In Ano

I want to discuss on anal fistula medication. If there is a patient of fistula asks you to recommend some medication please tell him clearly that there is no any medication needed other than Kshar Sutra ligation in fistulous tract. No need of any medicine after ligation before or after because if you give any medicine like antibiotics or even homoeopathic medicine if not consulted properly it will bock the track of fistula and it will cause worsening of fistula because it will make more tracs in fistula.

2 people found this helpful

How Ayurveda Can Help Manage Piles & Fissures?

Dr. Atray Bhatt 92% (54 ratings)
BAMS, MD - Alternate Medicine
Ayurveda, Vadodara
How Ayurveda Can Help Manage Piles & Fissures?

Piles, fistula and fissures are the most common problems affecting the rectum and the anus. Both the rectum as well as the anus has a very rich vascular supply. There could be swelling of these blood vessels or tearing which can lead to the above conditions. Read on to know additional details about each of these conditions. 

Piles: In simple words, swollen blood vessels of the anal region are called piles. It can be internal or external, depending on how far it is from the anal canal. If it is located farther inside the anal canal, it is called internal piles.

Causes:

Symptoms: Starts off as painless bleeding, which happens in drops after bowel movement; the swelling happens much later. They can continue to grow and develop blood clots.

Treatment:

  • In the early stages, once identified, simple topical medications for symptom relief are sufficient.
  • Diet should be rich in fiber, with fruits and vegetables
  • Increased water consumption
  • Surgery if the disease has reached the stage of blood clots
  • Prevention is advised if there is a family history by consuming a fiber-rich diet and maintaining hydration

Fistula: When an infected anal gland bursts into the anal canal, it constantly discharges pus into the anal canal and becomes a fistula. Hygienic toilet habits can help in preventing fistulas.

Symptoms:

  • A constant wet feeling in the anal area, due to pus discharge.
  • This would be intermittent, and there would be periods with no discharge.
  • There could be a foul smell due to pus discharge.

Diagnosis and Treatment:

  • Identifying the exact location is important as surgery may be required.
  • An ultrasound scan or an MRI is usually done.
  • Newer techniques like Video Assisted Anal Fistula Treatment (VAAFT) are used. This locates the piles accurately and uses electric current to seal it with staples and surgical glue.
  • Conventional surgery is also used for economic or accessibility reasons.
  • Fissures: These cracks anywhere in the length of the anal canal are extremely common.

Symptoms

  • Very painful and the person may not want to go to the toilet
  • Rarely bleeding is also seen, maybe in very small amounts

Treatment:

  • Over 90% of the fissures do not require surgery
  • Switching to a high-fiber diet and improving hydration will help in managing these symptoms.
  • Topical relief can be provided by medications.
  • When they are recurrent, a procedure known as lateral sphincterotomy is done. This is an outpatient procedure and provides immediate relief.

Though one condition can lead to another, in most people, there is a strong genetic component, and working towards prevention is highly recommended. In case you have a concern or query you can always consult an expert & get answers to your questions!

4651 people found this helpful
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