Horseshoe Anal Fistula

Dr. Ramesh Bhardwaj D.H.M.S  •  Dr. Puja Bhadel Bhardwaj  M.D.


Horseshoe anal fistula is an anal fistula partially encircling the anus and opening at both ends on the cutaneous surface.

The male-to-female ratio is 1.8:1.

1.The anterior type; which is less frequent has its origin in the anterior part of the sub-epithelial space. 
2. The posterior type has its origin in the post- anal space.

Parks described three locations for the horse-shoe fistula. The first may take place at the superfacial part of the ischiorectal fossa, the second level is formed from the high inter-sphincteric space infection, and form the deep horse-shoe fistula . The third variety, is located in the pararectal tissue above the levator ani muscles.


The infection in the ischiorectal fossa a common presentation of the fistula abscess disease; it usually starts at one side and then the infection spread to the other side to form tracks that have the appearance of a horse-shoe. It is a common manifestation of the infection that starts in the sub-epithelial space; and the anal canal interstics. The infection in the ischiorectal fossa; has its origin in the post-anal space; and spread to one side first and then it may spread to the other side to form a complete horse shoe fistula. 

Etiology/Causes of horseshoe fistula include the following:
* Anorectal abscess (most common cause).
* Piles or hemorrhoids.
* Anal fissures.
* Surgery for piles or fissures usually gives rise to fistula in future.
* Constipation.
* A healed sore in the rectal area
* Inflammatory bowel disease
* Diverticulitis
* Previous radiation therapy for prostate or rectal cancer
* Tuberculosis
* Steroid therapy
* trauma (especially obstetric - after traumatic delivery)
* Patients who are immunocompromised for any reason.

Signs and Symptoms:-
Patients often provide a reliable history of previous pain, swelling, itching, boils, abscess and pus discharge from ano-rectal area.
Perianal discharge
Skin excoriation
External opening

Lab Investigations in Horseshoe Anal Fistula:-
Endorectal/endoanal ultrasound.
CT scan.
A barium enema/small bowel series to rule out inflammatory bowel disease.

Homeopathic Treatment of Horseshoe Anal Fistula:-
The patients of horseshoe fistula are usually advised surgery for their problem. There are several operations like fistulotomy, Lay-open of fistula-in-ano, Cutting section, Fibrin glue injection, Fistula plug, Endorectal advancement flap, Anal Fistula Plug.

But this is just a temporary solution as invariably the fistulas recur. Also a lot of complications can occur due to surgery like urinary retention, bleeding, thrombosed hemorrhoids, fecal impaction, incontinence of stool, anal stenosis because of fibrosis, delayed wound healing.

Invariably patients come to a homeopath after many years of suffering and sometimes after going through multiple surgeries.

How homoeopathic medicine works?

1. It will first work to control the infection in the area thereby preventing attacks of the abscess formation.
2. Later, the remedies will start new tissue development to close down the tract.
3. When the process of redeposit is complete the opening closes down and the fistula is cured permanently.
4. Complete painless.
5. No painful or shameful dressing.
6. Also prevent recurrence in future.

This is a prolonged process and the time required varies from person to person, depending on the length and depth of the tract. A fistula usually takes almost one year and sometime even more to completely heal. Hence patients should have a lot of patience while on homeopathic treatment in order to achieve a complete and permanent cure.
Dr. R. Bhardwaj has successfully cured many patients of fistula during his 22 year of practice.
 Many surgically spoiled cases of Fistula-In-Ano also have been cured successfully.