Anus Infection Tips

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.

An anorectal abscess can be a combination of various conditions such as a rectal abscess, perianal abscess, anal abscess etc. It is a condition where pus and stool ooze out from areas of the rectum and the anus. Some of the possible causes of an anorectal abscess include infection in the anal area, sexually transmitted infections and blocked glands in the anal region. Disorders such as diverticulitis and Crohn’s disease can also lead to a deep rectal abscess.

What are the risk factors for this disease?
Some of the common risk factors of this condition include sexual activities involving the anal region, certain medications such as chemotherapy drugs, uncontrollable diabetes, a weak immune system due to conditions such as AIDs and HIV. An anorectal abscess can also be witnessed in toddlers if there exists a family history of this disease.

What are the common symptoms of this condition?
Some of the common symptoms of this condition include

1. Frequent constipation
2. Discharge of pus from the anal region
3. Nausea and fatigue
4. General malaise
5. Formation of a nodule or lump in the rectum area,
6. Night sweats
7. Hardened tissue
8. Redness and swelling of the lump near the anal area 
9. Frequent discharge of pus
10. Painful stool, etc.

Diagnosis and complications:
A rectal exam conducted by the doctor can reveal the condition. In case of any doubt, a doctor often prescribes a proctosigmoidoscopy to rule out other conditions. The doctor might still prescribe tests such as MRI scan, CT scan, ultrasound etc. to get a detailed picture of the area where pus is getting collected near the rectal region. Complications of an anorectal abscess includes scars, anal fistula, constant pain, sepsis and recurrence of pus.

What are the treatment options available in Ayurveda?

1. Curcumin: Curcumin is the pigment extracted from turmeric. This pigment is considered to be the most powerful naturally occurring anti-inflammatory agent. Its medicinal effect can cure many diseases. For patients suffering from an anorectal abscess, curcumin can control pain and inflammation in the anal region. Furthermore, it ensures that the condition does not aggravate to the next stage.
2. Triphala: Triphala is a combination of three herbs- harara, bahera and amla. These three herbs should be consumed in a powdery form twice a day to clean the wound and balance the doshas. Triphala can speed up the process of recovery for patients suffering from an anorectal abscess.
3. Guggul: Guggul is a gum resin that is extracted from the tree known as the Commiphora Mukul. It is used to treat a wide range of medical conditions. Although it seldom cures the condition alone, it cures many ailments when used in union with Triphala and other herbs.
4. Neem: Neem leaves have many medicinal properties. It is anti-inflammatory in nature and its application in the powdery/paste form can pay rich dividends in curing an anorectal abscess. Furthermore, neem leaves when boiled and applied near the rectal region helps to ease the muscles and remove the blocked pus in the rectum.

An anorectal abscess is a painful swelling near the anus or in the buttock. The swelling contains pus. 60% anorectal abscesses are superficial and resulting from infection in small anal glands present in between internal and external anal sphincters (intersphincteric space). They are known as a perianal abscess. 30% of anorectal abscesses are deep-seated and results in systemic infection. They are call Ischiorectal abscess. Submucous abscess, pelvirectal abscess and pilonidal abscess developed from versatile cause are comparatively less common. Inadequate and improper management of anorectal abscess may potentially cause complication like fistula formation.

Fast facts on Anorectal abscess-

* Anorectal abscess should be drained at the earliest.
* Conservative medical management almost invariably invites complication like fistula formation.
* Surgical drainage of pus reduces the chance of fistula formation by 50%.

What causes Anorectal abscess?

* Blocked and infected anal glands (cryptoglandular infection).
* Untreated anal fissure that becomes infected.
* Sexually transmitted infections.
* Penetrating injury of the perianal or buttock region.
* Crohn’s disease.
* Colon cancer.
* Tuberculosis.

What are the symptoms of Anorectal abscess?

Superficial abscess-

* Constant and throbbing pain that worsens on sitting down.
* Swelling, redness and tenderness of the skin around the anus.
* Discharge of pus.
* Pain is often associated with bowel movement.

