Fistula-in-Ano is a track, lined by granulation tissue which opens deeply in the anal canal or rectum and superficially on the skin around the anus. It arises from anorectal abscess due to blocked infection in anal glands lying between the two layers of anal sphincters. It can extend to the lower back, sub scrotal region, vagina etc. It is characterised by swelling, pain, inflammation and discharge of pus leading to discomfort and uneasiness. It can be managed in various ways according to the pathology associated with it and sometimes treatment and surgery helps with the healing process.



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This condition is usually found in young people and predominantly men. Male to female ratio is roughly 5:1

Classification of Fistula-in-Ano

• High Anal: Fistula track which is having an internal opening in between the pectinate line to just below the anorectal ring. It has 3 varieties:
a) Intersphincteric
b) Transphincteric
c) Supralevator

• Low Anal: In these fistulae generally it opens at a level of anal crypts at a level of the pectinate line. It has 5 varieties:
a) Subcutaneous
b) Sub mucus
c) Low anal
d) High anal
e) Pelvic rectal

Causes of Fistula-in-Ano

• Physical strain
• Defecation problems
• Low fiber diet
• Weak anal sphincter muscles
• Skin dry, especially mucous membranes
• Small tight anus
• Prolong standing disease like tuberculosis, ulcerative colitis, Crohn’s disease, Ca-rectum or Ano rectal or gynecological surgery

Fistula-in-Ano Signs and Symptoms

• Swelling
• Itching
• Boils, abscess and pus discharge from the anorectal area
• Perianal discharge
• Pain
• Bleeding
• Diarrhea
• Skin excoriation
• External opening
• Fever
• Pricking, stabbing feeling in the anus
• Weight loss
• Changes in bowel habits
• Abdominal pain
• Irritation due to pus discharge
• Systemic spread of infection

Investigations for Fistula-in-Ano

• Complete case history
• Physical examination
• Digital examination
• Proctoscopy
• Sigmoidoscopy
• Probing
• Blood test
• Biopsy in some cases
• Fistulography
• Endorectal ultrasound
• MRI and CT scan
• Barium enema

Treatment for Fistula-in-Ano

• Antibiotics
• Analgesics
• Anti-inflammatory
• Anti bacterial drugs
• Surgery

Prognosis of Fistula-in-Ano

Prognosis of Fistula-in-Ano is good after surgery with postoperative management and treatment. Personal hygiene level should be maintained high to avoid infection. Rate or recurrence is very low.

Complications of Fistula-in-Ano

• Pain
• Bleeding
• Fever
• Pus formation
• Fecal impaction
• Sitting difficulty
• Urinary retention

Differential diagnosis of Fistula-in-Ano

• Piles
• Anorectic fistula
• Crown’s disease
• Perinatal abscess
• Anal abscess
• Thrombosis piles
• Dilapidation disease
• Bartholdi gland abscess

Diet / management of Fistula-in-Ano

• Take plenty of fluids
• Add fibre to diet
• Exercise regularly
• Follow regular bowel habits
• Take hygienic measure to keep anus clean and dry
• Treat constipation or diarrhoea immediately
• Avoid friction or injury
• Use dry cleaning by toilet paper
• Avoid scratching
• Avoid spicy, oily, non-veg food
• Quit smoking and limit alcohol
• Limit coffee intake
• Before passing stool sit in a shallow bathtub of warm salt water for 10-15 minutes
• Never suppress an urge for passing stool

Homeopathic treatment for Fistula-in-Ano

Berberis vulgaris:
• Constant urging to stool
• Diarrhoea painless clay coloured
• Burning and smarting in anus and perineum.
• Tearing around anus
• Worse motion, standing

Calcarea Phos:
• Bleeding after hard stool
• Diarrhoea from juicy fruits or cider
• Green, slimy hot sputtering
• Undigested with fetid flatus
• Fistula-in-Ano, alternating with chest symptoms
• Involuntary sighing
• Chest sore
• A suffocative cough, better lying down
• Hoarseness, pain through lower left lung

Carbo vegetabilis:
• Itching, gnawing and burning in the rectum
• Acrid corrosive moisture from rectum
• Soreness, itching, moisture of the perineum at night
• Discharge of blood from rectum
• Burning at anus
• Painful diarrhoea of old people
• Frequent, involuntary cadaverous smelling stools followed by burning
• Pain after stool

Nitric acid:
• Pain as from splinters, sticking pains
• Amelioration while riding in a carriage
• Pain during stool, as if rectum were torn
• Discharge very offensive
• Hopeless despair
• Sensitive to noise, pain, touch, jar
• Violent cutting pains after stools lasting for hours
• Haemorrhages from bowels, profuse, bright

Silicea Terra:
• Best suited for suppurative processes
• Best remedy for all fistulous borrowings
• Ripens abscesses since it promotes suppuration
• Suits to persons who are chilly, huge fire, wants plenty of warm clothes
• Lack of vital heat
• Great sensitiveness to take cold
• Ailments attended with pus formation
• Painful with spasm of sphincters
• Stool comes down with difficulty, when partly expelled, recedes again.
• Great training, rectum strings, closed upon stool
• Constipation always before and after menses
• Diarrhoea of cadaverous odour

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