FISTULA-IN-ANO

• Fistula-in- ano is an inflammatory track which has an external opening in the perianal skin and an internal opening in the anal canal or rectum. The track is lined by unhealthy granulation tissue and fibrous tissue
• Patients complain of pain, swelling, discharge of blood or pus from the anus with irritation of the surrounding skin
• Even though multiple openings are seen in the perianal skin , the internal opening is always single

Classification

Low fistula (below anorectal ring)

• Subcutaneous
• Submucous
• Intersphincteric
• Transphincteric
• Suprasphincteric

High fistula (above anorectal ring)

• Extrasphincteric
• Transphincteric
• Pelvi-rectal fistula

• The fistula usually originates from a perianal abscess in the intersphincteric space of the anal canal from infection of the anal gland
• Secondary causes – ulcerative colitis, crohn’s disease, tuberculosis, colloid carcinoma of the rectum, radiation therapy, actinomycosis, chlamydial infections, diabetes, AIDS, Tuberculosis

• Past history of perianal abscess – Dull perianal discomfort and pruritus
• Tiny discharging sinus
• Pain
• Swelling
• Blood stained discharge
• Skin excoriation
• Sometimes single or multiple

Goodsall’s rule

• This rule relates the location of the internal opening to the external opening
• If the external opening is anterior to an imaginary line drawn across the midpoint of the anus, the fistula runs straight directly in to the canal
• If the external opening is posterior to that line, the track usually will curve and the internal opening will be on the midline posterior of the anal canal
• When the external opening is anterior to this imaginary line, but is situated more than 1 1/2 inches away from the anus, the track will curve posteriorly and end in the posterior midline

Rectal examination – internal opening can be felt by digital examination. Even if there are multiple external fistulae, there may be one internal opening

• Proctoscopy – sometimes necessary to visualize internal opening of the fistula
• Lipiodol injection – into the external opening prior to radiography will reveal the track of fistula
• Chest X-ray – to exclude tuberculosis
• MRI
• Anal manometry
• Endorectal ultrasound
• Fistulography
• Colonoscopy or proctosigmoidoscopy
• CT scan
• Fistula probe

• Paramedical
• Surgical – fistulotomy/ fistulectomy , mucosal advancement flap, seton placement

Ayurvedic Treatment

Internal medicines

• Trayantyadi kashaya
• Chiruvilwadi Kashaya
• Guggulupanchapala choorna
• Avipathi choorna
• Triphala guggulu
• Kankayana vati
• Guggulutikthaka Ghrita
• Gandhaka Rasayana

Procedure

• Kshara sutra
• Avagaha - Triphala kashaya