What is an anal fistula?
Anal fistula, or fistula-in-ano, is an abnormal connection between the epithelialised surface of the anal canal and (usually) the perianal skin.
What causes a fistula?
After an abscess has been drained, a tunnel may persist connecting the anal gland from which the abscess arose to the skin.
Symptoms
- Pain
- Discharge – either bloody or purulent
- Pruritus ani – itching
- Systemic symptoms if abscess becomes infected
Treatment
There are several options:
Doing nothing – Drainage seton can be left in place long-term to prevent problems. This is the safest option although it does not definitively cure the fistula.
Lay-open of fistula-in-ano – this option involves an operation to cut the fistula open.
Cutting seton – if the fistula is in a high position and it passes through a significant portion of the sphincter muscle, a cutting seton may be used.
Seton stitch – a length of suture material looped through the fistula which keeps it open and allows pus to drain out.
Fistulotomy – till anorectal ring
Colostomy – to allow healing
Fibrin glue injection is a method explored in recent years, with variable success. It involves injecting the fistula with a biodegradable glue which should, in theory, close the fistula from the inside out, and let it heal naturally.
Fistula plug involves plugging the fistula with a device made from small intestinal submucosa.
Endorectal advancement flap is a procedure in which the internal opening of the fistula is identified and a flap of mucosal tissue is cut around the opening. Success rates are variable and high recurrence rates.
LIFT Technique – It is a novel modified approach through the intersphincteric plane for the treatment of fistula-in-ano,
VAAFT Technique : This technique involves use of an endoscope.
Fistula and Ayurveda
The fact that so many of us from far & vide have gathered here is in itself evidence of the coming back of age of old science of life ayurveda is picking up momentum not only in India, but also in other countries.
Globalization of ayurveda brings with it increased requirement of all types of Ayurvedic preparation and even standardization of this preparation. Availability of standard Ayurvedic drug, even those which are widely used, is a problem at many places even in India where expensive or sparingly used drugs are considered, this problem raises steel higher. Ksharsutra is one such preparation
Treatment of anorectal disease through ayurveda is solely becoming popular in India. People have started realizing that ayurveda has a lot to offer in this field life in many others ksharshutra is undoubtedly the preparation of prime importance in this field. However manufacturing and marketing of ksharshutra has not been given due importance till date and almost all Ayurvedic anorectal physician have to prepare their own ksharsutra which makes it more difficult to work in this filed.
We shall have to accept that there is not a single reference text book of the method of preparation of ksharshutra as it is used today though there are same references indicating use of medicated thread in the management of piles and fistula in Sushruta and Bhavparkasha.
