An anal fistula is a disease in which a tunnel forms in the anal region. Patients of all ages, genders, and backgrounds can be affected by it, but it is not commonly discussed or treated as other conditions are. However, much like other diseases affecting the gut or rectum, ignoring symptoms of anal fistula can make treatment more difficult and cause further complications.
The main symptoms are pain and inflammation near the anus or under the buttocks; if you have a persistent discharge from the affected area, it could also be an indication that you have an anal fistula.
What is an Anal Fistula?
An anal fistula is a tunnel that develops between an internal opening in the anal canal, and an external opening in the skin near the anus. Anal fistulae typically develop as a consequence of infections that did not properly heal. These infections are often related to conditions such as ulcerative colitis and Crohn’s disease.
An anal fistula can be divided into 2 main types:
- Simple anal fistulas are easy to treat; they are shallow, short, and small.
- Complex ones have more complicated issues, such as length and depth.
Causes of an Anal Fistula
Anal fistulas are caused by inflammation, blockage, and infection of the anal glands. The infection and blockage grow until it forms a connecting cavity between the anal canal and the surface skin near the anus where it can drain.
If an infection or a blockage originates around the intestines, it can cause pus to collect inside the anal glands. Eventually, the pus will drain out, possibly forming a small hole in the skin near your anus. If you have an anal fistula, you may experience pain and discomfort during bowel movements.
Sometimes fistulas grow from perianal abscesses that have been surgically drained.
Symptoms of an Anal Fistula
There are many symptoms that can be associated with an anal fistula. However, the most common symptom of an anal fistula is the presence of a draining sinus. The pus that drains through this sinus may contain red blood mixed in with it. Other symptoms of an anal fistula include itching around the anus, pain in the area, and swelling around the anus. These other symptoms are often present in addition to the presence of a draining sinus. Here are some of the most common symptoms of an anal fistula:
- Swelling, redness, and itching around the anal area
- Yellow discharge/pus or bleeding near the anal opening
- Pain in the anal area
- Holes or hardened tissue around the anus
How are Anal Fistulas Different from Hemorrhoids?
Anal fistulas and hemorrhoids both involve anal bleeding, but they are not the same. Fistulas are localized outside the anus area and are a result of functional diseases such as inflammatory bowel disease and Crohn’s disease.
Hemorrhoids are a common condition that affects millions of people. The causes of this disease are not fully understood, but they are believed to be related to diet, lack of exercise, and aging. Symptoms include bleeding, itching, and pain and appear in the lower rectum and anus. Unlike hemorrhoids, anal fistulas occur when the muscles near the anus tear causing an abnormal opening. There may be associated pain, discharge, or bleeding from the anal area as well as a constant feeling of pressure. This condition is also known as a perianal abscess or anal sinus.
You should begin the treatment process with a doctor as soon as the symptoms appear.
Anal fistulas are stubborn, and if you leave them untreated, the condition will not go away. If you have pain or pus discharge in the anal area, see a doctor as soon as possible for a proper diagnosis and treatment plan.
Diagnosis of Anal Fistula
Review of the patient’s medical history: The doctor will begin by asking you about your symptoms and your medical history.
Physical examination: The doctor will look at the skin and fur around the anal area for signs of redness, pus, bleeding, etc.
MRI: If your doctor suspects you have a complex fistula or a difficult-to-find fistula, he or she may order an MRI scan to get a better view of the fistula tract between the inner and outer openings. This allows her to provide you with the most accurate and effective treatment.
Treatment Methods for Anal Fistula Surgery
Removing an anal fistula may be difficult, depending on the location and complexity of the fistula. In principle, however, surgery should remove the entire fistula, prevent recurrence and protect sphincter muscles from damage.
The general goals of the procedure are to remove the anal fistula and prevent its recurrence, while also preserving or enhancing sphincter muscle function.
Simple Anal Fistula
Anal fistulas can be treated with open surgery. The doctor makes a small cut in the fistula’s internal opening to scrape and drain out all the pus and infected tissue. The wound will be left to heal naturally, with new tissue growth and filling the gap. It takes about one month for this tissue to heal. This method provides about a 90% cure rate with only about a 10% chance of recurrence. However, this method can result in side effects—patients may experience fecal incontinence if the doctor is not skilled enough and the sphincter muscles are excessively cut. For this reason, it is vital that the surgery be performed by a highly skilled and experienced doctor.
Complex Anal Fistula
In the case of deep or complex fistulas, removing the fistula tract entirely would require too much of the sphincter muscle to be excised, resulting in fecal incontinence. For this reason, other methods of treatment are often necessary.
LIFT (Ligation of Intersphincteric Fistula Tract)
LIFT is a surgery that closes off the internal opening of the fistula in order to prevent bacteria inside the anus from entering the cavity. As long as patients do not have an injury to the anal sphincter, they will not experience problems with incontinence post-surgery.
Seton placement involves the placement of a silk or latex string (seton) into the fistula to help drain the infection. The seton is progressively tightened, making the fistula smaller and smaller behind it and allowing the body to gradually heal the wound and repair itself. This method results in gradual tissue repair with constant tension from the seton so that fecal incontinence is avoided.
Advancement Rectal Flap
For patients who develop a rectal fistula, doctors sometimes use an Advancement Rectal Flap, which involves taking mucosal tissue from the lining of the rectal wall before removing the fistula’s internal opening. The flap is then used to cover the repair.
Laser treatment involves the insertion of a laser probe into the opening of a fistula and the gradual destruction of abscessed tissue, which eventually shrinks into scar tissue. As the laser is drawn out of the fistula, it seals and closes up the channel behind it.
Recovery and Postoperative Self-Care
For simple fistula surgeries, patients usually stay in the hospital for one day. For complex procedures, patients should expect to stay in the hospital for 1-2 days; they should adhere to the following post-surgical self-care instructions:
- Clean your wound carefully with mild soapy water, and then rinse it in clean tap water regularly. Pat your area dry with a clean cloth until the wound heals, which generally takes about 4-6 weeks.
- To help prevent blood or discharge from staining clothing, place a gauze pad or a sanitary pad or napkin over the wound.
- Eat normally: no need to limit the diet to soft foods.
- After surgery, your doctor may suggest that you take laxatives or stool softeners to help with bowel movements.
- The doctor may also give other medications to take at the same time, such as painkillers or antibiotics.
- Please stay home at least 2 additional days before driving again.
- Please refrain from exercising or engaging in other physical activities at the discretion of your physician.
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