What Is an Anal Fistula?
An anal fistula (fistula-in-ano) is an abnormal tract connecting the anal canal or rectum to the skin near the anus. It usually develops after an anal abscess fails to heal completely.

Some fistulas are simple. Others are high, branching or recurrent, and these need careful evaluation before treatment.
Common Symptoms
• Recurrent pus or fluid discharge near the anus
• A small opening that heals and reopens
• Swelling, pain or discomfort, especially while sitting
• Repeated abscesses
• Itching or irritation around the anus
Symptoms may settle when an abscess drains, but the tract usually remains.

What Causes It?
• Previous anal or perianal abscess, which is the most common cause
• Recurrent perianal infection
• Inflammatory bowel disease
• Previous surgery or trauma
• Certain specific infections

Fistula, Piles or Fissure?
PIles: Swollen hemorrhoidal tissue. Main symptom: Bleeding, prolapse

Fissure: Tear in the anal lining  Main symptom: Sharp pain during motion

Fistula: Abnormal tract to the skin  Main symptom: Recurrent discharge or abscess

Each condition needs a different treatment, so accurate diagnosis comes first.

How We Diagnose

1. Clinical and proctological examination

2. Sonography, in selected cases

3. MRI, for complex or recurrent fistulas, to map the tract, its branches and its relation to the sphincter muscles

Why Careful Planning Matters

A fistula tract often runs through the muscles that control bowel continence. Treatment must address the fistula while protecting these muscles. This is especially important for:

• High fistulas

• Multiple or branching tracts

• Recurrent fistulas

• Fistulas with repeated abscesses

Our Treatment Approach

Treatment is chosen according to each patient’s fistula anatomy, any associated infection and their overall health. Options include:

• Ksharasutra therapy

• Para-surgical procedures

• Surgical procedures based on Ayurvedic Shalyatantra

• Conservative and supportive care

Ksharasutra Therapy

Ksharasutra is a traditional Ayurvedic medicated thread, or seton, placed through the fistula tract. The tract is then managed gradually under regular medical supervision.

The technique has been practised in India for centuries. It was revived and standardized for modern clinical use by the late Prof. Dr. P. J. Deshpande. Whether it suits a particular fistula is decided after specialist evaluation.

Why Choose Susrutha?

• 40 years dedicated exclusively to ano-rectal care

• More than 1 lakh patients treated

• Experience with complex and recurrent fistulas

• MRI-supported treatment planning

• Led by Prof. Dr. B. SatyaNarayana, Retired Professor of Shalyatantra

When to See a Specialist

Don’t ignore:

• Discharge that keeps coming back

• A recurring swelling or opening near the anus

• Repeated abscesses

• Symptoms that return after previous treatment

Early evaluation helps prevent a simple fistula from becoming complex.

Frequently Asked Questions

Can an anal fistula heal on its own? 

Rarely. The tract usually persists even when symptoms settle temporarily, so specialist evaluation is advised.

Is Ksharasutra suitable for every fistula? 

No. Suitability depends on the fistula’s anatomy and complexity, which are assessed during evaluation.

Do I need an MRI? 

Not always. MRI is recommended mainly for complex or recurrent fistulas, where it helps map the tract accurately.

Do you treat fistulas that recurred after surgery elsewhere? Yes. Recurrent fistulas are evaluated individually, with imaging where appropriate.