Anal fistula
An anal fistula is a narrow passage that forms between the anal canal and the skin around the anus. A fistula often develops after an anorectal abscess — a collection of pus caused by infection — has drained or been treated. The original abscess resolves, but a connection remains through which fluid or pus can discharge again.
An anal fistula may cause problems such as discharge, irritation, itching and pain around the anus. Sometimes the opening seems to close temporarily, after which swelling and discharge occur again.
Because a fistula is an anatomically shaped process, regular assessment is important and permanent treatment often requires surgery. Acupuncture and Chinese herbal medicine can be used in addition, for example to treat complaints, support the recovery and look from Chinese medicine at factors that may maintain the problem.
Common symptoms
The complaints vary depending on the location of the fistula and whether there is an active ignition. Possible complaints are:
- an opening or small wound next to the anus where moisture, pus or sometimes blood comes out
- recurrent swelling, irritation or itching around the anus
- pain or tenderness, especially if an inflammation or abscess develops again
- moisture or pus that irritates the skin around the anus
- periods during which complaints are reduced, followed by re-secretion or swelling
When to contact your doctor?
Fever, increasing pain, redness or swelling may indicate a new abscess or an expanding infection and ask for medical assessment. Also in a new fistula, in case of doubt about the cause, or when complaints are associated with general malaise, it is important to have this medically assessed first, especially since some fistulas are associated with underlying conditions such as Crohn's disease.
Possible causes
Most anal fistulas originate from an anorectal abscess. An infected gland in the anal canal can lead to a build-up of pus. When the abscess traverses its way to the skin or is drained, a corridor may remain between the anal canal and the skin.
Because the fistula is connected to the anal channel, it can get irritated or infected again and again. A close opening can also prevent inflammatory fluid from being properly removed.
Some fistulas may be associated with underlying conditions, including Crohn's disease. Therefore, in recurrent or complex fistulas research into the cause is important.
What can acupuncture do?
An existing fistula usually does not disappear due to acupuncture. Therefore, treatment should not be considered as a replacement for medical or surgical treatment.
In Chinese medicine acupuncture can be used in addition, focusing on the stage of the complaint and the underlying TCM pattern. During and immediately after a treatment acupuncture may be aimed at:
- reducing local pain, itching and swelling around the fistula opening
- reducing Dampness-Heat when inflammation, pus or irritation are in the foreground
- stimulating local blood flow to support tissue repair
- supporting the general recovery of an operation and handling additional complaints
The acupuncture points chosen therefore differ per person and per stage of the complaint.
What can Chinese herbal medicine do?
Also Chinese herbs cannot simply make an existing fistula go away. In an anal fistula herbs are therefore mainly used in addition and adapted to the stage of the complaint. Unlike acupuncture, herbs are used daily, to support the body systemically in recovery.
Depending on the pattern, herbal treatment may include:
- reducing Dampness-Heat and remaining Heat at persistent secretion
- structural strengthening of Qi and Blood to support tissue repair in long-term complaints
- feeding Yin in case of chronic dryness and mild heat phenomena
- supporting the overall condition during a longer recovery process
In case of an active infection or a new abscess, medical treatment is important; herbs are not a substitute for drainage or other necessary treatment.
How does Chinese medicine view an anal fistula?
Within the traditional Chinese medicine (TCM), not only the fistula itself is considered, but also the pattern in which it develops and continues to exist.
An important role is attributed to Dampness-Heat in the Lower Burner. Dampness stands for a tendency to build up moisture and secretion, while Heat can manifest itself in inflammation, redness, pain and yellow or strongly smelling pus. When this combination accumulates around the anus, according to TCM, an abscess can occur. After breaking or draining, Dampness-Heat can stay behind and maintain the separation.
In the event of a prolonged course, the image can change. When the body has insufficient Qi and Blood to repair damaged tissue, the fistula can continue to secrete chronically and hard to heal. Even more prolonged complaints may also result in Yin deficiency, where there are insufficient cooling and nourishing body substances and mild heat phenomena can occur.
A recognizable combination of symptoms and symptoms is called a pattern within TCM. Only the most common patterns in anal fistulas are described below; other patterns are possible. Multiple patterns can occur at the same time and the image may change during the course. Not everyone with the same pattern has all the mentioned symptoms. Therefore, the pattern is determined by the overall picture of complaints.
Most common TCM patterns in an anal fistula
Damp-Heat
This pattern fits in particular with a fistula where clear signs of inflammation are still present, for example after an anorectal abscess has been formed or treated. From TCM Dampness and Heat have not completely disappeared, leaving irritation and secretion.
Common symptoms: thick yellow and possibly strong smelling discharge, pain, itching, irritation or swelling around the fistula opening, feeling warm or feverish, bitter taste, loss of appetite, dark or concentrated urine and sometimes constipation or difficult stools.
Westernly, this image is particularly suited to an active or recurrent inflammation of an anal fistula, in which again a perianal abscess can arise.
Qi- and Blood deficiency
With a long-lasting fistula, TCM can weaken recovery capacity. Qi can easily be seen as the functional energy used by the body to perform processes, while Blood is inter alia connected to nutrition and tissue recovery.
Common symptoms: small amounts of thin, grey or aqueous secretion, low swelling or pain, sometimes itching, dark or purple discoloration around the opening, fatigue, paleness, fast cold or clammy, shortness of breath, low appetite and loose stools.
Westernly, this image may fit with a chronic fistula with persistent low secretion and few acute inflammatory symptoms.
Yin-deficiency
Yin stands within TCM for the nourishing, moistening and cooling aspects of the body. In case of very long-term complaints, Yin may weaken, especially if previously prolonged inflammation and Heat have been present.
Common symptoms: long-term fistula with small amounts of thin or turbid secretion, an irritated or itchy anus, warmth in the afternoon or evening, night sweats, restless sleep, dry mouth, lips or throat and tendency to constipation.
Within TCM, in addition to feeding Yin, attention may be needed for remaining Dampness-Heat.
Outlook
An anal fistula is different from many functional complaints treated with acupuncture and herbs: a fistula has actually developed. As a result, complete healing with Chinese medicine alone is not always realistic, and many anal fistulas require surgical treatment.
The course depends, among other things, on the fistula location and branches of the fistula, recurrent infections, the presence of an abscess and possible underlying conditions. Chinese medicine can be used in addition, e.g. for complaints surrounding the fistula or during recovery after medical treatment. If no clear improvement occurs within a few weeks, re-assessment of the chosen approach is important.
Contact
Do you have an anal fistula and do you want to know whether acupuncture or Chinese herbal medicine can add value to your complaints? During a first appointment, we will discuss your complaints, the course of the fistula and any medical treatment. We will then consider whether and how Chinese medicine can be used responsibly as part of your treatment process.