Fistula in Ano (Bhagandar):

• Fistula in Ano is a chronic inflammatory condition having a tubular structure, opening in Ano rectal canal at one end and surface of perianal skin on the other hand.
• Classical fistula has two openings. One iteral (in Ano-reclalcanal) and other external (in the skin of peri anal area).
• Chronic pus discharge in the peri anal area indicates – fistulous opening.
• Pain off and on, pus discharge from external opening some time it closes itself anal again opens after the pus formation.
• Deep seated abscess in the source of pus.

Causes of Fistula:

• An acute abscess in one or more potential spaces around Anorectad canal. Source of infection could be a number of predisposing conditions e.g.
• Infection at the root of pile. mass.
• Infected and inflamed anal crypt.
• Traumatized muco-cutaneous lining of Ano rectal canal due to indigested foreign body e.g. fish bone.
• Inflamed and /or thromboseal condition of previously existing pile mass.
• Retained sutures after Haemorrhoidectomy.
• Injection of chemical for treating piles.
• Foreign Body Penetrating from out side.
• Radiation burns from x-Rays and radiotherapy.An anal fistula usually starts because a gland in the anus becomes blocked and infected. Instead of the infection breaking through back into the anus, it breaks through to the skin next to the anus and thus creates a tunnel. As long as the internal opening does not close up, the fistula usually do not heal.

An anal fistula may also follow after an abscess that has been drained. This could be that at the time of the abscess, there was already an opening to the inside of the anal canal from the abscess but was not evident at the time of surgery for the drainage of the abscess. This manifests itself as persistent draining of pus from the wound of the incision and drainage, and that the wound would not close completely.

What are the symptoms of an Anal Fistula ?

Some fistulas start as a small pimple around the anus. This bursts and some pus and / or blood is discharged out. It then heals, but after a period of time, the pimple can form and burst again.
Another way that the fistula may manifest would be after an abscess has been drained. The wound heals nicely initially, but even after a long time, does not close completely. In some cases, the skin heals, but soon has a swelling under the scar, and then pus comes out when the point in the scar burst.

Diagnosis of a Fistula:

Most of the time, a history of repeated swelling and discharge can point towards the diagnosis of the abscess, and examination of the area may even reveal the presence of the tract that leads from the skin into the anus.
For some complex fistula, additional imaging such as endoanal ultrasound (by putting a small ultrasound probe into the anus) or magnetic resonance imaging (MRI) may be required to see the entire length of the fistula tract.

Treatment:

There are several stages to treating an anal fistula:

Kshar-Sutra Treatment:

This method is most effective non surgical method. This treatment can be done by an Ayurvedic physician. In this method medicated Kshar-sutra is applied through the fistula tract with the help of special probe and it is changed weekly. Within few weeks the fistula tract is cured. Successful rate in this treatment are tremendous. Few surgeons who are aware of this treatment are also suggesting this treatment to the patients.