Anal Fistula

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Anal Fistula Symptoms

Anal fistula symptoms, including the following, seldom recede on their own:

  • Recurrent anal abscesses.
  • Skin irritation and discomfort.
  • Throbbing pain that worsens when you are seated or having a bowel movement.
  • Constipation.
  • Pus or blood discharge when passing a stool.
  • Irritation (swelling, tenderness and/or redness) of the skin near your anus.
  • Fever.

Anal Fistula Causes

Most anal fistulas result from an anal abscess healing improperly after the pus has drained away, leaving a small conduit behind; approximately one of every two – four people with an anal abscess will develop one.

Less ordinary causes of anal fistula include:

  • Hidradenitis suppurativa, an ongoing condition that triggers abscesses and scarring.
  • Infection caused by complications of surgery near the anus.
  • Crohn’s disease, a long-term disorder of an inflamed digestive system.
  • Diverticulitis, a condition in which small pouches develop and thrust through vulnerable spots in the colon (large intestine) wall.
  • Infection caused by tuberculosis (TB) or HIV.
  • Complications of surgery performed close to the anus.

Diagnosis of Anal Fistulas

Clinical evaluation, including a digital exam of the rectum if not painful, is generally all that is required to identify an anal fistula. Rarely, the examination may require anesthetization.

However, for some patients, screenings may be needed to test for:

  • Sexually transmitted infections (STI).
  • Cancer of the rectum.
  • Inflammatory bowel disease (IBD).
  • Diverticulitis.

Treatment of Anal Fistulas

The cure for an anal fistula is surgery; the type of procedure used is dependent upon the location of the fistula. The goal of surgery is to allow the fistula to heal without damage to the muscles of the sphincter, the impairment of which could cause a failure of bowel control (incontinence).

Presently the only non-surgical treatment available for an anal fistula is Fibrin sealant, an adhesive that is injected into the fistula tract to close it, then secured with stitches. Although safe and painless, the initial success rates of 77% drop to 14% in less than 18 months’ time.

Surgical options for anal fistulas include:

  • Fistulotomy. Used in 85-95% of cases, this entails cutting the entire length of the fistula to allow the contents to be flushed out. After healing for one–two months, the incision becomes a level scar.
  • Seton Techniques. A piece of surgical thread (Seton) is left in the fistula tract when there is a high risk of incontinence as the fistula overlaps the muscles of the sphincter; this may help avoid the need to cut the sphincter muscles directly. Several operations may be necessary.
  • Advancement Flap. Following the removal of the fistula tract, a piece of tissue from the rectum or skin (advancement flap) is reattached to the opening of where it was. The procedure is typically employed when the fistula is thought to be complex, or when the possibility of incontinence is high. The success rate is around 70%.
  • Bioprosthetic Plug. Cone-shaped and made from human tissue, bioprosthetic plugs are used to obstruct, but not seal the inside opening of the fistula, holding it in place with stitches. The objective is the growth of fresh tissue that will heal the fistula. It has shown success in 80% of limited trials.

Fistula Surgery Risks

As with any surgery, there are risks to anal fistula surgeries. These may include:

  • Bowel incontinence.
  • Infection.

* Recurrence of fistula.

Following Anal Fistula Surgery

Most people can move around and eat and drink once the anesthetic has worn off. You may be able to go home the same day, though a longer stay may be necessary if the surgery is problematic. You can expect to lose only a minimal amount of time from work or school.

You will probably be given medicine for pain relief. Take the prescription as directed. Do not wait until the pain becomes severe.

Unless you have diabetes or a comprised immune system, antibiotics are usually not needed.

Healing ordinarily takes about six weeks. Stool softeners may be used to ease the discomfort of your bowel movements, as well as prevent or treat constipation. A gauze pad may be worn to prevent drainage from harming your clothes.

It is important that you follow up with your healthcare provider as instructed.


General Surgeons

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