Fistula in Ano Treatment in Pimpri Chinchwad

Understanding Fistula in Ano

A fistula in ano is a chronic tunnel that forms between the inside of the anal canal and the skin around the anus, usually as a result of an infection in the anal glands that did not heal completely. It can cause recurrent pus discharge, pain, swelling, and significant discomfort in daily life. Pimpri Chinchwad residents often first notice this problem as a small opening near the anus that keeps leaking or forming painful boils again and again.

Modern proctology now offers advanced options like laser ablation and specialised Ayurvedic techniques (Kshar Sutra), and centres in PCMC such as Vitthal / Vithai‑type piles hospitals have developed focused expertise in these treatments.

 

From Fissure and Constipation to Anal Fistula: What Really Happens

Many patients with fistula in ano have a background story of fissure, painful defecation, or long‑standing constipation.

• When stool size is large and the anal opening is tight, repeated friction of hard stool over the delicate anal mucosa can cause small internal wounds or fissures inside the anus.
  
• Prolonged sitting, straining, and chronic constipation prevent these tiny tears from healing, and stool particles plus bacteria get inoculated into these wounds.
  
• Medical understanding of pathophysiology supports this:
• Just inside the anus are small anal glands that normally secrete mucus; when their ducts are blocked and infected, an abscess can form.
  
• Around 30–40% of anal abscesses eventually develop into a chronic fistula, creating a tunnel from the inner anal canal to the skin around the anus.
  

Over time:

• The pus tracks through the perianal tissues and forms a tube with one opening on the inner anal mucosa and another opening on the surrounding perianal skin.
  
• The body and bacteria together create a thick inner lining along this tract (granulation and epithelial tissue), which acts like a protective coat for the bacteria.
  
• This lining prevents antibiotics or topical medicines from fully penetrating the tract, which is why fistulas rarely heal with medicines alone.
  

So, the actual aim of treatment is not just to “dry the pus” but to destroy or remove this hard inner lining of the fistula tube, allowing healthy tissue to close and heal from inside out.

 

Symptoms and When to Suspect Fistula in Ano

Common features include:

• Recurrent boils or abscesses near the anus.
  
• Persistent pus or blood‑stained discharge from an opening near the anal region.
  
• Pain or swelling that eases when pus drains out and then reappears.
  
• Irritation, itching, and soiling of underwear.
  
• In some complex cases, multiple openings or branching tracts.
  

Any such recurring problem around the anus, especially with a history of painful defecation or prior abscess, should be evaluated by a proctologist.

 

Diagnosis: How Doctors Confirm Fistula in Ano

In centres around Pimpri Chinchwad and Pune, diagnosis usually involves:

• Clinical examination:
  

• • • Inspection of the perianal area for external openings, scars, or active discharge.
      
    • Gentle digital rectal examination to feel internal openings, induration, or abscess pockets.
      

• Proctoscopy / Anoscopy:
  

• • • To visualise the anal canal and look for internal openings or associated pathologies like fissure or piles.
      

• Imaging (for complex cases):
  

• • MRI fistulogram or endoscopic ultrasound helps map complex, high, or branching tracts, especially when sphincter muscles are involved.
    

Accurate mapping of the tract guides the choice of treatment and helps reduce recurrence and protect continence.

 

Why Antibiotics Alone Cannot Cure Anal Fistula

As explained earlier, the fistula tract develops a thick inner lining made of granulation tissue and partially epithelialised tissue. This acts like a tube wall:

• Bacteria and debris hide inside.
  
• Systemic antibiotics may reduce acute infection or abscess but cannot remove the lining.
  
• Once antibiotics stop, residual bacteria and blocked drainage allow infection to flare again.
  

Therefore, definitive treatment must physically destroy or remove the tract lining, while preserving anal sphincter function as much as possible.

 

Modern Treatment Options: Focus on Laser Ablation and Kshar Sutra

Traditional options include fistulotomy (lay‑open), fistulectomy, or seton techniques, but these may be associated with higher recurrence or risk of incontinence in some complex or high fistulas. Over the last years, two approaches have gained popularity in India:

1) Laser Ablation of Fistula Tract

Laser surgery is considered one of the best modern options for many fistula in ano cases in centres around PCMC.

Basic idea:

• After proper examination, the tract is cleaned and any abscess cavity is drained.
  
• A special radial laser fibre is passed through the fistula tract from the external opening towards the internal opening.
  
