What causes an anal fistula?
The leading causes of an anal fistula are clogged anal glands and anal abscesses.
Other less common conditions that can cause an anal fistula include:
- Crohn’s disease (an inflammatory disease of the intestine)
- Radiation therapy (for cancer)
- Trauma
- Sexually transmitted diseases
- Tuberculosis
- Diverticulitis (a condition in which small pouches form in the large intestine and become inflamed)
- Cancer
What are the Symptoms of anal fistulas?
- Simple or low fistulas: These fistulas involve a single tract that connects the rectum to the skin around the anus.
- Complex or high fistulas: These have multiple tracts that branch out in different directions and may involve other organs, such as the vagina, bladder, or intestines.
How is anal fistula Diagnosed?
Your doctor can usually diagnose an anal fistula by examining the area around the anus. First, they will look for an opening (the fistula tract) on the skin. The doctor will then try to determine how deep the tract is and the direction in which it is going. In many cases, there will be drainage from the external opening.
- Physical examination: The doctor will examine the anus and rectum to look for signs of a fistula, such as an opening or redness.
- Anoscopy: A thin, flexible tube with a camera on end is inserted into the anus to examine the internal structure of the anal canal.
- Imaging tests: A CT scan or MRI is used to identify the extent and location of the fistula.
- Sometimes your surgeon must examine you in the operating room (called an exam under anesthesia) to diagnose the fistula.
Treatment of anal fistulas:
- Fistulotomy: is the gold standard for an acute anal fistula and entails first identifying the fistula tract using a probe. This most common treatment involves cutting the fistula tract open and allowing it to heal naturally.
- Seton placement involves placing a small piece of surgical material called a seton in the fistula tract to keep it open and allow it to heal gradually.
- Fibrin glue injection involves injecting a special glue into the fistula tract to seal it shut.
- Flap surgery involves using nearby tissue to cover the fistula tract and promote healing.
- Laser treatment: This involves using a laser to destroy the fistula tract.
- Reconstructive surgery: may be an option in some cases.
- Ligation of the inter-sphincteric fistula tract (LIFT): A skin incision is made. The fistula tract is exposed and then tied and divided. A modification of this procedure, called BioLIFT, involves placing a biological mesh to prevent a fistula reforming. However, this needs a more extensive skin incision and increases the risk of infection.
It’s essential to seek medical attention if you experience symptoms of an anal fistula, as prompt treatment can prevent complications such as infection or incontinence.
Is any follow-up treatment necessary for an anal fistula?
Most fistulas respond well to surgery. However, after the surgery, your surgeon may recommend that you soak the affected area in a warm bath, known as a sitz bath, and take stool softeners or laxatives for a week.
If opioids are prescribed, they are usually used for a short period.
If the abscess and fistula are adequately treated and healed, they will probably not return.
When recovering from anal fistula treatment, take pain medicine as directed by your surgeon. Finish all of your antibiotics. Don’t take any over-the-counter medicines without first talking to your provider.
Other essential instructions may include:
- Soaking in a warm bath 3 or 4 times a day
- Wearing a pad over your anal area until healing is complete
- Resuming normal activities only when your surgeon clears you
- Eating a diet high in fiber and drinking plenty of fluids
- Using a stool softener or bulk laxative as needed
What are the Complications of anal fistula surgery?
- Recurrence of fistula
- Incontinence to flatus or stool
- Chronic draining wound
- Anal stricture
Anorectal fistulas are characterized by their tract location relative to the internal and external sphincters. Parks and Gordon.
