Advanced Laser Fistula Treatment
Anal Fistula
What is Anal Fistula?
An anal fistula is a tunnel that runs from the anal opening and connects the skin around it. An anal fistula mostly forms after an infection that did not heal properly. In human anatomy, the external opening through which feces are expelled is known as the anus. Multiple small glands that make mucus are located inside the anus. When these glands get clogged and infected due to dirt and debris, it can lead to the formation of an abscess. Most of these abscesses turn into an anal fistula
How does Anal fistula form?
When the abscesses that form near and around the anal mucosal tissues are not treated, it tends to keep growing and worsening over time. Eventually, the abscess punches out like a hole making its way outside the skin.
Types of Anal fistula
☛Intersphincteric
☛Transsphincteric
☛Suprasphincteric
☛Extrasphincteric
☛Transsphincteric
☛Suprasphincteric
☛Extrasphincteric
Causes
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Trauma to the anal tissues
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Infection in the anal gland
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Radiation from cancer treatment
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Crohn’s disease
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Sexually transmitted disease (STDs)
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Tuberculosis
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Diverticulitis
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Cancer
Symptoms
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Pain and swelling around the anus
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Frequent anal abscesses
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Foul-smelling bloody drainage from anal opening
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Presence of blood in stool
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Pain during bowel movements
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Fever, chills and fatigue
Risks & Complications
During the surgery
Like any other surgical treatments, there are potential risks and complications associated with surgery if anal fistula too. Common complications may include:
Infection – When incisions are made in the skin, every surgery carries some risk of infection. The same is with the procedure of fistulectomy. In certain cases, where the fistula tract is too deep, the doctor might need to perform the surgery in several stages. In that case, there is a high possibility that the fistula might spread throughout the body and cause systemic infection. In case of infection from anal fistula, the doctor might prescribe antibiotics. If the infection is too severe, the patient might even require to get admitted to a hospital and undergo intravenous administration of antibiotics.
Bowel incontinence – If the fistula surgery is not performed by an expert anorectal surgeon, there are chances that the anal sphincter muscles may get damaged. The anal sphincter muscles are responsible of keeping the anus and controlling the bowel movements. In any case, if the sphincter muscles are damaged, the strength of the anal muscles are compromised which may cause leakage of feces. This condition is known as bowel incontinence. Bowel incontinence is estimated to affect 3-7 percent of the total patients who undergo anal fistula surgery.
Anal fistula recurrence – An estimated 7-21 percent of patients who have undergoes surgery for anal fistula suffer from recurrence of anal fistula after surgery. The chances of recurrence is ten highest in case of treatment of anal fistula through fibrin glue.
If left untreated
If you are diagnosed with any anorectal disease including anal fistula, it is always better to undergo treatment without delay. In the words of a senior proctologist at Surgical Sathi, “Home remedies should not be relied for long duration if you have been diagnose with anal fistula or any other anorectal disease. Home remedies can only help reduce the severity of symptoms such as pain, swelling, soreness, redness, and inflammation in the anal region. For a permanent cure, undergoing surgery is the only safest and best method.”
If left untreated, anal fistula can lead to the following complications:
Unbearable pain – Untreated fistula-in-anal can cause severe and unbearable pain in the anal area. The pain can get worse with time and even the condition might be complex to treat. Untreated anal fistula is likely to cause foul smelling anal discharge that can hamper your lifestyle and make you feel embarrassed.
Unable to sit or walk – Diseases like anal fistulas can make you feel uncomfortable while sitting and walking. So, it is advised to undergo surgery as soon as you are diagnosed with any of them.
Extension of anal fistulas – An untreated anal fissure can extend into the internal anal sphincter muscle that holds your anus closed. In such cases, it is difficult to heal the fissure and can cause severe pain and discomfort that would require medication therapy along with surgical intervention.
