Anal Fistula

An anal fistula is an abnormal tunnel-like connection between the inside of the anal canal or rectum and the skin near the anus. It often develops from an infected anal gland that doesn't heal properly and creates a chronic, infected tract.

In Ayurveda, an anal fistula is known as Bhagandara, which translates to a "crack or opening around the anal region." Ayurveda describes Bhagandara as a result of imbalances in the body’s doshas (especially Vata and Kapha) and toxins (known as Ama) that accumulate in the anal area, leading to infection and eventually creating the fistulous tract.

Infection or Abscess: When an anal gland becomes blocked, it can lead to an abscess (a pus-filled infection) that creates a path to the outside of the skin, forming a fistula.

Infection or Abscess: When an anal gland becomes blocked, it can lead to an abscess (a pus-filled infection) that creates a path to the outside of the skin, forming a fistula.

Chronic Conditions: Certain conditions, like Crohn’s disease (an inflammatory bowel disease), tuberculosis, or trauma, can increase the likelihood of developing a fistula.

Common causes of anal fistula

• Anal Abscess: An untreated or recurring abscess near the anus is the most common cause.
• Infections in Anal Glands: Bacterial infections in glands inside the anus can lead to abscesses and fistulas.
• Crohn’s Disease: A chronic inflammatory condition of the digestive tract that increases the risk of fistula formation.
• Ulcerative Colitis: Another inflammatory bowel disease that can contribute to fistula development.
• Trauma or Injury: Physical injury in the anal area may lead to infection and fistula formation.
• Tuberculosis (TB): In rare cases, TB can cause anal fistulas.

•  Diverticulitis: Inflammation or infection of small pouches in the digestive tract, potentially leading to fistulas.

Symptoms of Anal Fistula are

• Pain and swelling around the anus
• Recurrent abscesses or infections
• Discharge of pus or blood near the anus
• Pain during bowel movements
• Fever (if infection is) present

Types of Anal fistula

Types vary based on the fistula’s path and which muscles it passes through or around.

• Inter-sphincter Fistula: Runs between the internal and external anal sphincter muscles.
• Trans-sphincter Fistula: Passes through both the internal and external anal sphincter muscles.
• Supra sphincter Fistula: Starts above the anal sphincter muscles and curves down to the outside.
• Extrasphincteric Fistula: Begins above the sphincters and extends directly to the outside skin near the anus.
• Subcutaneous or Sub mucosal Fistula: Located just under the skin or mucosal layer near the anus.

As per Ayurveda, Bhagandara (anal fistula) is classified into five main types

• Shataponaka: Causes severe pain and spreads quickly.
• Ustragriva: Has a winding, tortuous tract, similar to a camel's neck.
• Parisravi: Discharges pus continuously
• Shambukavarta: Has a spiral or circular tract, resembling a shell.
• Unmargi: Has multiple openings and irregular tracts.

Each type varies based on the fistula’s shape, tract, and symptoms.

Treatment of Anal Fistula

Ayurvedic treatment for Bhagandara aims to reduce inflammation, remove toxins, and restore dosha balance. This approach typically involves:

Kshar Sutra Therapy: This is an Ayurvedic para-surgical procedure where a medicated thread (Kshar Sutra) is inserted into the fistula tract. The thread slowly cuts through and heals the tract, helping in drainage and promoting healing.

Dietary and Lifestyle Changes: An emphasis on a fiber-rich diet, regular bowel movements, and avoiding heavy, oily foods is crucial. Specific herbs and dietary practices help prevent further infection and support healing.

Herbs used to treat Anal Fistula

Triphala (Combination of Haritaki, Bibhitak, and Amalaki):

Triphala improves digestion and supports gentle bowel movement and also helps healing the abscess with its anti -microbial properties.

Preferably Triphala powder or tablet is given with warm water to prevent constipation and help in healing.

Guggulu (Commiphora mukul):

Benefits due to its Anti-inflammatory, detoxifying properties, and helps tissue healing.

Turmeric (Curcuma longa):

Benefits: Anti-inflammatory, antimicrobial, helps reduce infection.

Use: Can be taken with warm milk or as a supplement to support healing.

FAQ

1.  Is fistula cancerous?

No, a fistula is not typically a sign of cancer. A fistula is an abnormal tunnel between two parts of the body, usually caused by an infection that didn’t heal well, such as an abscess near the anus. However long-standing fistula that has been untreated for years might increase the risk of cancer in that area.

2.  Is anal fistula life threatening?

A fistula itself is usually not life-threatening, but it can lead to serious complications if left untreated.

The main risks include recurrent infections, abscess formation, and potential damage to nearby tissues, which can make the fistula larger or more complex over time.

3.  Does anal fistula have a recurrence?

Yes, fistula can recur, depending on its type, underlying conditions, surgical complications, it is important to follow strict diet restrictions.

4.  Are there any home remedies for helping heal fistula?

Here are some simple home remedies that may help support healing of an anal fistula

• Warm Sitz Baths: Soaking the anal area in warm water for 15-20 minutes several times a day can soothe discomfort and promote healing.
• High-Fibre Diet: Eating plenty of fruits, vegetables, whole grains, and legumes helps soften stools and reduces straining during bowel movements
• Hydration: Drink plenty of water to stay hydrated, which helps maintain regular bowel movements and prevents constipation.
• Turmeric Paste: Applying a paste of turmeric (known for its anti-inflammatory properties) mixed with water to the affected area may help reduce inflammation.
• Neem Tea or Paste: Neem has antibacterial properties. Drinking neem tea or applying a neem paste can help fight infection.

5.  Does an Anal Fistula bleed?

Yes, an anal fistula can bleed. Bleeding is common, especially when there’s an infection or abscess in the fistula tract. You might notice blood on toilet paper, in stool, or as discharge from the fistula opening on the skin.

The bleeding is usually mild, but if it’s persistent or heavy, it’s important to consult a doctor, as it could indicate an infection or a complication that needs treatment.