Deep abscess-

* All or some of the symptoms of a superficial abscess.
* Fever with chill and rigor.
* General weakness.
* Sometimes fever is the only symptom of the deep abscess.

The anorectal abscess should preferably be explored under general or spinal anesthesia. Medical management often fails and subsequently fistula is formed.

A Fistula refers to an abnormal connection between an organ and another structure. Fistulas develop whenever an organ becomes inflamed or suffers an injury. They happen to be a very common complication of Inflammatory Bowel Disease. Fistulas are particularly common when rectum and the colon are involved.

Surgical procedures are the traditional methods of treatment for Fistula. One of the surgical methods, which doctors usually choose is Fistulotomy. Here, the fistula channel is opened by cutting along the length of it. The diseased tissue gets cleaned out but the track remains intact. The laser surgery is the more convenient option for treating this problem. It involves less incision and removes the affected part around the anus while keeping the remaining part intact.

In Ayurveda, Jiva Kshar Sutra therapy is a very effective treatment method for Fistula. The therapy makes use of medicated alkaline thread to cure the disease. Before looking at the tips regarding laser surgery and the role of Ayurveda in treating the problem of Fistula, let us briefly discuss the symptoms and causes that result in the problem of Fistula:

Symptoms

The symptoms of Fistula include:

• Pain near the anus
• The area might become red
• One could notice swelling around their anus.
• People can even come across bleeding during bowel movement

Causes

There are several glands inside one’s anus that make fluid. Sometimes, they can get blocked. When that happens, a build-up of bacteria can create a swollen pocket of infected tissue and liquid. This is regarded as abscess by the doctors.

Most of the times, an abscess leads to the formation of Fistula. There are certain other conditions as well, which can result in this problem:

• Tuberculosis
• Sexually transmitted diseases
• An ongoing illness that tends to affect bowel movements

Tips for Laser Surgery in Fistula and Role of Ayurveda in it

The following are some of the tips which patients must follow while undergoing laser surgery:

• Laser surgery happens to be an extremely effective treatment option as it is less invasive in nature.
• It does not involve any tissues to get cut.
• People do not have to suffer from too much pain or bleeding.
• Most importantly, they can resume their routine work within a couple of days.
• They can even have a normal diet within 4 hours of the procedure.
• Ayurveda Kshar Sutra is equally effective in treating the problem of Fistula.
• The therapy of Kshar Sutra involves the use of medicated alkaline thread to cure the problem. No hospitalization is needed and chances of recurrence are also reduced.
• Ayurveda ensures modification of diet by making a shift from non-veg, spicy foods to more consumption of fruits and vegetables along with regular intake of water to get rid of this problem.

Rectal prolapse means complete rectal prolapse where the rectal walls have prolapsed to a degree where they protrude out of the anus and are visible outside the body.

Types

The different types of prolapse are as-Internal prolapse (internal intussusception). Full thickness or a partial rectal wall is affected but the prolapsed tissue does not pass out of the anus.

1. External Prolapse- If they protrude from the anus and are visible externally. Full thickness, circumferential, true intussusception of the rectal wall which protrudes from the anus and is visible externally.
2. Full-thickness rectal prolapse- A full thickness of the rectal wall protrudes through the anus.
3. Mucosal prolapse- Protrusion of only the rectal mucosa (not the entire wall) from the anus.
4. Circumferential- Where the whole circumference of the rectal wall prolapse.
5. Segmental- Where only parts of the circumference of the rectal wall prolapse.

Grades of Prolapse

Grade I: Non-relaxation of the sphincter mechanism

Grade II: Mild intussusception

Grade III: Moderate intussusception

Grade IV: Severe intussusception

Grade V: Rectal prolapse

Causes

1. Pelvic floor dysfunction
2. Parasitic infections such as Amoebiasis, schistosomiasis
3. Pregnancy
4. Cystic fibrosis
5. Pertussis (whooping cough)
6. Neurologic disorders - Previous lower back or pelvic trauma/lumbar disk disease, cauda equina syndrome, spinal tumors, multiple sclerosis
7. Disordered defecation (stool withholding)
8. Previous surgery
9. Diarrhea
10. Benign prostatic hypertrophy
11. Chronic obstructive pulmonary disease (COPD)

Symptoms of Rectal Prolapse
History of a protruding mass- Initially, the mass protrudes from the anus only after a bowel movement and usually retracts when the patient stands up. As the disease process progresses, the mass protrudes more often, especially with straining and valsalva maneuvers such as sneezing or coughing.