Complications that can be caused as a result of delayed treatment for anal fistulas may also include:
Sharp pain during bowel movements
Burning and itching sensation in and around the anus
Leakage of pus from the anus
Formation of skin tags or lumps at the anal area
Development of anal ulcers.
When to consult a doctor for anal fistula?
Many people tend to ignore the early symptoms of anal fistula. Not knowing the symptoms of the disease can make you ignorant of the fact as to when to approach the right doctor. Getting medical treatment and professional help can help you avoid timely complications of the condition. If you experience any of the following signs, it could be an indication of anal fistula. Without further delay, you should consult with an anorectal surgeon in that case:
If you notice foul-smelling discharge from your anal region.
If you see blood in your stool or blood in the toilet seat/ tissue paper, consult with a doctor at the earliest. Blood in the stool is a common sign for most anorectal disease and not fistula-in-ano alone. Hence, this symptom needs to be discussed with the doctor to evaluate the condition and to determine the best course of treatment.
When no medication and home remedies provide you relief or effective results from your symptoms.
If you notice foul-smelling discharge from your anal region.
If you see blood in your stool or blood in the toilet seat/ tissue paper, consult with a doctor at the earliest. Blood in the stool is a common sign for most anorectal disease and not fistula-in-ano alone. Hence, this symptom needs to be discussed with the doctor to evaluate the condition and to determine the best course of treatment.
When no medication and home remedies provide you relief or effective results from your symptoms.
Treatment Options & Cost
Non-surgical treatments
Fibrin glue – Fibrin glue is a therapeutic for anal fistulas which activates thrombin to form a fibrin cloth. The procedure helps close the fistula tract mechanically. Fibrin glue is a liquid sealant thought to assist in fistula tract healing by stimulating migration and activation of fibroblasts.2 It is a tempting treatment modality: the technique is simple, repeatable, and involves only minor surgical trauma to the anal sphincter. Fibrin glue treatment is very easy to use and is considered as a good treatment for people who are not in favor of surgery. However, fibrin glue is not the best replacement for skilled anorectal surgery.
Seton placement – This procedure involves placing a suture or a rubber band (also known as seton) in the anal fistula that is progressiveley tightened. The rubber band lets the fistula heal behind the seton. The treatment is non-invasive and the risk of recurrence is also quite low.
Surgical treatments for anal fissure
Once you have developed anal fistula, antibiotics or home remedies alone will not cure the condition. You will require surgical intervention to get the condition treated. Surgical options for anal fistula treatment include:
Fistulotomy – In this treatment, the fistula is opened and allowed to heal from inside out. The surgery is usually an outpatient procedure. As such, the patient can return home the very same day.
Laser surgery for snal fistula – Laser treatment for the closure of fistula-in-ano is a minimally invasive and low-complication treatment which is considered as the most effective treatment for complex fistulas. The treatment does not cause any severe damage or injury to the sphincter muscles.
How to prepare for anal fissure surgery?
Anal fistula surgery is not a very complicated treatment and as such requires no thorough preparation. The preparation is even simpler in case of lser surgery for anal fistula. But like any other surgery, of complications/ side effects in case of suregry for anal fistula too. Hence, you need to follow the doctor’s instructions to ensure that your surgery goes well and you recover without any complications. Before your surgery for anal fistula:
Do not eat or drink anything heavy. Eat a very light meal, preferably only breakfast.
Do not drink any form of carbonated or caffeinated drinks, just consume clear liquids at least for 5 hours before the surgery.
If you are on any anti-inflammatory, allergy medicines or any blood thinners, the doctor will recommend you to stop it as soon as possible before the treatment.
Stop smoking and drinking alcohol. It will help you heal faster after the surgery.
Recovery after surgery
The recovery route after anal fistula surgery is usually simple with no major complications. If you follow the doctor’s recommendations and tips with diligence, you will not experience any complications. Here are a few tips that can help you heal and recover easily after anal fistula surgery:
Eat a diet rich in fibre.
