An anal fistula is not a topic of discussion that would occur with the ordinary individual, but it does affect thousands of people on this planet. This small tube that forms between the end of the bowel and the skin of the anus can be very painful and irritating. To know what it is, its symptoms, and how to treat an anal fistula can motivate patients who are affected by it to visit a doctor early without hesitation or shame.
Most simply stated, an anal fistula takes place when the anal abscess – an irritating pocket of pus – fails to heal in its normal fashion upon drainage. A tunnel instead is formed, in which a space from the formerly infected anal gland is established which connects with a skin opening which girds the anus. The recurring tunnel creates a conduit for bacteria and fragments of stool to move into the tract on a constant basis, inhibiting natural healing and causing continuous symptoms.
The most common symptom of an anal fistula is pain around the anus, especially with bowel movements. Drainage of pus or blood from an opening near the anus is present in most patients. The drainage can be irritating to the skin and smelly. Recurring abscesses that occur and drain when the external opening is temporarily blocked occur in some individuals. Unless treatment of anal fistula is performed, these symptoms do not resolve spontaneously.
Some there are some risks that increase the likelihood of getting this condition. Crohn’s disease, or chronic inflammatory bowel disease, has a very high association with development of fistula. Other risks include a history of radiation to the pelvic area, injury to the anal sphincter area, and some infections. This anal fistula can occur in anyone, though it occurs mostly in adults who are 20 to 40 years of age and also men more than in women.
Diagnosis of an anal fistula is normally by clinical examination where the physician searches for openings around the anus. Further examination using MRI scans, endoscopic ultrasound, or fistulography might be needed to determine the exact course of the fistula tract to allow planning appropriate anal fistula treatment.
Surgery is the conventional therapy for anal fistulas because they never close spontaneously. The procedure used depends on where and how bad the fistula is. Fistulotomy – cutting along the whole fistula tract so it heals outward from the inside – is the most frequently used procedure for straightforward fistulas that need little sphincter muscle.
In more serious cases, particularly where making a cut in the sphincter muscle may result in incontinence, more specialized procedures are used. Some of these involve seton insertion (putting in a surgical thread to stimulate slow healing), advancement flap procedure (patching the internal opening with tissue), or LIFT (ligation of intersphincteric fistula tract) procedure. Each of these treatment methods for an anal fistula seeks to seal the fistula without affecting the function of the sphincter.
Recovery from fistula surgery usually occurs over a few weeks. Wound care is critical during this period to aid in healing as well as infection prevention. Recovery is normally enhanced through sitz baths, cleanliness of the area, and adherence to certain food recommendations in order to prevent constipation. Pain medication controls pain, especially in the initial days post-surgery.
The majority of people who receive treatment for anal fistulas recover well, but success rates vary depending on how complex the fistula is and the type of procedure. Fistulotomy to treat simple fistulas cures 90% of patients, and complex fistulas may require repeated interventions.
While healing an anal fistula is physically and emotionally challenging, understanding the condition and immediate medical intervention can make proper treatment possible as well as improve quality of life.
