About Anal Fistula
Anal Fistula or fistula-in-ano is the abnormal communication between the epithelial surface of the anal canal and perianal skin. Anal fistula is frequently the result of previous or current anal abscess. Fistula can occur spontaneously or secondary to anal abscess.
Anal fistula is termed as Bhagandara in Ayurveda. It means the condition resulted due to laceration or lesion in guda (anus) bhanga (Pubic region) basti (area of bladder). In Ayurveda Fistula or other diseases classified according to the vitiation of one or more doshas i.e. Vata, pitta, kapha. According to Ayurveda boils that about 2 angula (1.5 inches) around the anus if burst open form a track which is known as Bhagandara. It's a kind of Sanipataja Nadivarna (Complimentary Fistula).
What are the causes of anal fistula?
Anal Fistula usually caused by the previous abscess, infection or trauma to that area. Often it is result of chronic discharge of pus or stool from the opening of the skin.
- Crohn's Disease
- Inflammatory Bowel Disease
- Cancer
- Diverticulum Disease
- Radiotherapy
- Tuberculosis
What are the types of Anal Fistula?
- Transsphincter fistula are the result of ischiorectal abscesses with extension of tract through the external sphincter. It accounts about 25% cases of all fistulae.
- Intersphincter fistula are confined to the intersphincteric space and internal space. They result from the perianal abscesses. It accounts about 70% of all fistulae.
- Suprasphincter Fistula are the result of supralevator muscle abscesses. It accounts about 5% of all fistulae.
- Extrasphincter Fistula Bypass the anal canal and sphincter mechanism, passing through the ischiorectal fossa and levator ani muscle, open in the anal canal. It accounts only 1% of all fistulae.
According to Ayurveda anal fistula (Bhagandara) can be classified as follows:-
- Shataponaka - Dominance of vata dosha. Excess intake of dry, astringent, spicy and pungent substances cause vitiation of vata dosha and in turn they cause the boil in the anal region.
- Ushtragreeva - Dominance of Pitta dosha. Due to intake of spicy, hot substances and relative habits pitta dosha aggravates and in turn they from blood filled/oozing blisters around the anus and discharge with smell.
- Parisraavi - Dominance of kappha dosha. Due to intake of cold, beverages, unctuous food and relative habits kapha dosh severely aggravates in turn there is a formation of bigger boils. They hard, stable and mature gradually. When these boils are burst open the track appear with white discharge (Pus) with mild pain.
- Shambookavarta - Dominance of all three dosha Due to aggravation of all three doshas (Vatta, Pitta, Kapha) multiple color blisters formed around the anus and anal region.
- Unmargi - Due to injury /external cause this kind of Bhangandara is due to injury or prick of needle, nails and stick over the perianal region. Small abrasions are formed due to this and they get worsen due to bad food habits
What are the Symptoms of Anal Fistula?
- Pain which is usually throbbing, constant, worsen in sitting position.
- Discharge of pus and blood.
- Constipation or pain associated with bowel movement.
- Fever.
How to Diagnose Anal Fistula?
Usually in clinical examination, digital rectal examination is sufficient to diagnose the anal fistula.
But some Patients requires additional test also:
- Sexual transmitted infection.
- Inflammatory bowel disease.
- Rectal cancer.
What is the Prognosis of Anal Fistula?
According to Ayurveda it is most miserable and critical disease due to bad prognosis. Due to bad prognosis there is a maximum chances of reoccurrence. Among these Sambookavarta and urnmargi is difficult to treat. The fistula which is associated with severe discharge, worms and stool in its discharge is incurable.