Avoid lifting heavyweights.
Use a stool softener to help you in having smooth bowel movements.
Stay hydrated. Drink at least 8-10 glasses of water every day.
Do not strain while passing a stool.
Cost of Piles Surgical Treatment in India
Cost of anal fistula surgery in Delhi – Rs. 40,000 to Rs. 50,000
Cost of anal fistula in Gurgaon – Rs. 40,000 to Rs. 50,000
Cost of anal fistula in Pune – Rs. 35,500 to Rs. 45,000
Cost of anal fistula in Mumbai – Rs. 37,000 to Rs. 45,000
Insurance coverage
Anal fistula treatment is generally covered under health insurance. Most insurance companies offer a specific amount of coverage for anal fistula and other anorectal diseases. The amount of coverage you have will depend on the policy you buy.
One thing you should know is that medical treatment for anal fistula won’t be covered in the insurance policy. Only the expenses of surgical treatment are covered and you also need to be hospitalized for at least 24 hours to file for a claim. You can opt for cashless payment or get reimbursement claims from your insurance providers as well.
If your claim is approved, you will be able to cover the entire cost of treatment, including diagnostic tests, medications, hospital stay, bed charges, and other consumables. Some of the best and most popular healthcare insurance providers are Oriental, Religare Health, Manipal Cigna, United India Insurance, Care Health, New India Insurance, Star Health & Allied, Bajaj Allianz General Insurance, ICICIA Lombard, Max Bupa Health Insurance.
One thing you should know is that medical treatment for anal fistula won’t be covered in the insurance policy. Only the expenses of surgical treatment are covered and you also need to be hospitalized for at least 24 hours to file for a claim. You can opt for cashless payment or get reimbursement claims from your insurance providers as well.
If your claim is approved, you will be able to cover the entire cost of treatment, including diagnostic tests, medications, hospital stay, bed charges, and other consumables. Some of the best and most popular healthcare insurance providers are Oriental, Religare Health, Manipal Cigna, United India Insurance, Care Health, New India Insurance, Star Health & Allied, Bajaj Allianz General Insurance, ICICIA Lombard, Max Bupa Health Insurance.
Recovery Timeline
"The healing capacity of every person is bound to bedifferent and hence the timeline of recovery after anal fistula surgery varies for all. In most cases, recovery after open surgery for anal fistula takes around 2-3 months and complete recovery after laser surgery takes 1 month to 45 days.
Recovery after 1 month
For at least 1 month after anal fistula surgery, the patient needs to follow the recovery tips and recommendationsof the doctor. It is advised that the patient avoids doing anything that puts strain on the surgical site. The patient should avoid eating anything too oily and spicy and consume only food rich in fibre. The patient should keep the surgical area free of any infection and take regular sitz baths.
Recovery after 2 months
After 2 months, the patient would experience much relief from the pain at the surgery site. But the scars might take some more time to disappear. The patient might get back to normal work life without any major complications and also resume normal dietary habits.
Recovery after 3 months
After 3 months, the patient would be free from all post-surgery discomfort. There would be no scars at the surgical site and the wound would be healed completely too. "
Recovery after 1 month
For at least 1 month after anal fistula surgery, the patient needs to follow the recovery tips and recommendationsof the doctor. It is advised that the patient avoids doing anything that puts strain on the surgical site. The patient should avoid eating anything too oily and spicy and consume only food rich in fibre. The patient should keep the surgical area free of any infection and take regular sitz baths.
Recovery after 2 months
After 2 months, the patient would experience much relief from the pain at the surgery site. But the scars might take some more time to disappear. The patient might get back to normal work life without any major complications and also resume normal dietary habits.
Recovery after 3 months
After 3 months, the patient would be free from all post-surgery discomfort. There would be no scars at the surgical site and the wound would be healed completely too. "
“Surgery ke sath bhi, Surgery ke baad bhi”
— Hum hain na
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