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Overview

Anal Fistula: Treatment, Procedure, Cost and Side Effects

What is the treatment?

An anal fistula refers to an infected tunnel that develops right between the muscular opening at the end of the digestive tract (called the anus) and the skin. Anal fistulas are caused by an infection that is present in the anal gland. When the infection stays for a while, it ends up leading to an abscess that is either drained naturally by the body or through a surgery through the skin present next to the anus. As a result the fistula develops between the skin and the infected gland. It can only be treated by surgery.

There are many different treatment options for an anal fistula however all of them require some amount of surgery. A fistulotomy is one such option. You can also have an advancement rectal flap to correct the fistula. Seton replacements are also commonly suggested treatments. You can also have a fibrin glue or collagen plug put in to close the fistula. Lastly, your doctor may also suggest ligation of the intersphincteric fistula tract (LIFT) in order to correct this condition.

How is the treatment done?

The first step to beginning the treatment is to find out the exact path of the fistula. Without knowing exactly where it is or how big it is, the doctors cannot suggest the most effective treatment plan for you. Thus, an MRI will be conducted for them to find out. Sometimes, an endoscopic ultrasound may needed to form a clearer picture. There is also a specific procedure known as a fistulography, which is essentially a high contrast X-Ray of the fistula. Other than these, a fistula probe, anoscope, flexible sigmoidoscopy, or an injected dye solution are also viable methods to find out more about your fistula.

Based on what the doctors find, your treatment plan will be decided. If you are going through a fistolotomy, the surgeons will cut the internal opening of the fistula and scrap the entire lining to get the infection out before closing the channel with stitches. In an advancement rectal flap, the surgeon will first close the internal opening of the fistula and then cover it with a flap taken from the rectal wall. If the treatment suggested to you is a seton placement, then the surgeon will use a string made of latex or silk to drain out the infection. If a fibrin glue or collagen plug is being used, then the internal opening of the fistula will first be closed before the glue or plug is injected into the fistula to close the tunnel. If a LIFT procedure is being used, there are two steps to expect. The first is that the surgeon will start with a seton procedure to widen the fistula over a period of time. Then the fistula will be closed.

Who is eligible for the treatment? (When is the treatment done?)

If you have developed an anal fistula, then you are eligible to seek out treatment for it.

Who is not eligible for the treatment?

If you are allergic to silk or latex, a seton placement and a LIFT procedure may be out of the question for you. Furthermore, if you do not have an anal fistula, then you cannot seek treatment for it.

Are there any side effects?

Since all the procedures to treat anal fistulas are surgical, there are a few common side effects to expect. With most surgeries, bruising, swelling and pain is common. Anal incontinence is also one of the side effects of getting surgery in the anus or rectal walls. Constipation, an inability to walk, and disorientation due to pain are also some side effects that one can experience. Some people end up being allergic or latex or silk and therefore can develop complications if they have opted for a seton placement or a LIFT.

What are the post-treatment guidelines?

One of the major post treatment guidelines is a strict control over the diet as it is imperative that the digestive tract functions normally in the days after surgery. This is because the aim is to allow the anus and rectal walls to heal in their natural state, otherwise it can cause problems with excretion later on. As a result, the patient will have to maintain a diet that is high in fibre and stay away from spicy food for a while. For often than not, if everything is going smoothly, patients are discharged after their first successful bowel movements and are allowed to recover in the comfort of their homes.

How long does it take to recover?

Patients are normally discharged after having their first bowel movement, which normally occurs within one or two days. However, it takes close to two weeks to recover fully from the surgery and its effects. The internal stitches within the body also dissolve around this time.

What is the price of the treatment in India?

The surgical procedure can cost anywhere between Rs 98,000 – Rs. 3,00,000, depending on the hospital and city that you get the procedure done from.

Are the results of the treatment permanent?

The results of the treatment are permanent.

What are the alternatives to the treatment?

There are no home remedies or alternatives to the treatment. It is important to get the fistula corrected as soon as possible as further infections can lead to complications.

