Dear Dinesh Ji,

Anal fistula can be a painful and uncomfortable condition that affects daily life, sitting, walking, and overall well-being. When surgery is recommended, patients and their families often feel concerned about treatment costs and recovery. Many people therefore want to know whether anal fistula treatment and surgery can be done under the PM-JAY (Ayushman Card) scheme or not.

Can Anal Fistula Surgery Be Done Under the Ayushman Card?

Yes, if :

• The patient is eligible under Ayushman Bharat – PMJAY
• The hospital is empanelled under PMJAY
• Surgery is medically necessary
• Package approval is completed

then selected anal fistula treatments and surgeries may be available under cashless treatment at eligible hospitals.

Coverage may include :

• Hospital admission
• Surgery charges
• OT expenses
• Doctor consultation during admission
• Hospital stay
• Basic investigations related to treatment

Final approval depends on :

• Patient eligibility
• Hospital empanelment
• PMJAY package verification
• Surgeon assessment

What Is an Anal Fistula?

An anal fistula is an abnormal tunnel that usually develops due to infection near the anal area.

Common symptoms may include :

• Pain near the anal region
• Swelling
• Pus discharge
• Bleeding
• Irritation
• Fever in some cases

Proper medical evaluation is important because untreated fistulas may lead to recurrent infections.

Which Doctors Usually Treat Anal Fistula?

Treatment is usually managed by : 

• General surgeon
• Proctologist
• Colorectal surgeon

Doctors may recommend :

• Physical examination
• Blood tests
• MRI or imaging in selected cases
• Infection assessment

These investigations help determine the exact condition and treatment plan.

Documents Usually Required

Please keep these documents ready :

• Ayushman / PMJAY card
• Aadhaar card
• Medical reports
• Doctor prescriptions
• Previous treatment records if available

These documents help with eligibility verification and surgery approval.

How to Check PMJAY Hospitals?

Verification Steps

• Visit Ayushman Bharat Official Portal
• Open the “Find Hospital” section
• Select :
  • State
  • District
  • Specialty – General Surgery

Nearby PMJAY empanelled hospitals can be checked there.

Treatment for Anal Fistula (General Surgery Options)

Surgery is almost always necessary to treat an anal fistula, as it rarely heals on its own. The goal of surgery is to close the fistula while protecting the sphincter muscles to prevent incontinence. Common surgical procedures include

• Fistulotomy : This is the most common procedure for simple fistulas. The surgeon cuts open the entire length of the fistula, allowing it to heal from the inside out.
• Seton Placement : For more complex fistulas, a seton (a piece of surgical thread or rubber) might be inserted into the fistula to drain the infection and promote healing over several weeks or months, before a definitive surgery.
• Advancement Flap Procedure : For complex fistulas that might involve the sphincter muscles, a flap of healthy tissue is used to cover the internal opening of the fistula after removing the infected tissue.
• LIFT Procedure (Ligation of Intersphincteric Fistula Tract) : This technique involves accessing the fistula tract between the two layers of sphincter muscles, ligating (tying off) the tract, and removing the infected tissue.

Post-Surgery Care Tips

• Maintain good hygiene around the anal area.
• Take prescribed pain relievers and antibiotics as directed.
• Eat a high-fiber diet and drink plenty of water to prevent constipation.
• Take warm sitz baths to relieve discomfort and promote healing.

How HexaHealth Can Assist with PM-JAY

• Eligibility Check : HexaHealth can help you understand if you are eligible for the Ayushman Bharat scheme for your anal fistula treatment.
• Hospital Network : We can connect you with HexaHealth partner hospitals in your city that accept the PM-JAY scheme for general surgery, ensuring you receive quality care without financial burden.
• Seamless Process : Our team assists with the documentation, admission, and discharge processes, making your treatment journey smoother under the Ayushman Bharat scheme.
• Expert Consultation : We can help you book consultations with experienced general surgeons specializing in proctology (diseases of the rectum and anus) who can accurately diagnose and recommend the best surgical approach for your condition.

It's important to consult a general surgeon or a proctologist for an accurate diagnosis and to discuss the most suitable treatment plan for your specific condition. HexaHealth is here to support you in finding the right doctor and hospital, and in navigating the Ayushman Bharat scheme for your treatment.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth