ColomboSurgeon

Anal Fistula

What is an anal fistula?

 

An anal fistula is an abnormal tunnel-like connection between the inside of the anus or rectum and the skin around the anus. It usually results from an infection in an anal gland that forms an abscess, which then creates the fistula.

 

What causes fistulae?

  • Infections or Abscesses: These are the most common causes.
  • Inflammatory Bowel Diseases: Such as Crohn’s disease.
  • Trauma or Injury: To the anal or rectal area.
  • Tuberculosis or Cancer: Rarely, certain conditions may lead to fistula formation.

Symptoms

Common symptoms include:

  • Persistent drainage of pus or blood from an opening near the anus.
  • Pain or discomfort, particularly during bowel movements.
  • Swelling or redness around the anus.
  • Irritation of the skin near the fistula opening.
  • Recurring infections or abscess formation.

 

Types of Anal Fistulas

Anal fistulas are classified based on their location and relationship to the anal sphincter muscles:

  • Intersphincteric: The most common type, passing through the internal sphincter.
  • Transsphincteric: Passes through both internal and external sphincters.
  • Suprasphincteric: Passes above the external sphincter.
  • Extrasphincteric: Extends beyond the sphincter muscles, often due to trauma or a medical condition.

How are fistulae diagnosed?

Doctors typically diagnose an anal fistula through:

  • Physical Examination: Identifying external openings or signs of infection.
  • Imaging Tests: MRI or ultrasound may be used for complex fistulas.
  • Proctoscopy or Sigmoidoscopy: To examine the rectum and anus more closely.

 

Treatment for fistulae

Anal fistulas usually require surgical treatment to heal completely. Common procedures include:

  • Fistulotomy: The fistula is opened and flattened, allowing it to heal from the inside out.
  • Seton Placement: A surgical thread is placed to help drain infection and allow healing.
  • Advancement Flap Surgery: A tissue flap is used to close the internal opening.
  • Fibrin Glue or Plugs: Non-invasive options to seal the fistula (may not work for all types).
  • LIFT Procedure: A sphincter-sparing technique to close the fistula.
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Preventing fistulae

While not all anal fistulas can be prevented, you can reduce the risk by:

  • Promptly treating anal infections or abscesses.
  • Managing underlying conditions like Crohn’s disease or diabetes.
  • Maintaining good anal hygiene.

 

When to see a Doctor

Contact your doctor if you experience:

  • Persistent anal pain or swelling.
  • Drainage of pus or blood from around the anus.
  • Symptoms of an abscess (severe pain, fever, or chills).