What Is Anal Fistula?
An anal fistula is an abnormal passageway that develops from inside your anus to the skin outside. It usually develops in the upper part of your anus (butthole), where your anal glands are. When these glands become infected, drainage from the infection can create a fistula. This infection is called a perianal abscess. (Sometimes an anal fistula is also called a perianal fistula. “Perianal” means in the region of your anus.)
How common is this condition?
A fistula is a relatively common anorectal condition. It’s twice as common in men and people assigned male at birth (AMAB). About half of people who get an infected anal gland will develop a fistula. An infected gland that forms an abscess, a pocket of pus that needs to drain, causes 75% of anal fistulas.
Causes Of Anal Fistula:
Anal fistula can develop due to the following causes:
- Anal abscess
Anal abscess, if left untreated, tends to burst and cause an anal fistula to develop.
- Inflammation of the intestines
Anal fistula is a known complication of the following diseases:
- Crohn’s disease
- diverticulitis
- Syphilis
- AIDS
- Tuberculosis
- Chlamydia
- Complication in surgery
- a growth or ulcer (painful sore)
- an inborn health problem
Symptoms Of Anal Fistula:
The following symptoms are exhibited by those who develop anal fistula:
- Recurrent anal abscesses
- Pain and swelling around the anus
- Pain with bowel movements
- Bleeding
- Bloody or foul-smelling drainage (pus) from an opening around the anus. The pain may decrease after the fistula drains.
- Irritation of the skin around the anus due to persistent drainage
- Fever, chills, and a general feeling of fatigue.
- Diarrhea
- Weight loss
- Vomiting
Diagnosis Of Anal Fistula:
Anal fistula is generally diagnosed via the following methods:
- Physical exam
- Rectal examination
- Protoscopy
- CT scan
- MRI
- Anal endosonography
Treatment Of Anal Fistula:
What is the treatment for an anal fistula?
Most anal fistulas will require surgery to fix. Spontaneous healing is usually followed by recurring infections and abscesses that reopen the fistula. However, if your fistula is caused by inflammatory bowel disease and isn’t infected, it’ll occasionally heal with medical treatment. Your provider might try treatment with an immunomodulator, like infliximab, before resorting to surgery for these fistulas.
Surgery
Anal fistula surgery can be simple or complex, depending on how simple or complex the fistula is. The most common anal fistulas are simple, intersphincteric fistulas, which only involve a small amount of muscle. These are safe to treat in a single operation. More complex fistulas may need surgery in stages.
Simple fistulas
If your anal fistula involves only a minimal amount of muscle and doesn’t have any branches, it’s considered a simple fistula. The surgical treatment for a simple fistula is called a fistulotomy. This one-and-done procedure is the easiest and the most effective way to treat an anal fistula (about 95%).
Fistulotomy: Your colorectal surgeon will cut through the roof of the fistula, allowing it to fill in from the bottom up. They might also remove infected tissue. Cutting through the roof may mean cutting through a small amount of muscle, but a little is OK. Cutting too much muscle risks damaging your bowel control.
Complex fistulas
Your fistula is considered complex if it involves a significant amount of muscle, if it has branches or if you have preexisting conditions that raise your risk of complications from surgery. Complex fistulas may require multiple surgeries to fix. Your colorectal surgeon may use one or more of these techniques:
- Seton drain. A seton is a type of surgical thread that isn’t absorbed over time but must be removed. A surgeon loops the seton through your fistula to help keep it open long enough to drain all the discharge out. A seton can also slowly cut through the fistula tract, allowing the tissue to heal as it cuts through the muscle. Lastly, it helps with local scarring of the tissue so that the wound doesn’t pull apart later. Your surgeon may later remove the drain and close the fistula with a fistulotomy or another procedure. If your fistula is caused by a chronic condition, like inflammatory bowel disease, your surgeon might leave the seton drain in place indefinitely.
- Endorectal advancement flap. This procedure avoids cutting into the roof of the fistula so your sphincter muscles stay intact. Instead, your surgeon cuts out the infected tissue around the inside opening of your anal fistula. Then they cover this opening by pulling down a flap of healthy tissue from the inside of your rectum above it. The fistula should continue to drain out of the outside opening and then begin healing from the inside out. This procedure is considered about 70% effective, but in some cases, the infection and fistula still come back. There’s also still some risk (approximately 30%) of injuring the sphincter muscle when cutting the flap.
- LIFT procedure. LIFT stands for “ligation of intersphincteric fistula tract”. This means closing (ligation) the part of the fistula that passes between your two sphincter muscles (intersphincteric), usually with stitches. Your surgeon may then remove the entire fistula tract from this space or scrape out the infected tissue inside. This procedure usually follows a seton drain procedure. It’s a little less effective than fistulotomy (75%) but it doesn’t risk harming your sphincter muscles.
What are the risks of anal fistula surgery?
The main risks are:
- Recurring infection. If the infection isn’t completely gone from your fistula, it may continue inside your healing fistula. Antibiotics can usually treat a recurring infection.
- Recurring fistula. An anal fistula may come back after surgery if it doesn’t heal completely. This might be because of underlying chronic conditions, or because of the technique used.
- Fecal incontinence. Some people experience slightly compromised fecal continence after anal fistula surgery. For example, they might have trouble holding in gas or have some fecal leakage. These complications are less common with more experienced colorectal surgeons.
What is recovery like from anal fistula surgery?
Anal fistula procedures are generally outpatient procedures, so you can go home the same day, although some people will need to return for more surgery later. You’ll have prescription pain medication to take home with you, along with some instructions for self-care. These may include:
- Water and fiber supplements. Pain medications can cause constipation, so your provider might prescribe fiber supplements to prevent this. It’s important to take these with lots of water.
- Sitz bath. Soaking your anus in a sitz bath (a warm, shallow bath) at least once a day will help soothe it and quicken healing.
- Wound management. You may need to apply dressings to your wound to collect drainage and change them often to keep it clean.
Reference:
https://my.clevelandclinic.org/health/diseases/14466-anal-fistula
By : Natural Health News
