The literal meaning of Bhagandara (Fistula) is Darana, which means splitting or bursting up. This indicates that bursting of ripened) abscesses results into communicating track between anal region with surrounding perianal structures. Bhagandara is therefore correlated to the Fistula-in-Ano and is defined as “An inflammatory track which has an external opening in perianal skin and an internal opening in the anal canal or rectum, which is lined by unhealthy granulation and fibrous tissue”.
The incidence of fistula ranges from 26-38%. Men are more prone to fistula in ano when compared to women. The patient experiences pus discharge, immense pain and difficulty in passing bowels (stools) leading to difficulty in sitting on a hard surface. This becomes scary and eventually leads to stress and anxiety.
With industrialisation and advancement in technology lifestyle of an individual has become faster and faster. With this advancement the individual adopts many habits in his lifestyle which are harmful to his health and eventually leading to anorectal diseases.
From the onset of civilisation, the humanity suffered from various diseases and among the many uncomfortable conditions, Bhagandara (fistula-in-ano) is considered as one of the grave diseases and is included in list of eight major diseases (Ashta Mahagada)
Anal fistula is mostly because of the result of a previous or current anal abscess. Fistula in ano is an abnormal cavity with an external opening in the perianal area that is communicating withthe rectum or anal canal by an identifiable internal opening.
Fistula in ano is a hollow tract lined with granulation tissue, connecting a primary opening inside the anal canal to a secondary opening in the perianal skin. Secondary tracts may be multiple and can extend from the same primary opening.
Normal anatomy of the human body consists of small glands just inside the anus. Very Occasionally the glands get clogged and thus potentially become infected leading to formation of an abscess. The infected glands are not connected to the abscess through a tunnel-like structure called fistula.
Anal fistulae are also a common complication of various inflammatory conditions of the intestines. This includes:
Irritable bowel syndrome (IBS) is a chronic disorder affecting the digestive system leading to abdominal pain, diarrhoea and constipation.
Diverticulitis is the formation of small pouches which stick on the lining of the large intestine (colon), and become infected and inflamed.
Ulcerative colitis is a chronic condition that causes the colon to become inflamed and can causeulcers to form on the lining of the colon.
Crohn’s disease is a chronic condition which leads to inflammation of the lining of the digestive tract.
Various types of anal fistula are Trans sphincteric fistulae, Inter sphincteric fistulae, Supra sphincteric fistulae and Extra sphincteric fistulae.
Trans sphincteric fistula are a result of ischio rectal abscesses, with its track extended through the external sphincter. Account for about 25% of all fistulae.
Inter sphincteric fistula are confined to the inter sphincteric space and internal sphincter. They result from perianal abscesses. Account for about 70% of all fistulae.
Supra sphincteric fistulas are the result of supra levator abscesses. They pass through the levator ani muscle and over the top of the puborectalis muscle into the inter sphincteric space. Account for about 5% of all fistulae.
Extra sphincteric fistulae bypass the anal canal and sphincter mechanism. It passes through the ischio rectal fossa and levator ani muscle and open high in the rectum. It accounts for about only 1% of all fistulae.
Ayurveda treatment aims at pacifying Vata (air and space) and Pitta (water and fire) dosha. Different measures are used at different stages of disease for effective cleansing and healing and also for disease modulation. Ayur Healthcare based on Ayurvedic classical text skilfully merges the condition with good disease modifying medicine, diet and rasayana (immune modulators). Virechana (therapeutic purgation is used when the abscess is in unripe stage along with fasting measures. Virechana expels the morbid and disease causing doshas from the body and thus acts like a cleansing mechanism and also ripens the wound or fistula tract. Other therapeutic measures like, oil enema, pichu (Gauze dipped in oil and applied), pouring of medicated liquid over affected parts and herbal paste with unctuous substances are also practised in case of fistula in ano.