Safety: Medium Effectiveness: Medium Timeliness: Medium Relative Risk: High Side Effects: Medium Time For Recovery: Medium Price Range:

Rs 98,000 - Rs 3,00,000

Popular Health Tips

AV Fistula - Why It Is Used In Dialysis Process?

MBBS, MS - General Surgery, Fellowship in Vascular Surgery, Ted Rogers Fellowship
Vascular Surgeon, Delhi
AV Fistula - Why It Is Used In Dialysis Process?

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!

3127 people found this helpful

Fistula - How Can It Be Treated?

MD - Ayurveda, PGDPC, Degree in Yog And Ayurved
Ayurveda, Nashik
Fistula - How Can It Be Treated?

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!

3093 people found this helpful

Fistula-in-Ano or Anal Fistula - How Advancement Flap Procedures Can Help?

MS - General Surgery, MBBS Bachelor of Medicine and Bachelor of Surgery
General Surgeon, Kolkata
Fistula-in-Ano or Anal Fistula - How Advancement Flap Procedures Can 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!​

2803 people found this helpful

Anal Fistula - What Causes It?

M.S. (Ayurveda), Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Delhi
Anal Fistula - What Causes It?

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!

6632 people found this helpful

Is Ayurveda Successful In Treating Piles & Fistula?

BAMS, MD - Ayurveda Pharmacology, Ph.D - Diabetes Prediction Thesis, BA (Sanskrit), MA (Entire Russian Language)
Ayurveda, Pune
Is Ayurveda Successful In Treating Piles & Fistula?

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!

5365 people found this helpful

Popular Questions & Answers

I am suffering from fistula from 6 Years ago. Can you suggest me what should I am? Sir. I do not ant to surgery .can I take a medicine?

MBBS, DNB (General Surgery), Membership of the Royal College of Surgeons (MRCS)
General Surgeon, Faridabad
Medicine is unlikely to resolve fistula in ano. Better get a planned surgery done. Minimally invasive anal fistula surgery and laser surgery are good options with less discomfort and good results. Chances of recurrence is there in all types of surgery to about 10 to 15 percebt. But early surgery has good results. So get a planned surgery done.

I am 41 years old male suffering from complex anal fistula which extended towards roots of pennies. In penis it is located in left inferior of corpus spongiosum, 7 cm length and 5 mm dia. Internal opening located at 12'o' clock position 20 mm above anal Verge. This is the report I got. Can be done surgery? Which is best way for treatment?

MS - General Surgery, MBBS Bachelor of Medicine and Bachelor of Surgery
General Surgeon, Pune
Surgery is the only way to deal with your problem. Though the tract is long it is not deep, hence no likelihood of damage to sphincter.
1 person found this helpful

Hello sir, I have intersprenctic fistula in ano (type 1), please suggest me which is the best treatment fistulectomy or kshur sutra, I am in depression.

MSW, Clinical Hypnotherapy, MBA, Post Graduation in Counselling, Research Scholar
Psychologist, Guwahati
Consult a qualified physician for years condition and to rule out any kind of complications. You need to engage yourself in some form of yoga or relaxation to take care of years stress and anxiety as apparently from years situation it seems you are very anxious. U should also share y issues with close friends and pursue years hobbies to buildup years self esteem. Maybe gardening, writing, painting, music etc.
2 people found this helpful

Dr. on 1st my fistula in anno surgery was there after that still pus & sticky water is coming latrine came today little but it was paining can you tell how many days it will take to heal & when latrine will come.

MCh(Minimally Invasive & Robotic Surgery), MS - Surgical, MBBS
General Surgeon, Guwahati
Fistula surgery is generally done by excising the tract and keep the wound for secondary healing. If is the situation with you, then do not worry, the healing will be over by 3 to 4 weeks. Please continue to sit in warm water with betadine till healing is complete.

