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Anal Fistula

An anal fistula is an infected tunnel that runs between the skin and the anal opening. This is usually the result of an infection that originates in an anal gland and causes an abscess - a swollen pocket of infected tissue and fluid. The fistula forms a tunnel under the skin and connects with the infected gland.

The small glands inside the anus produce mucous and occasionally become infected. Infections that don't heal in the right manner can lead to an anal fistula. 

Risk factors for anal fistula

A person who has an anal abscess is at higher risk for getting an anal fistula. Health conditions that affect the bowels are other factors that increase the chances of developing a fistula. These conditions could include Crohn’s disease, sexually transmitted diseases, tuberculosis, certain cancers and diverticulitis.

Causes of anal fistula 

The most common causes of an anal fistula are clogged anal glands and abscesses. Other conditions that may cause an anal fistula are Crohn’s disease, which is an inflammatory condition of the intestine, radiation received as treatment for cancer, trauma, sexually transmitted diseases,  tuberculosis and diverticulitis - a disease in which small pouches form in the large intestine and become inflamed. Patients suffering from certain cancers also develop anal fistula.  

Symptoms of anal fistula

A patient suffering from an anal fistula is likely to observe the following signs and symptoms.

  • Pain and swelling around the anal area.
  • Blood or foul-smelling liquid discharge from an opening around the anus.
  • Irritation of the skin around the anus.
  • Pain during bowel movements.
  • Fever, chills and fatigue.

Diagnosis of anal fistula

If a patient it is experiencing symptoms of an anal fistula the doctor will start by examining the area around the anus. The doctor will check if there is an opening on the skin, which is also called the fistula tract. She or he will aim to find out how deep this tract may be, and the direction in which it is going. Quite often there is drainage from this external opening.

In some cases, the fistula is not visible on the skin’s surface and the doctor may recommend additional tests. These tests could include:

  • An anoscopy to get a view inside the anus and rectum.
  • The physician may also recommend an ultrasound or MRI of the anal area for a better view of the fistula tract.
  • In some cases, the surgeon may need to conduct an examination of the patient under anaesthesia in the operation theatre for a proper diagnosis.
  • If a fistula is found, your doctor may want to conduct additional tests in order to identify the cause, especially to check whether it is related to Crohn’s disease, as approximately 25% of the people who suffer from Crohn’s disease develop fistulas. In this case, you may require blood tests, X-rays and a colonoscopy, which is performed under sedation and enables the doctor to view the colon. 

Treatment of anal fistula

  • Fistulotomy: This is the most common type of surgery for anal fistulas. This involves cutting along the whole length of the fistula to open it up so it heals as a flat scar. 
  • Advancement flap procedures: This option is usually performed when the fistula is complex (long, high and/or recurrent), or if there is a high risk of incontinence. The advancement flap is a piece of mucosa and submucosa taken from the rectum (with an intact vascular pedicle) and transposed over the internal orifice in order to close it.
  • VAAFT (Video Assisted Anal Fistula Treatment): This is a new minimally invasive and sphincter-saving technique for treating complex fistulas. It allows to directly see the fistula tracts and cavities with the fistuloscope and treating them under direct vision with an electrode. The internal orifice can be closed either with a flap or with a stapler. With this technique, no seton is used, no painkiller medication is necessary, and there is minimal to no risk of sphincters injury (no incontinence risk).
  • Laser treatment
  • Collagen matrix paste injection
  • Stem cells injection
  • PRP gel injection

Post-surgery your surgeon is likely to recommend that you soak the anal area in a warm bath, also known as a sitz bath. It is also advisable to take stool softeners or laxatives for some days. Once an abscess and fistula have been treated correctly and heal they usually do not recur.

For the best treatment of an anal fistula consult a colorectal specialist at Medcare.

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