Anal Fistula: Treatment, Procedure, Cost and Side Effects

The human circulatory system is a highly complex and well-orchestrated system designed with two sets of channels. The arteries are a chain of vessels which carry oxygenated blood to all parts of the body from the heart. The venous system, on the other hand, carries impure or deoxygenated blood from each of the end organs to the heart. These start from minute branches in the distant parts of the body and gradually grow in size until they reach the heart.

These two channels do not interact unless either created artificially or in disease conditions. Naturally, these could be due to developmental anomalies or as a result of an aneurysm and would require a surgical correction. The AV fistula is, however, commonly created naturally in people who have to undergo hemodialysis.

Why an AV fistula: Generally, an artery in the forearm is sewn into a vein in the forearm. This AV fistula may take about 4 months to heal or mature, and a needle is then inserted into the vein during dialysis. When an AV fistula is created, there is a decrease in the peripheral resistance as the blood does not have to exert as much pressure as before, and there is an easy movement of blood into the veins.

How to care for it:

1. There could be initial limitations on the amount of weight that can be lifted
2. Keep the dressing in place for 1 to 2 days
3. Do not sleep on the fistula arm
4. Do not wear jewelry on the arm
5. Always wash hands before touching the access
6. Avoid lifting heavy objects using the hand
7. Avoiding damage to the arm like cuts or bruises
8. Regular checking for the pulse or thrill in the arm
9. Monitoring for signs of infection (redness, blood clots, swelling, pus formation, etc.)

Advantages:

1. Uses the body’s own blood vessels, no artificial material (as in catheter for instance)
2. Reduced chances of clotting
3. It provides good blood flow for dialysis
4. Is more effective than other types of access (graft or catheter)
5. Lesser complications compared to other access types
6. Is done on an outpatient basis and are less expensive
7. Usually last longer than other access methods

Disadvantages:

1. Longer maturity time (sometimes up to 4 months), so are not available for ready use
2. Stenosis or narrowing of the vessels is common, sometimes leading to blood clots.
3. If they fail to mature, a fresh fistula may need to be created
4. Usually created on the forearm, so are quite visible

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

An abnormal junction or connection between two organs or tissues is referred to as a “fistula”. It targets two hollow organs, vessels, or tissue structures. It occurs mostly in the rectum, vagina, however can affect the intestines and the eyes too. It results in extreme pain, discomfort and should be treated as immediately as possible to prevent infection.

It can induce sensations of:

1. Extreme irritation or itching
2. Discharge with unusual odor (if the fistula is located near the anus/vagina)
3. Irritable bowel syndrome
4. Excess pus
5. High body temperature
6. Blood discharge

Diagnosis
In case or prolonged tension and pain in these areas, a proctoscopy should be conducted for diagnosis. It most commonly occurs in women who have sustained prolonged labor (over 2-3 days). However, other causes include:

1. Digestive malfunction
2. Abscesses(formation of pus in hollow organs)
3. An unhealthy lifestyle which includes excessive indulgence in alcohol and tobacco

Ayurvedic treatment for fistulas are available which aim to sooth the inflammation by slowly remedying the wound through natural and safe measures. Since Ayurvedic practices are non-toxic, non invasive and completely safe, one can avoid the drastic measures that surgery consists of, and also avoid the side effects of medicines.

Ayurvedic remedies of fistulas include
Ayurvedic doctors have developed several oils, ointments and medications that are readily available in the market. The medications usually consist of a mixture of herbs, roots and plants that aim to restore the physical systems and also soothe the affected area.

1. The importance of buttermilk added with rock salt and black pepper also allows the enzymes of our body to multiply and thereby cure the fistulas internally.
2. Radish juice with a pinch of cumin is also recommended to be consumed after meals to improve digestion and empower the immune system.
3. A healthy lifestyle and fitness routine consisting of yoga and exercises also contribute to improve conditions in the patient by facilitating blood circulation and metabolism.

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

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!​

Anal Fistula - What Causes It? 
An anal fistula refers to a small infected tunnel connecting the anus to the outer skin. Your body eliminates solid waste products or feces through the anus. When any of the glands inside the anus becomes infected or blocked, an abscess may form, which in turn results in formation of anal fistula. In about 50% of the cases, abscesses develop into fistulae. What are the causes for anal fistula? Anal fistulae occur primarily due to the formation of an abscess or infection in the anus. If the abscess does not heal completely after the pus has been drained away, a fistula can develop. 

Other factors responsible for the occurrence of anal fistulae are- 

1. Crohn’s disease- a chronic condition where the digestive system becomes inflamed. 
2. Diverticulitis- an inflammation of the small pouches that develop along the intestinal walls. 
3. Hidradenitis suppurativa- a chronic painful skin condition which causes scarring and abscesses on the skin. Apart from these, people with HIV or infected with Tuberculosis disease also develop anal fistulae. If you’ve had a surgery around the anus, then post-surgery complications may lead to infection or abscess on the skin. 

What are the symptoms to watch out for? 
The commonly observed signs and symptoms of anal fistulae include- 

1. Irritation or discomfort on the skin around the anus 
2. Occasional throbbing pain, especially while seated, moving around or having a bowel movement 
3. Nodular swelling around anal region 
4. Intermittent Discharge of blood or pus from an opening near anal orifice. 

How does Ayurveda treat anal fistulae? 
Ayurveda recommends Ksharsutra treatment for complete healing of Anal Fistula.

In this procedure; Ksharsutra – a medicated thread is placed in Fistula tract. Medicine released from Ksharsutra debrides the fistula tract and induces healing. This medicine remains active for about 5-7 days so this thread needs to be changed with a new thread at weekly interval. No. of Ksharsutra changes required for complete healing of Fistula depends on length depth and branching pattern of fistula. It has been observed that Fistula heals at the rate of 0.5 to 1 cm per Ksharsutra changes so for a fistula tract of 3 cm length about 4-5 weekly thread changes are necessary for complete healing. Clinical trials conducted by Indian Council of Medical Research at AIIMS New Delhi have proved that Ksharsutra treatment is more convenient and more effective than Surgery in case of Anal Fistula. In this way Ksharsutra is the best way to treat Anal Fistula without Surgery. In case you have a concern or query you can always consult an expert & get answers to your questions!

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!