• Degrees of fecal incontinence which may simply present as a mucous discharge
• Fecal leakage
• A sensation of obstructed defecation (tenesmus)
• Pelvic pain
• A feeling of bearing down
• Rectal bleeding
• Diarrhea
• Constipation(20%-50% of patients) also described as tenesmus (a sensation of incomplete evacuation of stool) and obstructed defecation
• Erratic bowel habits 

Signs of Rectal Prolapse 

• Sulcus noted between anal canal and rectum
• Solitary rectal ulcer (10%-25%)
• Decreased anal sphincter tone
• Protruding rectal mucosa
• Thick concentric mucosal ring

How will you Diagnose?

1. Proctoscopy/ sigmoidoscopy/ colonoscopy
2. Colonic transit studies
3. Anorectal manometry
4. Anal electromyography/Pudendal nerve testing
5. Differential
6. Diagnosis
7. Hemorrhoids
8. Intussusception
9. Proctitis 

Treatment

1. Conservative- Dietary adjustments, including increasing dietary fiber may be beneficial to reduce constipation. 
2. Surgery- Surgical approaches in rectal prolapse can be either perineal or abdominal.

A perineal approach refers to surgical access to the rectum and sigmoid colon via an incision around the anus and perineum. Abdominal approach (trans-abdominal approach) involves the surgeon cutting into the abdomen and gaining surgical access to the pelvic cavity.

• Laparoscopic procedures 
• Perineal procedures
• Perineal rectosigmoidectomy

An anorectal condition can be difficult to live with and often remains undiagnosed, due to it being perceived as an embarrassing ailment. Fistulas are conditions where two body parts, that are not meant to be connected, become linked as part of the disorder. Rectal fistulas can be painful and standard treatments are available, which can cure the condition. However, these treatments come with serious side effects.

Most people prefer Ayurvedic fistula treatments over conventional medications for the lack of side effects as such. Ksar sutra is one such branch of treatment in Ayurveda, which has shown tremendous results against fistulas. Here is a look at all that you need to know about Kshar Sutra.

What does Kshar Sutra mean?
Kshar Sutra is a form of treatment, which uses threads laced with the juices of medicinal herbs to treat rectal fistulas. ‘Kshar’ refers to the herbs and ‘Sutra’ stands for the thread used for the treatment. It is a minimally invasive surgical procedure with almost no side effect or danger. The Kshar Sutra form of treatment was first discovered by Sushruta, Vagbhata and Charak. In recent times, BHU’s Shalya Tantra Department has once again proved its efficacy in case of rectal disorders.

How is the treatment done?
Once the thread has been coated with the medicinal herbs, the same thread needs to be inserted into the fistula in ano. The patient is anaesthetized and the thread is inserted into the fistula using a probe. The thread is then taken out from the other side and the two ends of the thread are tied together. This thread is changed after every 7 days. This thread insertion effectively cuts the tract and unhealthy tissue is removed from the region.

Why is Kshar Sutra beneficial?
Benefits for this form of treatment include-

1. Lower risk of anal incontinence, which may occur in the case of conventional medicine and surgery.
2. Lower risk of the anal canal getting narrower after the treatment is completed.
3. Minimally invasive treatment, which is why patients can resume a normal life after just 3-4 days of recovery.

Apart from the treatment, patients should also follow a diet rich in fibre, fruits and vegetables. Drinking large quantities of water will also result in a better prognosis. Lastly, engaging in daily walks will also help you deal with the condition.

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 fistulacan 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.

