A fistula is an abnormal tunnel connecting two body cavities (such as the rectum and the vagina) or a body cavity to the skin (like the rectum to the outside of the body). One way a fistula may form is from an abscess a pocket of 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. Fistulas are more common in Crohn’s disease than in ulcerative colitis. Approximately one quarter of people with Crohn’s disease develop fistulas.
Fistulas often occur in the area around the genitals and anus (known as the perineum). The four types of fistulas are:
- Enterocutaneous: This type of fistula is from the intestine to the skin. An enterocutaneous fistula may be a complication of surgery. It can be described as a passageway that progresses from the intestine to the surgery site and then to the skin.
- Enteroenteric or Enterocolic: This is a fistula that involves the large or small intestine.
- Enterovaginal: This is a fistula that goes to the vagina.
- Enterovesicular: This type of fistula goes to the bladder. These fistulas may result in frequent urinary tract infections, or the passage of gas from the urethra during urination.
There are two types of Fiber:
- Insoluble fiber : doesn’t dissolve in water, and it helps move food through the digestive tract. Whole wheat flour, cereals, pastas, seeds, nuts, green beans, cauliflower, tomatoes, flax seeds, and potato skins contain insoluble fiber.
- Soluble fiber : dissolves in water and forms a gelatinous-like material which lowers blood cholesterol and glucose levels. You can find soluble fiber in oats, barley, carrots, broccoli, artichokes, fruits, and berries.
What causes an Anal Fissure ?
The anal opening is only so big. To have a bowel movement the anal sphincter relaxes and open up as much as it can, but the stool must be still be soft enough to squeeze through the opening. If the stool is dry and hard, the anal sphincter is forced to open even wider than normal. This difficult passage can cause a tear in the rim of the anal opening, resulting in a fissure. Other causes of a fissure include severe diarrhea, inflammatory bowel disease, and sexually related trauma.
Treatment in India
More than half of all fissures heal either by themselves or with non-surgical treatment. Stool softeners can help reduce pain during bowel movements. Antibiotics may be used for a short time. Special medicated creams may also be used, especially if the fissure has become ulcerated or infected. It is important to keep the anus and area between the buttocks clean and dry. After bathing, the patient should gently pat dry with a soft towel. Applying talcum powder is frequently recommended. Sitz baths may help relieve discomfort and promote healing. A sitz bath is soaking the anal area in plain warm — not hot — water for 15-20 minutes several times a day.
If the fissure is not responding to treatment, the physician re-examines the patient. There are conditions, such as muscle spasm or scarring, that could interfere with the healing process. Fissures that do not heal can be corrected with surgery. It is a minor operation that is usually done on an outpatient basis. The surgeon removes the fissure and any underlying scar tissue. Cutting a small portion of the anal muscle prevents spasm. This helps the area to heal and rarely interferes with the control of bowel movements. Complete healing takes place in a few weeks. However, the pain often disappears after a few days.
Over 90% of the patients who need surgery for fissures have no further problems. Patients can help avoid the return of fissures by drinking at least eight glasses of water a day, and maintaining adequate fiber in the diet. This prevents constipation, which is the cause of most fissures. Minimally Invasive surgery is the best option.
Anal Fissures Vs Anal Fistulas in India
These two conditions are often confused. A fissure is a tear or crack in the anal lining. A fistula is a totally different problem but often occurs in the same anal area. A fistula is more like a tunnel between the rectum and other body parts – such as between the rectum and the vagina ( a recto-vaginal fistula), or between the anal canal and the nearby skin.