Anal Fistula - First Hand Experiences

Fistula never jumps on you - it gives you fair warning. That fair warning is through constipation. One of the most important things for a healthy life is the ability to pass motions freely everyday. Chronic constipation is a sign that you body is crying for help & this cry for help should not be neglected.  I had recurring cases of constipation over the previous 15 years. After the initial bout of constipation, I had blood in my stool and was diagnosed with anal fissure. It's also referred to as hemorrhoids. Anal fissure is a pretty simple problem by itself. It happens when the stool becomes so hard that when you strain to pass motion, it essentially rips the internal anal lining. It's like ripping your internal muscle with hardened stool. Why did I have this ? It was mainly about food habits at that time.  Fissures can be extremely painful. One of the worst consequences of a painful fissure is that to avoid the pain, your body will stop the passing of motion. This means y...

 After about 10 years of recurring cases of constipation, some of which led to anal fissure, I was hit with the first step towards a fistula. I was travelling for work - sitting for long hours during the travel & significantly changed diet over the next few days. On the 2nd day of my travel, I found a large lump on my buttocks near my anus. The lump was turning black & was pretty hard & a bit painful. It was about the size of large gooseberry or a small tomato. Whenever I have boils on my body, I consider it to be an expression of the Ayurvedic concept of 'ushna' i.e. overheating of the body. I assumed this lump too was a boil due to an overheated body. To reduce the heat, I took fenugreek seeds (methi seeds). Fenugreek seeds had a salubrious effect & the size of the lump reduced significantly. However, during my 2 weeks of travel, the lump persisted even though it was under control thanks to a daily dose of fenugreek seeds. Once I was back in my home, after 15 ...

 I set out to understand what this fistula was all about. I had never heard of this before & hence I relied on internet searches to understand this. There are many reliable sites that help you understand about anal fistula - just google it. But here, I will share a basic summary.  What's a fistula ?                A fistula is a narrow tunnel or passage way that links one organ to another. So a fistula can form not just near the anus, but in other organs too.      2. What's an Anal Fistula ?           This is a pipe/tunnel that is formed that abnormally connects the inside of the anus to the external           skin of the buttocks. This is the most common type of fistula. It's important for you to understand                this very clearly. Here's a picture from wikipedia that is a reasonable view of a fistula...

The anal fistula is just a pipe between your anus & the external skin. So by itself, it cannot cause any major problem. But because it's connected with the anus which is the place through which fecal matter passes, the same fecal matter will also pass through the new pipe/tunnel. You will also find that when you fart, some part of the fart will pass through this tunnel giving you a very uncomfortable, but not painful, feeling.  However, this is not a natural body opening - it's an abnormal one & so it's not suited to allow passing of fecal matter. So it will get infected and/or clogged due to such fecal matter passing into it. The following symptoms will be there: There will be persistent swelling around that area.  The skin area around the fistula will turn darker compared to the rest of your buttocks.  A constant flow or seepage of pus like fluid will be discharged from the fistula. The amount of discharge will vary based on the level of infection at the time. T...

OPTIONS: With the diagnosis being anal fistula or the more medical term "fistula-in-ano", I started looking for second opinions and alternative treatments. My research using the internet gave me the below: The fistula will not cure on it's own if left untreated There is no non-surgical treatment for anal fistula While there are many available options in allopathic medicine to treat fistula, the most common & recommended ones in India: a. Fistulotomy - This is essentially cutting your skin & muscle all the way from outside until the fistula tract. If you think of fistula as a road tunnel, fistulotomy is like demolishing the roof of the tunnel. This means the tunnel will no longer be a tunnel, but just another open road. This has been historically the most common way to treat a fistula b. Fistulectomy : This is more recent method which involves closing the fistula by stitching it. Before that they stitch they also remove the inner flesh of the fistula as it would ha...

 I visited a well known Ayurvedic physician in my city. This person was affiliated to the renowned 'Kottakal Arya Vaidya Sala' too. For those who are not aware the Kottakal Arya Vaidya Sala is a very old & premier ayurvedic hospital & pharamaceutical company based in Kottakal in Kerala. Ayurvedic medicines from this brand are considered to be one of the best. My family has had a good previous experience with this Ayurvedic physician and so I paid a visit with my case file. Unfortunately, he said that he does not perform Ksharasutra, but said that he would want to try a more conservative treatment using oral medicine. He said that this might not even be a fistula, but just an infection due to the abcess. This was wishful thinking from my side. I should have ideally got myself examined (through MRI) to be sure if there was a fistula or not. But at that time, I was glad to be able to find any solution that could prevent a surgery as surgery was fraught with later complicat...

