Anal Fistula

                                                       Anal Fistula

   Anal Fistula is a chronic abnormal communication between the epithelialized surface of the anal fistula and usually the perianal skin. An anal fistula can be described as a narrow tunnel with is internal opening in the anal canal and its external opening in the skin near the anus. Anal fistula commonly occurs in people with a history of anal abscesses. They can form when anal abscesses do not heal properly. 

  Anal fistula originates from the anal glands, which are located between the internal and external anal sphincter and drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually extend to the skin surface. The track formed by this process is a fistula. Abscesses can recur if the fistula seals over, allowing the accumulation of pus. It can then extend to the surface again- repeating the process. 

  Anal fistulae per so do not generally harm, but can be very painful, and can be irritating because of the drainage of pus. Additionally, recurrent abscesses may lead to significant short term morbidity from pain and, importantly, create a starting point for systemic infection.

  Treatment, in the form of surgery, is considered essential to allow drainage and prevent infection. Repair of the fistula itself is considered an elective procedure which many patients opt for due to the discomfort and inconvenience associated with an actively draining fistula. 

  Homeopathy is an excellent alternative mode of treating many surgical diseases including anal fistula. It is particularly beneficial for treating anal fistula. In most cases, homeopathic medicines save a person from undergoing surgical procedures for this painful problem. 
  
 The best homeopathic medicine for anal fistula treats the condition with gentleness and safety and with no side effects because of its natural origins. With regular use of homeopathic medicines, the discharge associated with anal fistula gradually decreases and the symptoms of pain, swelling, and itching are also managed. In addition, homeopathic treatment for anal fistula helps in healing the tract of fistula. The natural medicines assist in regularising bowel movement and treating hard stool, which could otherwise lead to a recurrence of symptoms. They are also helpful in cases of anal fistula that reform even after surgical correction in the past. 

Causes: 

  An anal fistula is a small tunnel with an internal opening in the anal canal and an external opening in the skin of the perianal area. An anal fistula usually results after improper healing of being anal abscess following pus drainage. It may also appear as a result of surgery near the anus. Other causes for anal fistula are Crohn's disease, diverticulitis, syphilis, tuberculosis, and sexually transmitted infections. 

Symptoms of Anal Fistula: 

  Predominant symptoms of an anal fistula are fluid/ pus discharge from the opening near the anus. The discharge may even be throbbing. The attending features are perianal swelling and pain. the pain could vary in natural bowel movement. Symptoms can include burning and irritation or itching in the perianal area. Fever may also be present in a few cases. 
- Skin maceration
- Pus, serous fluid, feces discharge can be bloody or purulent 
- Pruritus ani- itching 
- Depending on the presence and severity of infection:
  - Pain
  - swelling
  - tenderness
  - fever
  - unpleasant odor
- Thick discharge, which keeps the area wet.

 Classification:

  - Park's classification: this was done by parks: From the UL in 1976, before MRI or endoanal ultrasound was available. It classified the fistula in four grads. 
- Garg classification: This was done by Pankaj Garg in 2017. This classification is an improvement. Over both Parks and St James University Hospital Classification. This was based on MRI studies and operative findings in 440 patients. It classified the fistula in five grades. The grades of this classification correlate quite well with the severity of the disease. 
Grade I & II  are simpler fistulas and can be managed by fistulotomy whereas grade III-V are complex fistulas in which fistulotomy should be not be done. They should be managed by fistula experts.  

Types: 

  Depending on their relationship with the internal and external sphincter muscles, fistulae are classified into five types: 

- Extrasphincteric fistulae begin at the rectum or sigmoid colon and proceed downward, through the levator ani muscle and open into the skin surrounding glands are located. Causes of this type could form a rectal, pelvic or supra levator origin, usually secondary to Crohn's or an inflammatory process such as appendiceal or diverticular abscesses. 

- Suprasphinteric fistulae begin between the internal and external sphincter muscles, extend above and cross the puborectalis muscle, proceed downward between the puborectalis and levator ani muscles, and open an inch or more away from the anus. 

- Transphincteric fistulae begin between the internal and external sphincter muscles or behind the anus, cross the external sphincter muscle and open an inch or more away from anus. These may take u shape and form multiple external openings. This is sometimes termed a"horseshoe fistula". Intersphincteric fistulae begin between the internal and external sphincter muscles, pass through the internal sphincter muscle, and open very close to the anus. 

- Submucosal fistulae pass superficially beneath the submucosa and do not cross either sphincter muscle. 

Get plenty of fiber:

  If you're constipated, passing large, hard, or dry stools can cause an anal fissure. Getting plenty of fiber in your diet, especially from fruits and vegetables can help prevent constipation, though. get 20 to 35 grams of fiber per day. foods that are good sources include:
- Wheat Grain, Oat Grain
- Whole grains, including brown rice, oatmeal, popcorn, and whole grain kinds of pasta, cereals, and bread. 
- Peas and beans, seeds and nuts, prunes and prune juice. 

Stay Hydrated:

 That can help you prevent constipation, drink plenty of liquids adds fluid to your system, which can make stools softer and easier to pass.
- Be sure to drink more when the weather gets warmer or as you become more physically active. 
- Not all drinks are good choices for staying hydrated. Too much alcohol can dehydrate you. Also, although a caffeinated drink may help you go to the bathroom, too much caffeine can dehydrate you as well. 

 Exercise:

 One of the most common causes of constipation is lack of physical activity. Exercise for at last 30 min most days to help keep your digestive system moving and in good shape. 

Don't ignore your urge to go:

 If your body tells you it's time to have a bowel movement don't put it off till later. waiting too long or too often can weaken the singles that let you know it's time to go. The longer you hold it in, the dryer and harder it can get, which makes it tougher to pass.  



Write To Dr. FAROOQ KHAN : 

Write to Dr. FAROOQ KHAN and get a reply on how homeopathy can help you in treating your disease condition.