Anal fistula otherwise known as Fistula-in-ano is a communication or tunnel between the bowel (where stool gets accumulated for defecation) and the outer skin around the anus.


Extrasphincteric fistula: starts from the rectum or sigmoid colon and opens into the skin around the anus. It is least common type of fistula and usually results after Crohn’s disease or diverticulitis abscesses.

Suprasphincteric fistula: the beginning point is between the muscles of external and internal sphincters and opening is an inch or more away from the anus.

Transsphincteric fistula: begins from the muscles between the external and internal sphincter or behind the anus but takes a longer route and often becomes U-shaped or horseshoe shaped and opens an inch or more away from the anus. This fistula may have multiple openings as well.

Intersphincteric fistula: begins between the muscles of external and internal sphincters, cross the muscles of internal sphincter to open very close to the anus. It is very common type of fistula.

Submucosal/ superficial fistula: doesn’t cross the muscles of any sphincter and begins and opens very near to the anus.



  • Pain in anal region especially while sitting, coughing, after passing stool.
  • Passage of discharge after stool which is often smelly and may be mixed with pus or blood or both.
  • Irritation around the skin of anus.
  • Swelling, redness in area around the anus with tenderness if abscess is also there along with fever.
  • Sometimes urination is also painful due to abscess.


The cause of formation of an abscess is infection around the anus. The anus is surrounded by various glands which produce fluid. Due to infection the glands are blocked and bacterial growth occurs and a swollen compartment is created which is known as abscess in medical term which is not able to drain out it’s secretions and becomes tender and painful. Either artificial opening is made by surgical procedure for the fistula to drain or if left unattended the abscess may grow to the surface near the anus and bursts to discharge the accumulated debris.

So mostly it’s the abscess which forms the fistula but fistula formation may also be seen in cases of tuberculosis, STD s as well.

Crohn’s disease which is an inflammatory disease of digestive tract, although is less common cause of fistula formation, forms extrasphincteric fistula. Diverticulitis may also form same fistula.

Sometimes fistula formation may come out as a complication of surgery performed near the anus.



  • First of all careful medical history with symptoms related to fistula are sought for.
  • Then physical examination is done.
  • In case of active abscess symptoms of fever, redness, tenderness on palpation and swelling is seen.
  • Sometimes the abscess is not so apparent from outside but rectal examination is painful with medical history of rectal pain.
  • Further proctoscopy is done to examine the rectum for diagnosis.
  • Colonoscopy would also help in diagnosing a case of abscess and determining the type of abscess as well.


The only treatment available for fistula is fistulotomy only but homeopathic medicines help in healing the fistula without surgery.


  • Management would include managing the abscess (infection), symptoms like pain, tenderness, discharge from the fistula etc.
  •  Usually surgery is the only possible treatment.
  • Constipation should also be managed in cases where constipation is the aggravating factor.


Homeopathic management of fistula is to prevent surgery and heal the fistula with medicines. There are many homeopathic medicines like silicea, hepar sulph, nitric acid, sulphur, calcarea carb etc but medicines should always be given after thorough case taking and on the basis of constitution of the patient.



  • Maintained hygiene
  • Add fibre to the diet


  • Avoid constipation