Most notorious anal condition with high incidence of recurrence
ANAL FISTULA
An abscess around the anal orifice that ruptures spontaneously can often lead to an anal fistula. Perianal, ischiorectal, and pelvirectal abscesses are common precursors. A fistula is essentially a tunnel-like wound connecting the anal canal (or sometimes the rectum) to the skin. Causes range from simple local injuries or infections to more serious conditions like ulcerative colitis, intestinal tuberculosis, and colon cancer. Symptoms typically begin with a painful swelling in the buttock or around the anus. If the abscess isn't drained, it will eventually burst, draining externally and leaking into the anal canal or rectum. While some cases heal naturally, most do not, leaving a small opening that repeatedly swells, drains pus, and subsides.
Anal fistulas typically require surgical intervention. Underlying conditions like tuberculosis or ulcerative colitis are often managed medically. It's important to note that fistula surgery may not be a one-time fix, as recurrence is common, sometimes necessitating multiple procedures. Repeated surgery can damage the anal sphincter muscles, potentially affecting continence.
To understand why this is a concern, it's crucial to understand the anatomy. Two sphincter muscles surround the anal canal: the external anal sphincter (EAS) and the internal anal sphincter (IAS). The EAS is composed of voluntary muscle fibers (under conscious control), while the IAS consists of involuntary muscle fibers (regulated by the nervous system). These sphincters are essential for controlling bowel movements and gas. Repeated injury to these muscles, as can occur with multiple fistula surgeries, can impair their function, leading to difficulty controlling stool or gas.
Therefore, choosing a minimally invasive surgical approach with a high success rate is crucial. Ksharasutra treatment, an Ayurvedic procedure, is one such option. Other techniques, such as video-assisted anal fistula treatment, laser closure, and fistulectomy, are also used with varying degrees of success.