Treatment of fistula in allahabad - www.ksharsutraallahabad.com

WHAT IS FISTULA?

Fistula means pipe or tunnel like.It is a chronic granulating tubular tract consisting of fibrous tissues with two openings communicating between two cavities or cavity to cutaneous surface of the body.Thus anal fistula has two openings,one on perianal or perinial skin surface and other in anal canal.Prolong use of antibiotics or homeopathic medicine may lead the fibrosis of tubular tract.The fistula may remain silent for months or years without any symptoms or traces of discharge may persist without any inconvenience.Any boil or abcess in the vicinity of 4.0 cm area around the anus is initially a fistula.

CAUSES OF FISTULA:    

The initial cause of fistula is anal abscess of any origin.

ANAL INFECTION:

This is the most common cause of anal fistula.The surgical anal spaces are filled with fatty tissues.Due to poor blood  and nerve supply these spaces have poor resistance to infection.The route of infection may be anal crypts,hematogenic or retrograde from ulcers,injuries,scratches or contamination of perineal region by septic materials.

Rarely impaction of foreign bodies like fish bones may cause anal abscess with fistula formation.

Anal abscess with fistula formation may also occur from injection of sclerosing agents (i.e. injection therapy of piles),into the hemorrhoids or after hemorrhoidectomy .

TUBERCULOSIS:

Sometimes anal abscess may occur as complication of pulmonary tuberculosis.The infection from swallowed sputum enters into the anal spaces through minute ulcer in the anal canal.Retrograde infection may reach in the anal spaces through minute cutaneous scratches at anal region by finger nail contaminated by his own sputum.Incidence of tubercular abscesses with fistula formation varies from 6-16%.

ULCERATIVE COLITIS :

This is the common cause of anal infection leading to abscess and fistula formation.

Overstraining during the course of defecation to evacuate the rectum, excessive intercourse, sitting in unusual position and excessive riding ( like horse, two wheelers etc) obesity, dietary habits, sitting in awkward position, bowel habits and trauma are some other important causes of fistula.

FISTULA SYMPTOMS:

Patient presents with complaints of discharging sinus at anal region, which developed after bursting of anal abscess /Boil/ furuncle(फोड़ा फुंसी) or after inadequate drainage of abscess. Commonly the opening is located at anal periphery within 3-4 cm distance from anal verge.some fistulous openings may occur beyond 4 cm and may be located at perineal,gluteal,sacrococcygeal and anterior perineal region up to the base of scrotal region.The maximum distance from verge may occur up to 13-14 cm.

The discharge might be intermittent or continuous,serous or purulent or mixed with blood,staining the underclothes.

Occasionally opening may be closed,even fibrosed without discharge.Opening may be single or multiple.Openings may be single or multiple on one or both sides of anus.

When there are two openings one on each lateral side,the fistula may be “HORSE SHOE SHAPED FISTULA” which is a bit tough to treat.

Fistula may occur in any age even in infants of six months or in elderly persons above 80 years,but most common between age group of 30-50 years.

Sometimes anal abscess bursts with discharge through the posterior vaginal wall or “BARTHOLIN'S ABSCESS”  may burst with discharge into the anal canal and anterior perineal  region. It is called “RECTOVAGINAL OR ANOVAGINAL FISTULA”. In  these cases the route of infection is through the vagina.

Pain in anal fistula is slight or absent .But when the opening is closed retaining the discharge, the abscess is formed. There is acute moderate to severe pain, which is relieved after the abscess is burst with discharge or it is surgically drained.

Itching at anal region is due to irritating discharge from fistula.

The per rectal digital examination will disclosed a fibrosed, indurated area most commonly in midline posteriorly in anal canal or posterolaterally at or above puborectalis sling where a chronically fibrosed abscess with wide area of induration,tenderness or fluctuation may be palpated.

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