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We often talk about Piles and constipation but is Fistula also an associated term or is it something else. Let’s try to find out from Dr. Parmeshwar Arora.
Q. What do we mean by the term Fistula? Is it associated with Piles or it is a different condition?
Fistula and Piles are quite different from each other. Though they can be considered similar in the sense that, like piles, Fistula is also an anal disorder or rectal disorder. In case of piles, there is formation of vascular mass or hemorrhoid whereas in case of fistula, there is formation of a tract and generally this tract originates from anal canal and opens on the outer surface of skin. Thus, while fistula is tract, piles is a mass of vascular tissue or a condition of venous dilatation i.e. inflated vein.
Q. It means Fistula is a bit different from piles though somewhat related with it. What are the problems associated with fistula which are significant to it?
In case of external piles, the patient experiences acute pain and in case of internal piles, the patient has bleeding. About fistula we can say that it is such a tract which is unable to heal and the patient has severe pain when he sits. It has two openings-first at the anal canal and the second on the outer surface, as a pore, where it can be seen as an abscess. So we can distinctly differentiate the patient of fistula from the patient of piles, when he tells us that he has an abscess near the anal canal which sometimes secretes puss and blood. Thus, when there is pain and secretion, it is condition of fistula. In my opinion, this condition is more complicated and severe as compared to piles.
Q. When does this condition occur in our body?
Whenever we talk about anal diseases, there are several of them like fistula or piles or sinus (in case of sinus, unlike fistula which has two openings, there is only one opening) or fissure (a condition in which a linear cut forms on the posterior surface of anal canal) or pilonidal sinus. Pilonidal sinus occurs when someone has hairs in anal area. If his hair follicle is somehow obliterated by keratin plug then this hair acts as an irritant internally. It creates an internal tract. There is putrefaction and formation of abscess. All the above mentioned conditions fall in the category of anal diseases and somewhere all of them are associated with constipation or sluggish digestion. They can also result from a damaged or injured anal canal which fails to heal because of septic conditions, or our inability to trace or apply healing agents locally, or recurring injury caused by hard stools which don’t let the injury heal as the process of healing is repeatedly disturbed by hard stools which further aggravates the injury. These are the conditions which deteriorate fistula. I would also like to tell you that, generally it is believed that if somebody has fistula, he has no option other than surgery. It can’t be treated with medicines as the entire part needs to be removed since it can’t heal.
Q. I am sure it must be very serious condition as it can’t be treated with medicines. But how can a patient identify fistula? Would he need to undergo some specific tests?
If the patient feels an existing abscess near his anal canal and this abscess gives out some secretions (whether it is in the form of pus or blood) along with pain, then this could be a primary indication about beginning of fistula. Here, we only have to check that whether this abscess is opening in the anal canal or not, and whether it is open at one end or both ends. If it is open at one end only, we start referring to it as sinus and if it is open on both sides, we call it fistula. So generally this is the condition where a patient can perform a self assessment or consult a doctor. After this, we have to do investigations or sure-shot diagnosis. For this we generally perform proctoscopy or colonoscopy wherein we look into the anal canal using telescope and then prepare a diagnosis of the patient depending upon whether he has, sinus, fissure, fistula or just a condition of piles.
Q. In Ayurveda we have a definition for everything – like what kind of deficiency or superfluity causes which particular condition. So, what is the reason behind occurrence of fistula in our body?
As I mentioned earlier, loss of digestive power or agni (fire) is considered as a reason for any type of anal disorder whether it is in the form of piles, sinus, fissure, fistula or pilonidal sinus. Thus, decrease in agni (sluggishness of digestion) has been considered to be reason for occurrence of fistula. If the reason for sluggish digestion is Vata (or air) disorder then it can be ‘Vatik fistula’, if the reason is pitta disorder it is said to be ‘Paitik fistula’ and if the reason is ‘kapha’ it is said to be ‘kaphage fistula’.
There is a shloka in shastras in this context, which means that for occurrence of Piles and other related conditions, sluggish digestion is the only contributing factor and as you improve patient’s digestive power and strengthen his digestive system, he would have better chances of getting treated from conditions of pile, fissure, fistula etc. If we talk about its medicine, there are two type of treatment in Ayurveda which we recommend specifically in case of fistula. Firstly we use medicines to create an aseptic condition. You would be glad to know that in almost 50% of the cases we successfully treat fistula with the help of medicines. We have certain substances which help in healing. So, we give our patients, such substances as medicines. Along with this, we try to keep his digestive system healthy and not let constipation to occur in their body. Thus, 50% of the patients get relief by medicines. For the others who do not respond to medicines well, we recommend ‘kshar sutra’. This is a very specific Ayurvedic treatment and in this procedure we basically treat the patient by tying a kshar (i.e. a medicated thread) to his fistula using probes and after repeated procedure of ‘kshar sutra’, the patient gets relief from fistula without the use of surgery.
Q. As you had said earlier, Fistula patients have no alternative to surgery as the condition can’t be treated using medicines. But as we have seen, Ayurveda is the science which can treat this condition without performing surgery. So, I would request all my viewers to immediately seek help from an Ayurvedic doctor if you are suffering from the condition of fistula. Or else, you can also approach Dr. Arora, if want to get treated for your fistula without surgery.
As you said, Dr. Arora, there are some Ayurvedic medicines which are able to treat 50% of the cases of fistula. So, what are those medicines?
As I said, firstly we target at creating an aseptic conditions. For this I would recommend a sitz bath with ‘phitkari bhasma’ (or calcined potassium alum). Potassium alum is known to be a good antiseptic agent and has immense healing power. Anyone who is suffering from fissure, sinus or fistula can use this treatment. You need to take a sitz bath, by sitting in a tub containing hot water mixed with ½ to 1 spoon of calcined potassium alum. I actually refer to heat application in the lower part. Do this sitz bath regularly for 5-10 minutes daily and there are very good chances that you will get relief. Along with this, I would also like to mention a few medicines. We advise ‘Manikya yog’, ‘Twaprabha’ which is a blood purifier as well as a healing agent.
We also give ‘Abhayarisht’ (4 spoons after meals) and ‘Chitrakadi vati’ ( 2 tablets after meals) with ‘Triphala guggulu’(2 tablets after meals) to fissure and piles patients . Consumption of these medicines increases agni or digestive power as well as decrease vaat (or air). In case you have constipation, you can take isabgol (or psyllium seed husk) with ‘Abhaya churna’ or ‘Niram vati’ at bedtime. This will ensure clear bowels. Clear bowels are important because though we start the healing process but if you are constipated, the process of healing gets disturbed. I would repeat that there are 50% chances that your fistula will be treated with these medicines. You have to take these medicines for at least three months. In case you do not get relief with these medicines, you can go for treatment of ‘kshar sutra’ which I have already mentioned.