Table of Content

What is the treatment?
How is the treatment done?
Who is eligible for the treatment? (When is the treatment done?)
Who is not eligible for the treatment?
Are there any side effects?
What are the post-treatment guidelines?
How long does it take to recover?
What is the price of the treatment in India?
Are the results of the treatment permanent?
What are the alternatives to the treatment?
Play video
Know More About Fistula
Ways to treat Fistula
Play video
Know More About Fistula
I m Dr. S. K. Singh. I did my MS from IMS institute of medical sciences BHU and I were also associated with Moolchand Hospital. Now we are running a Sushruta ano-rectal institute here in NewDelhi.

Tau aj hum fistula ke barey mein baat karenge. Fistula ke barey mein humein ek general awareness public awareness program launch kerte rahe hain aur ussi ke tehat yeh information hum ap logon tak puhanchana chahte hain. Fistula ek aisi bimari hai jau ke paraya aam logon mein discuss kerne ki jis ke barey mein ziada tar log discuss nahi kerte hain yeh ek choti si phunsi ki roop mein shuru hota hai. Anal canal kea as paas ek choti si phunsi hoti hai jis mein se kabhi halki soojan kabhi kabhi us mein se pus discharge nikalta hai. Aur kabhi yeh discharge apne ap thek bhi hojata hai. Amoman is mein ziada taqleef nahi hoti hai tau yeh salon saal aise ya kuch mahiney aise chalta rehta hai. Aur log aise antibiotic painkillers lete rehte hain lekin yeh puri tarah se thek nahi hota. Aur kaye baar is mein kaye multiple branches ban jati hain ya deep fistula ban jata hai jis mein phir ilaj kerne mein ziada pareshani hoti hai is liye is roop ki proper diagnosis samay rehte hue iska nedaam zaruri hai aur samay rehte iska ilaj bhi zaruri hai. Fistula ke ilaj ke barey mein aj kal kaye padattiyan humare samne hain. Jaise hum allopathic mein dekhte hain humare fistula surgery hai, waft hai aur hum aj kal blue technique ka bhi use kerte hain lekin in meinse kisi bhi chikitsavdhi mein kisi bhi procedure ke andar iska puri tarah se iska ilaj abhi tak saboh nahi ho paya hai. Usually surgery ya even waft ke baad bhi 15-20% cases mein fistula ke logon mein yeh bimari dobara dekhi gaye hain. Issi bimari ka is fistula ka ayurvedic mein bhi varhan kiya gaya hai aur ayurvedic mein jau chikitsa bataye gae hai usko hum kehte hain Ksharasutra chikitsa. Yeh Ksharasutra chikitsa fistula ke rogioun mein adrik surgery se bhi ziada adik perbavik paye gaye hai. Aur clinically bhi yeh all institute of medical sciences mein ICM mein ek trial kiya gaya tha indian council of medical ne us trial mein yeh paya gaya ke fistula ke rogioun mein Ksharasutra chikitsa adrik surgery se adi kargar hai aur sweda janam bhi hai. Ab aj kal is Ksharasutra chikitsa k eek improve version agaya hai jisey hum kehte hain graded Ksharasutra chikitsa, aur yeh swedah humare yeh jau research work hai yeh humare Sushruta institute mein kiya gaya hai aur yeh swedah is samay bharat mein kewat (inaudible2:38) hi mein uplubbd hai aur graded Ksharasutra chikitsa ke upyog se fistula ka aur adik perwaden se upyas sambhan hochuka hai. Fistula ki bimari ke bare mein aur adik jaan kari ke liye ap humari website www.iamcure.com per login kersakte hain ye phi rap mujh se lybrate ke through bhi connect hosakte hain aur personally ap patient ya (inaudible3:12) ap humare clinic pe asakte hain aur is swedah ka iska upyog ya iska laav utha sakte hain aur is information ko me chahunga kea p dosre logon ko bhi jau isse peerat hain un tak puhanchaye jisse unko iske bari mein jaankari prapt ho sake. Thank you!
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