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 arteriovenous fistula or AV fistula is a connection between the artery and vein made by a vascular surgeon at the time of hemodialysis. Hemodialysis is a treatment for kidney failure that involves a machine called dialyzer to filter the blood and remove the toxins. In order to gain a safe and easy access to the blood system during hemodialysis, the AV fistula is essential.

An AV fistula is placed in the upper arm and it causes extra pressure and extra blood to flow into the vein, thereby making it stronger and larger.

Benefits of AV Fistula

1. Lower complication rates
2. Less prone to injection or blood clotting
3. Enables greater blood flow
4. Relatively less expensive to maintain with a longer lifespan

Types of Fistula for Dialysis
All AV fistulas are created from the native blood vessels of the body, without any synthetic materials. The surgical process is quick and simple and requires a maturation time, in order to enable an increase and thickening of vessel walls.

1. Radial Cephalic Fistula – This access involves a connection of the radial artery and cephalic vein. It is the hardest to create and has a lower blood flow than the other types. Typically the first choice for hemodialysis access, the radial cephalic fistula at the wrist is recommended.
2. Brachial Cephalic Fistula – It is the easiest fistula that can be created by connecting the upper arm cephalic vein to the brachial artery. This access allows for a higher blood flow since the blood vessels in this part of the body are relatively larger. Also, it is easier to cannulate or introduce a tube into the vein, with a larger possible selection of cannulation sites.
3. Brachial Basilic Fistula – This access is more complex to create and typically considered when multiple access procedures have failed previously. It requires the vein to be elevated and transposed in order to enable easy access. A mobilized vein from a deep location is connected to a superficial tunnel.

How does the AV Fistula Work?
Before surgery is done to insert the fistula, the surgeon may perform a vessel mapping test to analyze blood vessels and determine the best blood vessels to use. Once the surgery is performed, the fistula needs 2 to 3 months to mature and accustomed to the body before it can be used for hemodialysis.

At the start of the dialysis, the patient or healthcare provider inserts two needles into the access. One needle referred to as the arterial needle carries the blood from the body to the dialyzer machine. The dialyzer performs the kidney’s function to filter out the toxins and then it returns the filtered blood through another tube. The other venous needle carries the filtered blood back to the body.

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.
4. Ksharsutra is a highly recommended minimally invasive treatment option. It is a graded thread that cuts through the tract gradually and at the same time promotes healing. It is the best surgical approach to fistula in ano, as there is almost negligible chances of recurewnce with it.

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!​