Brief Answer:
Surgery(LIFT) should be done,Conservative management is not successful.

Detailed Answer:

Hello,
Thanks for choosing HealthcareMagic for your query.
I am Dr Kumar a Gastroenterologist and would be answering your query.
Initially a MRI should be done to trace track of fistula.Once we have tracked the tract we could proceed with surgery.Conservative(medical) management is usually not successful in case of recurrent fistula's.
Options are-
1)Best for him if he is in a developing country-Ligation of intersphincteric fistula tract procedure-This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected glands. Reports from Chulalongkorn University have described a novel technique called LIFT for the treatment of recurrent anal fistulae. A success rate of 95% was reported in the treatment of 18 patients.For you to understand the main use is that this technique prevents the entry of fecal material into the fistula tract and eliminates the formation of a septic nidus(cause of recurrent infection) in the intersphincteric space to allow healing of the anal fistula permanently.

In case you can reach a developed country- cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. Mesenchymal adult stem cells extracted from certain tissues, such as adipose tissue, can differentiate into various types of cell. phase I clinical trials show that adipose-derived stem cells are safe for the treatment of a fistula in Crohn's disease.They reported that fistula healing was observed in 71% .


You should take the advice seriously because recurrent fistula contains pus.Pus is a thick, whitish to yellowish material composed primarily of dead cells that generally forms as a byproduct of bacterial infections. The inflammatory cells that participate in the body’s immune response at the site of an infection eventually degrade and die, creating the substance known as pus. When pus forms within enclosed spaces in the tissues, it causes abscesses.Formation of pus with pain indicate active bacterial infection.Agony is that antibiotics are not effective if pus formation is there.Only thing which can help apart from surgery is Draining pus regularly from abscess.

Anal fistula is a chronic abnormal communication between the epithelialised surface of the anal canal and the perianal skin,In a lay mans language it is breach of external skin and this breach results in direct communication of your anal canal with external enviroment and pathogens.It can be a potential source of infection if left untreated.Its just like a open wound where skin is breached this break in the skin provides a route for the germs to travel from the outside to the inside.
Even the pus inside the fistula can spread further leading to formation of multiple tracts and several opening in the skin around the anus. This makes the fistula more complex and further difficult to treat.
There is a risk, though low, of cancer formation in the long standing Anal Fistulas. Therefore, recuurent painful Fistulas should always be treated at the earliest.
If some how the bacteria's come in contact with blood this may result even in life threatening condition like Sepsis also.Mortality rate of patient landing up in shock due to sepsis is as high as 90%.



Some general suggestions for constipation are-

-Linseed: is extremely useful in difficult cases of constipation. One teaspoon of linseed with warm water should be taken at night for bulk and lubrication.
-Proper chewing: The diet alone is not enough. Food should be properly chewed-each morsel for at least 20 times.
-Taking a short walk is a good way to get some light exercise. Walking time should be gradually increased until it reaches 20 minutes.
- should drink at least eight glasses of water daily. Water helps push the food through the intestines and also helps lubricate intestinal tissues. When the body is dehydrated, the intestines absorb the fluids from the food waste, which in turn leads to hardened stools
- Avoiding alcohol and caffeine is also important as these substances contribute to dehydration.
-Use fish oil and castor oil-Fish oil is believed to encourage healthy digestion and castor oil produces a laxative effect when ingested
-Fruits and vegetables, which contain high amounts of fiber, aid in alleviating symptoms of constipation,Whole-grain bread, XXXXXXX oatmeal, beans and lentils can also relieve the problem so use it Instead of highly processed rice, eat brown rice, millet or bulgur.
-Eat 2 cups of fruit 3 cups of vegetables and about 35 grams of fiber per day
fruits: Generally all fruits, except banana and XXXXXXX fruit, are beneficial in the treatment of constipation.
Pears are beneficial in the treatment of constipation.
Guava fruit when eaten with seeds, gives roughage to the diet and helps in the normal evacuation of the bowels.
Grapes: have also proved highly beneficial in overcoming constipation. The grapes have the cellulose; natural sugar and organic acid make them a natural laxative fruit. Not only they clean the bowel, but also tones up the stomach and intestines to relieve the chronic constipation.
-While sitting on the toilet, support the feet on a small stool in order to achieve a normal position that aids in bowel movement.
-Continue taking lactulose.
Hope answer was helpful.
Feel free to follow up.
Thanks!

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Brief Answer:
Follow up.

Detailed Answer:
Hey there again,
I know he has fissures but everything is same for both.

Regards!

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