An anorectal condition can be difficult to live with and often remains undiagnosed, due to it being perceived as an embarrassing ailment. Fistulas are conditions where two body parts, that are not meant to be connected, become linked as part of the disorder. Rectal fistulas can be painful and standard treatments are available, which can cure the condition. However, these treatments come with serious side effects.

Most people prefer Ayurvedic fistula treatments over conventional medications for the lack of side effects as such. Ksar sutra is one such branch of treatment in Ayurveda, which has shown tremendous results against fistulas. Here is a look at all that you need to know about Kshar Sutra.

What does Kshar Sutra mean?
Kshar Sutra is a form of treatment, which uses threads laced with the juices of medicinal herbs to treat rectal fistulas. ‘Kshar’ refers to the herbs and ‘Sutra’ stands for the thread used for the treatment. It is a minimally invasive surgical procedure with almost no side effect or danger. The Kshar Sutra form of treatment was first discovered by Sushruta, Vagbhata and Charak. In recent times, BHU’s Shalya Tantra Department has once again proved its efficacy in case of rectal disorders.

How is the treatment done?
Once the thread has been coated with the medicinal herbs, the same thread needs to be inserted into the fistula in ano. The patient is anaesthetized and the thread is inserted into the fistula using a probe. The thread is then taken out from the other side and the two ends of the thread are tied together. This thread is changed after every 7 days. This thread insertion effectively cuts the tract and unhealthy tissue is removed from the region.

Why is Kshar Sutra beneficial?
Benefits for this form of treatment include-

1. Lower risk of anal incontinence, which may occur in the case of conventional medicine and surgery.
2. Lower risk of the anal canal getting narrower after the treatment is completed.
3. Minimally invasive treatment, which is why patients can resume a normal life after just 3-4 days of recovery.

Apart from the treatment, patients should also follow a diet rich in fibre, fruits and vegetables. Drinking large quantities of water will also result in a better prognosis. Lastly, engaging in daily walks will also help you deal with the condition.

There are glands inside the anus that secrete fluids. Sometimes these glands can get clogged. Pus builds up in the blocked clogs, which get infected. This is called an abscess. Unless the abscess is treated right away, it will keep growing. It eventually punches a hole through the skin near your anus to drain the infected tissues and pus. This tunnel that leads from the gland to the hole is called a fistula.

Usually, it is an abscess that causes a fistula. But sometimes a fistula can be caused by tuberculosis, a bowel illness or sexually transmitted diseases.

What are the symptoms of anal fistula?

The symptoms of anal fistula are-

• Pain while sitting down
• Soreness around the anus
• Swelling and redness
• Bleeding
• Painful defecation
• Fever
• Foul secretion from a hole near your anus

How is fistula diagnosed?

If you complain of any of the above symptoms, a doctor will perform a physical examination on you.

Sometimes a physical examination does not reveal a fistula because the fistula can close for a while and then open up again. So then your doctor might ask you to get the following tests done-

• A blue dye test
• Computerized tomography (CT Scan)
• Anorectal ultrasound
• Colonoscopy.

Treatment for anal fistula

Unfortunately, there are no medicines that can treat fistula. If you are diagnosed with fistula, you will require surgery. However, it is a minimally invasive surgery with no risks involved.

The surgery is performed under general anaesthesia. A fistula surgery can be done in the following ways-

• If the fistula is located beneath the sphincter muscles, the surgeon cuts the fistula open so that it can heal and new healthy tissues can develop there.
• If the fistula passes through the upper part of the sphincter muscles, then the surgeon runs a special stitch through the fistula (seton stitch) so that the fistula can drain properly and heal. It takes 6 weeks for the pus to drain and the wound to heal
• Sometimes, a doctor will simply plug the fistula so it does not seep pus.

General and specific complications of a fistula surgery

Though it is a safe surgery, some complications may arise, but rarely. These may be general or specific.

General complications-

• Bleeding and pain
• Scarring around the region of the surgery

Specific complications-

• Pain while urinating
• The involuntary passing of wind or lose faeces

An anal fistula is a painful condition that refuses to go away and the only way to cure it is 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.