Contributed by: Priyaish Srivastava
What is an anal fistula?
An anal fistula is an irregular connection formed between the perianal skin (skin around the opening of the anus) and the anal canal surface. The condition usually occurs when an infection like hemorrhoids or abscess (collection of pus) inflicts the anus. Almost always, anal fistula surgery or Fistulotomy is the only means to alleviate the symptoms and treat the condition.
Although most fistulas are simple to treat, if left unattended, they might turn into severe health issues like colon cancer.
Experts recommend that the patient should go for a complete rectal scan before final surgery to identify the exact location of the fistula and get it removed permanently. Magnetic resonance imaging (MRI) may be the best option to assess the fistula’s location in a patient’s body.
Top 3 causes of anal fistula
Anal fistula due to Crohn’s disease
Crohn’s disease is often termed as an inflammatory bowel disease (IBD) that may occur in the digestive tracts, especially in small and large intestines. It can cause inflammation and irritation that may give rise to fistula formation in the anus region. If you experience symptoms like diarrhea, rectal bleeding, weight loss, and abdominal pain, you might be suffering from an anal fistula and should consider visiting a doctor at the earliest.
Anal fistula due to cancer treatments
The treatment of cancer involves several types of surgeries and chemotherapy that necessitates experiencing a huge amount of radiation. These radiations tend to harm other organs of the body and bring about complications, such as anal fistula.
Anal fistula due to tuberculosis
Tuberculosis (TB) is a highly contagious disease caused due to infection of the lungs. It may also expand and affect other parts of the body like the brain, spine, and digestive tracts. The condition in which TB affects the digestive system is termed perianal TB and the condition might often be misidentified as Crohn’s disease. Perianal TB may affect the glands near the anus and create an unusual connection between the skin beneath the anus and the anal canal surface which brings about the condition of anal fistula.
Symptoms of anal fistula
The symptoms of an anal fistula may be painful, irritating, cause extreme discomfort, and won’t usually get better on their own, necessitating the need for surgery.
Here are some of the most common symptoms:
- Skin irritation around the anus.
- Pain, redness, and swelling of the skin around the anus
- Constant throbbing pain. The pain may worsen when any physical activity like walking or sitting takes place. It will also affect when a person coughs or bowel movements occur.
- Smelly and frequent abscess discharge from a hole near the anus.
- Passing blood and pus in the poop
Diagnosis and treatment of anal fistula
The doctor will ask for the patient’s medical history first to check if there have been any health complications in the past that led to the condition. Next, the physician will carefully examine the area around the anus to locate the fistula tract throughout the skin to determine the depth and direction. Some fistulas may not be easily located on the skin and would have to be identified by imaging tests like:
- An anoscopy: A procedure conducted to obtain the inside imaging of the anus and rectum.
- An MRI or ultrasound: To obtain better and more precise imaging of the anal fistula.
- The doctor may also perform a physical rectal examination to diagnose the fistula by giving a local or general anesthesia.
The anal fistulas cannot be treated without surgery. Thus, it is advised to go for anal fistula surgery under the supervision of a colon or rectal surgeon. Some of the main treatment options include:
- Seton procedure: In this procedure, the surgeon leaves a portion of thread inside the fistula that allows it to drain the abscess. It is a complicated procedure that may take a few weeks to finish and requires surgery to close the tract.
- Fistulotomy: It is the most effective method to resolve the fistula condition and involves slicing it to the complete length. After this surgery, just a flat scar is left behind to heal and fix the skin back to normal.
- Fibrin glue: The surgeon injects a composition of fibrinogen, thrombin, and calcium into the fistula tract that results in blood clotting. This clotting forms healthy tissues in the fistula to heal it
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