What is an anal fistula?
An anal fistula is an infected track/tunnel that forms between the anal canal and the external skin near the anus. Fistulas occur as a result of an injury (eg fissure) and usually begins due to an infected anal gland.
These infections lead to abscesses, and the pus from these abscesses collect in the area which then pushes its way through the body and creates a tunnel.
Fistulas affect 1-2 people in every 10,000 (taken from research paper – ‘Fistula in Ano and the vital role of Ayurveda inside and outside India’ – on next page)
Fistulas come in all shapes, sizes, lengths and quantity. They are awful to live with and can be extremely debilitating – physically, mentally and financially.
Different types of fistulas
1. Superficial or Submucosal – the fistula tract passes superficially, under the mucosal layer and does not meet either sphincter.
2. Intersphincteric– the fistula tract lies between the internal and external sphincter.
3. Transsphincteric– the fistula tract crosses the external sphincter and often takes on a horseshoe shape.
4. Suprasphincteric– the fistula tract lies between the internal and external sphincters, passing through the puborectalis muscle.
5. Extrasphincteric– the fistula tract begins at the rectum or sigmoid colon and moves through the levator ani muscle. Most commonly found in Crohn’s patients.
Imaging
Below is the scan (which comes with a report) taken of my fistula in Bangalore via a Transrectal Ultrasound (TRUS) – a precise and easy to understand image tracking the exact route of the fistula track.
TRUS imagining is not utilised in Australia for fistula diagnosis.
Australia utilises MRI’s which can also show scar tissue from previous surgeries, which can result in misdiagnoses.
I arrived in Bangalore with a seton which aided in drainage and preparation for treatment in Bangalore.
Thankfully my seton was placed accurately. There are many instances of false tracks being created through forced probing during seton placement.
Seton
Seton placement is used to aid in drainage of the track and prevent it from closing, usually in preparation for surgical intervention. They are also used as a ‘permanent’ fixture, often kept in place for years to continually drain the track, but never to heal it.
Setons are not a cure, but purely a means to prevent the track from closing.
Surgery
Fistulas require treatment as they will not heal on their own. There are many surgical techniques available via Western medicine including:
Lay open fistulotomy (35% chance of success in complex fistulas. Effective for Superficial and Intersphincteric)
Cutting Seton (66% chance of fecal incontinence)
Fibrin Glue Injection (62% rate of failure)
Fistula plug (44% rate of failure)
Advancement flap (43% success rate)
LIFT procedure (40% failure rate)
Perfact procedure (73% success rate)
VAAFT (39% success rate)
(see more information about these procedures in the research paper ‘Fistula in Ano and the vital role of Ayurveda inside and outside India’ – on next page)
Kshar sutra has a 97% success rate and a 3% recurrence rate.
‘REPEATED SURGICAL PROCEDURES INCREASE THE INCIDENCE OF PHYSICAL DAMAGE, ECONOMIC LOSS AND MENTAL HEALTH ISSUES SUCH AS DEPRESSION, PTSD AND NARCOTIC DEPENDANCE’
Will a fistula heal by itself? What about drugs or homeopathy to heal a fistula?
“Homeopathy has had success in drying up a fistula but cannot heal it. The fistula will still physically be there. The reason for this is that the body already recognizes the fistula as healed.
A fistula is an improper way to heal from an internal injury. For example: If we fall and break our leg, the body will immediately begin to heal the break no matter what position the bone is in. Without a skilled person to set the bone the bone will heal in a way which cripples us. At that point we have 2 choices. Manage the pain of a misshapen bone and reduce symptoms (diet, exercise, homeopathy) or have a surgeon rebreak our bone and reset it properly.
A fistula is the same. It developed as a result of the body healing from an internal injury. It took a tube or cavity and healed it by lining it with epithelial tissue. The body has healed the injury but now we have misery. We have 2 choices. Manage the symptoms (homeopathy, diet) or have a surgeon rebreak the epithelial lining and reset the tissue to heal properly.”