• As the laser fibre is slowly withdrawn, controlled energy is delivered circumferentially, ablating the tract lining and collapsing the tunnel, while sparing the surrounding sphincter muscle

Advantages:

• Minimally invasive and sphincter‑sparing.
  
• Less postoperative pain and faster recovery compared to wide open surgery.
  
• Suitable for many simple and moderate‑complexity tracts.
  
• Often performed as a short‑stay or day‑care procedure.
  

Guideline‑level reviews and Indian experiences show that laser therapy, alone or in combination with other techniques, offers good healing rates with low incontinence risk when done in experienced hands.

2) Ayurvedic Kshar Sutra Therapy

Kshar Sutra is a well‑documented Ayurvedic seton technique practiced in India for centuries and evaluated in modern comparative studies.

How it works:

• • After probing the tract, a medicated alkaline thread (Kshar Sutra) is passed through the fistula path and tied, connecting internal and external openings.
    
  • Herbal and alkaline coatings on the thread gradually cut through the tract and induce sclerosis and healing, destroying the unhealthy lining while promoting fibrous closure behind the advancing thread.
    

• Key points from studies:

• Kshar Sutra has shown comparable or even lower recurrence than some open surgeries, with good sphincter preservation when properly used
  
• It is particularly useful in complex, high, or trans‑sphincteric fistulas, where aggressive open surgery could risk continence.
  
• Some newer protocols combine laser inside the tract with submucosal Kshar Sutra application (e.g., DL‑KAST or similar hybrid methods) to use the strengths of both techniques.
  

In practice, many proctology centres now individualise choice: laser for suitable tracts, Kshar Sutra or combined approaches for complex, high‑opening, or recurrent fistulas.

 

Fistula in Ano Treatment in Pimpri Chinchwad (PCMC) Context

Specialty proctology centres in PCMC and Pune, such as Vitthal / Vithai‑type piles and fistula hospitals, focus heavily on:

• Laser‑based fistula ablation for most simple and moderate tracts.
  
• Kshar Sutra or combined laser‑Kshar Sutra protocols for complex, high, or trans‑sphincteric fistulas, especially those with high internal openings.
  
• Individualised treatment planning to control infection, protect anal sphincter muscles, reduce recurrence, and shorten recovery time.
  

Local proctologists with many years of fistula practice often refine standard procedures into centre‑specific protocols aimed at minimising recurrence and complications.

 

Post‑Operative Care and Recovery

Irrespective of technique used, good recovery depends on:

• Wound care and hygiene – warm sitz baths, gentle cleaning, keeping area dry.
  
• Pain management – usually milder with laser; local care and prescribed analgesics.
  
• Bowel management – soft stools using fibre, fluids, and stool softeners to avoid straining.
  
• Regular follow‑up – to monitor healing, detect early recurrence, and adjust care.
  

Most patients can resume light daily activity within a few days after minimally invasive procedures, although complete internal healing takes several weeks.

 

FAQ

1) Can an anal fistula ever heal on its own without surgery?
Spontaneous, complete healing of a true anal fistula is very rare. Once a tract with a persistent inner opening and epithelialised lining forms, antibiotics or home remedies may only reduce discharge temporarily. Because the thick inner wall prevents full closure and keeps traps for bacteria and debris, definitive management almost always requires some form of surgical or minimally invasive intervention that destroys or removes the tract lining.

2) Which is better for fistula – laser treatment or Kshar Sutra?
There is no single “best for all” option. Laser ablation is excellent for many simple and moderate tracts: it is sphincter‑sparing, less painful, and offers faster recovery. Kshar Sutra, on the other hand, has strong evidence and long Indian experience for complex, branching, and high‑opening fistulas, with good healing and low recurrence when used carefully. Some centres now combine both techniques to handle especially complicated tracts. The right choice depends on fistula type, location, prior surgeries, and sphincter involvement, and is best decided by a specialist after imaging and examination.

3) What is the risk of recurrence after fistula surgery, and how can it be reduced?
Recurrence rates vary with technique, surgeon expertise, and fistula anatomy. Simple, low tracts treated correctly with laser or lay‑open have relatively low recurrence, while complex, high, or multi‑tract fistulas carry higher risks. Recurrence risk is reduced by: accurate pre‑operative mapping (MRI if needed), complete treatment of all branches, protecting sphincter function, optimising constipation and bowel habits, and attending follow‑up visits. Even if recurrence occurs, most can be handled with additional minimally invasive or combined procedures.