FISTULA IN ANO

**FISTULA IN ANO **

Definition

• Fistula in ano is an abnormal communication between the inside of the anal canal and the skin around the anus.

Types

• Intersphincteric fistula: a fistula that passes between the two sphincters, the internal and external anal sphincters.
• Extrasphincteric fistula: a fistula that passes outside the anal sphincters.
• Transsphincteric fistula: a fistula that passes through the external anal sphincter and then outside it.
• Suprasphincteric fistula: a fistula that originates above the anal sphincters.

Causes

• Infection of the anal glands
• Trauma to the anal region
• Anal surgery
• Inflammation of the anal region (proctitis)
• Certain diseases such as Crohn's disease

Pathology

• The anal glands in the wall of the anal canal can become infected and develop a fistula.
• The infection can spread to the skin around the anus, causing an abnormal connection to form.

Clinical Features

• A constant, thin, and usually painless discharge of pus or mucus.
• A small opening in the skin around the anus.
• The discharge may be accompanied by a foul odor.
• The patient may experience a feeling of incomplete evacuation after defecation.

Investigations

• Physical examination of the anus and rectum.
• Proctoscopy and sigmoidoscopy to visualize the anal canal and rectum.
• Anorectal manometry to assess the function of the anal sphincters.
• Fistulography or CT scan to visualize the fistula.

Complications

• Continual discharge and infection.
• Foul odor.
• Perianal abscesses.
• Fecal incontinence.

Management Strategies

• Initial management involves the application of warm compresses to the affected area to help the abscess drain.
• Antibiotics may be prescribed to treat the underlying infection.
• The fistula may be treated with surgery, either by laying open the fistula tract or by closing it with a seton.
• The patient may be advised to keep the anal region clean and to avoid straining during bowel movements.

Treatment

• Surgical treatment is usually recommended for fistulas that are chronic or complicated.
• The surgery is usually performed under general anesthesia.
• The surgeon will identify the fistula tract and lay it open to allow the abscess to drain.
• The surgeon may also use a seton to close the fistula tract.

Homoeopathic Therapeutic Medicines

• Calendula: for wound healing and to reduce inflammation.
• Aloe vera: to soothe and calm the anal region.
• Hypericum: to reduce pain and inflammation.
• Silica: to promote wound healing and tissue repair.

Operative Method

• The patient is placed in the prone position.
• The surgeon makes a small incision in the skin around the anus.
• The fistula tract is then identified and laid open.
• The abscess is drained, and the fistula tract is closed with a seton.
• The wound is then closed with sutures.