With the option between the Allopathic surgery & the Ayurvedic parasurgery, I chose the latter. My main motivation was to avoid recurrence & incontinence in the long term. I took an MRI fistulogram. It showed that my fistula was a Grade 4 Trans-sphincteric fistula with ischioanal abscess. This essentially meant I was had scored 4 out of 5 on a complexity scale. It also showed that the fistula also had developed a secondary path. Secondary path means that apart from that single pipe of fistula, it was starting to develop a branch mid way. I am not sure if this secondary tract existed initially or not, but my guess is that my 2 years of playing wishful thinking with the fistula had resulted in the secondary tract. The 2 to 3 instances of inflammation & clogging of the fistula tract during my 2 years of wishful thinking, would have led to the infection spreading to form a new branch i.e. secondary tract. The next decision was one of "Which doctor to choose" for Kshar...

Usually Ksharasutra procedure involves the following: 1. Initial Threading - It's usually done under local anesthesia, where a probe (think of it as long needle) with a surgical thread tied at one end is inserted through the fistula tract, extracted through the anus & the 2 ends tied.  2. First Kshara threading - The following day, the surgical thread is replaced by a Ksharasutra (literal translation is Caustic Thread).  3. Weekly rethreading - This is the weekly replacement of the Ksharasutra with a new Ksharasutra. All of this is accompanied by internal medicines to be taken orally.  In my experience, the initial threading was almost uneventful. It lasted for about 30 mins & was done under local anesthesia. I did not find much pain. I was able to walk immediately after the procedure and there wasn't much discomfort on that day. The first kshara threading was a different experience though. The threading itself was not too traumatic, but the next few hours ...

 After the secondary tract was considered reasonably healed, the doctor started tightening the Ksharasutra. The pain for the first 2 hours & the next 3 days turned out to be directly proportional to the tightening of the thread. In my case, apart from tightening the thread, a double thread was used to increase speed of cutting. The first time they tightened it with a double thread, the pain lasted the entire week. My doctor was usually very concerned about making it as painless for me as possible. So if I had a really painful week, she would loosen the thread in the next sitting to allow me to recover. Apart from my pain perception, she said that she wanted to avoid over traumatizing the tissues & hence some relaxation in the thread tightening. As I had told you, I was getting treated at an Ayurvedic medical college. While my doctor performed the procedure for the first many weeks, she started handing over the rethreading process to some interns (post grad students) in the ...

 After my switch from the medical college to a private clinic, the process remained the same. The only difference was the confidence that I had my doctor's full attention & was always in capable hands. During this time, as fate would have it, the thread once again came out of the tract on of it's own. It probably got frayed. This meant one more threading using the probe. Couldn't blame anyone this time.  However one more change happened. The pain from the rethreading almost vanished. My doctor said that the reason was because of a change in the thread composition. Now let's understand the KsharaSutra better.  The Ksharasutra or Caustic thread, is nothing but a surgical thread on which alternating layers of caustic alkaline chemicals & healing medicines are applied. In this mix, also comes a binding agent which works with the alkaline caustic chemical. I think there are about 7 layers of each applied on the thread. Preparation involves soaking the thread in the c...

After the fistula tract got fully cut, there was small but gaping wound that exposed the fistula tract. This was followed by about 2 weeks of wound dressing using Ayurvedic medicine (a type of clarified butter called Ghritam) and also dressing using silver colloidal gel. Thankfully the wound healed well in about 15 days. Followed by that, another 6 weeks of wound healing was necessary. Some internal medicines to help the healing were prescribed. The wound thankfully healed without complications, but the caveat is that fistula can recur. My doctor has said the chance of recurrence is about 20% & asked me to be careful It is important that there I avoid any trauma to the anal area. Trauma to the anal area is of 2 types - Internal trauma caused by indigestion, constipation etc. External trauma caused by long hours of sitting, uncomfortable seating pose like while reading a bike etc.  It's critical for me to avoid both kinds of trauma to give my body a chance to recover well & ...

 Here are some lessons that I have learnt during my struggle with Fistula Preventive Take Constipation seriously :  While it may appear to be trivial, if it continues or recurs, it's a cry for help from your body. Take farting seriously :  Farting is usually a topic of jokes, but for the body it is not. If your frequency of farting increases, please consult a doctor. Many doctors are theoretical about this & so is internet advice. They say it's okay to fart upto 2 times a day, but listen more to your body than to statistics that average millions of cases. If you rarely used to fart & are now farting every waking hour, then there's something wrong. So is the case, if the smell of your fart changes. Sedentary work is poison: Most while collar jobs are sedentary. Human physical evolution has been slower than the pace of social evolution. Our bodies still need a lot of activity to be fit. If you can't avoid sedentary work, ensure that you take breaks frequently. Ge...