About Fistula in ANO

A fistula is defined as the connection of two body cavities or as the connection of a body cavity to the skin (such as the rectum to the skin). This is not a normal occurrence. One way a fistula may form is from an abscess (pus in the body). The abscess may be constantly filling with body fluids such as stool or urine, which prevents healing. Eventually the fistula breaks through to the skin, another body cavity, or an organ.

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Know More about Fistula in ANO



  • An anal fistula usually develops after an anal abscess (a collection of pus) bursts.
  • When an abscess has not been completely treated.
  • A fistula can also be caused by conditions that affect the intestines, such as Croon’s disease or ulcerative colitis.
  • Tuberculosis.
  • As a complication of previous surgery.


  • Pain (usually relieved after discharge of pus).
  • Discharge-either bloody or purulent.
  • Itching.
  • Systemic symptoms, if abscess becomes infected like Fever, Weakness etc.


Requirements:  A simple standard classification of the types of anal fistula was described by Parks. The classification is particularly helpful in determining the type of treatment required by the patient.

There are basically 2 broad groups of anal fistula in clinical practice-simple and complex anal fistula.

The ‘complexity’ of the anal fistula is basically dependent on:

  • The amount of anal sphincter muscle involvement.
  • Presence of more than one anal fistula(secondary tract and/or with abscess cavity).
  • Anal fistula with tracts above the anal sphincter complex or with the internal opening in the lower rectum or with the external opening further away from the anal verge.
  • Anal fistula associated with other diseases (eg. Croon’s disease, tuberculosis).

‘Complex’ anal fistula is a more severe form of anal fistula. They will definitely require more complicated treatment. Sometimes, the treatment for these fistula is carried out in stages.



  • The opening of the fistula onto the skin may be seen.
  • The area may be painful on examination.
  • There may be redness.
  • An area of induration may be felt-thickening due to chronic infection.
  • A discharge may be seen.
  • It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this may be possible to find both openings of the fistula.
  • In complicated fistula some invasive investigations may be advised like Fistula grapey, Endo-Anal Ultrasound, MRI-Fistula gram etc.


Conservative Therapy

  • Sits baths
  • High fibre diet
  • Topical Analgesics
  • Antibiotics
  • Laxatives

Kshar Sutra Therapy

  • Indications.
  • Non-healing fistulas.
  • Complex anal fistulas.
  • High Rectal fistulas in which surgical interventions may cause incontinence (loss of control of bowel movements).
  • Increased risk factors for complications.
  • Patients not suitable for major surgery.
  • Patients not responding to major surgeries and fistula appearing again and again.

FAQ About Fistula in ANO

Most frequent questions and answers

An anal abscess is an infected cavity filled with pus found near the anus or rectum. If the skin over the abscess breaks, us may discharge out. Many people may confuse this with haemorrhoids (piles).

An anal fistula, almost always the result of a previous abscess, is a small tunnel connecting the anal gland from which the abscess arose to the skin of the buttocks outside the anus.

No. A fistula develops in about 50 percent of all abscess cases, and there is no way to predict if this will occur.

Yes, if not treated, the Fistula tract can branch into the facial layers of perianal region. Abscesses can also recur if the fistula seals, allowing the accumulation of pus. It may then point of the surface at the same site or different site, and the process repeats. This way more than one fistula openings may develop.

Duration of Kshar Sutra Therapy for Fistula-in-ano depends on the length, type and location of the Fistula. It requires weekly seating’s to change the Kshar Sutra.

Most patients can be discharged the same day after the Kshar Sutra Therapy. Discomfort after surgery can be mild to moderate for the first week and can be controlled with pain pills. You can resume your daily work within 3-4 days.

After every 1 week, old Kshar Sutra will be replaced with a new Kshar Sutra. Some pain and burning sensation is expected for first 24hrs after changing the Kshar Sutra as the medicine on the new Kshar Sutra is fresh. The amount of time lost from work or school is usually minimal.

Treatment of an abscess is followed by a period of time at home, though the patient may need to see a family clinic daily for dressing of the wound. It may be necessary to wear a gauze pad or mini-pad to prevent the drainage from soiling clothes. Bowel movements will not affect healing.

Recurrence rate after Kshar Sutra Therapy is negligible. However, it is important to follow the directions of your doctor to prevent recurrence or development of a new fistula at a different site.

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Piles is the swelling of the blood vessels near the anal opening.

Fissure in ANO

An anal fissure is a small cut or tear in the lining of the anus.

Pionaidal Sinus

A Pilonidal Sinus (PNS) is a small hole or tunnel in the skin.