What Is An Anal Fistula? Here’s Everything You Need To Know About It!

An anal fistula refers to the small tunnel, connecting an infected gland in the anus with an opening on skin surrounding the anus. Its basic symptoms are swelling, pain around anus.

What is an anal fistula?

An anal fistula connects an abscess to the opening on skin around anus. This abscess is nothing but an infected cavity in the anus. The abscess is the result of clogging of mucus-making glands present in the anus. Around half of such abscesses lead to the development of a fistula.

What causes anal fistula?

Clogged anal glands as well as anal abscesses are the leading anal fistula causes. Other less common conditions responsible are the following:

• Crohn’s disease, intestine’s inflammatory disease
• Trauma
• Radiation, treatment for cancer
• Sexually transmitted diseases
• Cancer
• Tuberculosis
• Chronic diarrhoea
• Ulcerative colitis

Anal Fistula Symptoms

There are several signs and symptoms indicating the formation of an anal fistula. These are as follows:

• Pain, swelling around anus
• Frequent abscesses of the anus
• An opening around the anus draining bloody and foul-smelling pus
• Irritation of skin around anus due to drainage
• Bleeding
• Pain with bowel movements
• Chills, fever and feeling of fatigue or tiredness

Anal Fistula Complications

Complications of anal fistula include the above symptoms along with redness, constipation, trouble in controlling bowel movements (faecal incontinence). Complications can be a result of recurring fistula. You should not miss these signs and contact a doctor immediately.

Diagnosis

When you visit the doctor, he’ll start the diagnosis by examining the area surrounding the anus. He’ll look for an opening or the fistula tract. The doctor tries to find out the direction of the fistula, while the external opening drains out pus.

Following are some procedures for better diagnosis, as sometimes the fistulas are not easily visible on the skin surface:

• Anoscopy is the method where a special instrument helps the doctor see the inside of anus and rectum. It’s a tubular device and guides through the anal tract.
• An ultrasound or MRI helps get a better view of fistula tract. This is suitable for knowing how deep-set the fistulas are.

How to treat anal fistula?

Surgery is almost necessary to cure an anal fistula. And it’s a colon and rectal surgeon performing the anal fistula surgery.

• Fistulotomy: This procedure involves opening up of the fistula inside out for better results and faster healing. The surgeon then cuts the opening, scrapes and cleans the infected area. Then he flattens and sutures it back. Fistulotomy involves cutting of the sphincter muscle and may be complicated when the entire channel needs removal.

• Filling the fistula: It’s a new technique. The doctor uses a special glue, or plug, for closing the inner opening of fistula. Then he’ll clear and clean the channel, and close the input of the fistula with sutures. Here, he’ll insert a special fibrous protein or fibrin in the fistula through its external opening. Finally, he’ll close shut the anal tract with a protein collagen plug.

• Reconstructive surgery: This kind of surgery happens in stages and in some particular cases after the surgeon’s recommendation. It has another name – LIFT or Ligation of the Intersphincteric Fistula Tract. It helps cure deep-seated fistulas and its different stages take several weeks apart.  

• Seton placement: This is suitable for more complex fistulas. The surgeon places a special drain, seton (a rubber band), and it helps drain out the infection. Complex fistulas demand invasive procedures such as Colostomy. In this procedure, the doctor makes an opening in the abdomen. He thus allows diversion of all waste and drain into a collection bag. It gives the anal area to heal.

• Muscle flap: It’s suitable for complex anal fistulas. This procedure involves using healthy muscles from buttock, thigh or labia for filling the fistula channel.

Patients with both a fistula and Crohn’s disease have to go through a medical therapy before surgery.

Management

For those dealing with an anal fistula, or recovering from one, here are some helpful practices:

• Soak the fistula area in warm bath 3-4 times a day
• Eat food rich in fibre and drink lots of fluids
• Avoid strenuous activities
• Use a laxative after the recommendation of your doctor

Follow-up Treatment

Done with anal fistula treatment, you may go for sitz bath and laxatives or stool softeners as per the doctor. He may inject local anesthetic to reduce pain and discomfort, and prescribe pain killers. You may ask him about further measures for post-operative care.

Does the abscess or fistula recur?

There are very much chances, the abscess and fistula when treated and healed properly, won’t come back. However, if they do and if you find similar symptoms, talk to your colon and rectal surgeon to manage the condition.

Who is a colon and rectal surgeon?

A colon and rectal surgeon is an expert in surgical as well as non-surgical treatment of diseases of colon, anus and rectum. He has advanced surgical training completed in such treatment, and also has full general surgical training. These surgeons can carry out routine screening examinations, as well as treat conditions surgically as and when needed.

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