What Is A Fistula? In simple terms, a fistula is an abnormal channel that connects two organs, vessels, or spaces in the body that are not supposed to be connected. While fistulas can occur in various parts of the body, an anal fistula is a specific type that develops near the anus. An anal fistula is essentially a small tunnel that forms between the anal canal or rectum and the skin surrounding the anus. This condition can lead to discomfort and requires medical attention for effective treatment.
Understanding Anal Fistulas
Anal fistulas are frequently the result of a previous or current anal abscess. An abscess is a painful collection of pus caused by infection. When an anal abscess drains, it may not fully heal, sometimes leaving behind a tunnel or tract beneath the skin. This tract is the anal fistula. These fistulas can cause a range of bothersome symptoms and typically won’t resolve without medical intervention, often requiring surgical treatment to correct.
Symptoms of Anal Fistulas
Recognizing the symptoms of an anal fistula is crucial for seeking timely medical help. Common symptoms include:
- Skin irritation around the anus: The area surrounding the anus may become itchy, inflamed, and sore due to persistent drainage and infection.
- Persistent pain: A constant, throbbing pain is often experienced, which can worsen with sitting, movement, bowel movements, or coughing.
- Discharge near the anus: A foul-smelling discharge of pus, blood, or mucus from an opening near the anus is a typical sign.
- Pain during bowel movements: Passing stool can be particularly painful.
- Swelling and redness: The area around the anus may exhibit swelling, tenderness, and redness, potentially accompanied by a fever if an abscess is also present.
- Bowel incontinence: In some instances, individuals may experience difficulty controlling bowel movements.
You might be able to see the external opening of the fistula as a small hole in the skin near the anus, but it can sometimes be difficult to spot on your own.
Seeking Medical Advice for a Fistula
If you experience persistent symptoms suggestive of an anal fistula, it’s important to consult a healthcare professional. Your General Practitioner (GP) will inquire about your symptoms and medical history, particularly any bowel conditions. A physical examination, including a gentle rectal exam, may be conducted to check for signs of a fistula.
If a fistula is suspected, your GP may refer you to a colorectal surgeon, a specialist in conditions affecting the colon and rectum. Further tests to confirm the diagnosis and determine the most appropriate treatment plan may include:
- Detailed physical and rectal examination: A more thorough examination by the specialist.
- Proctoscopy: A procedure using a thin, lighted tube with a camera to visualize the inside of the anus and rectum.
- Imaging scans: Ultrasound, MRI, or CT scans may be used to get a detailed picture of the fistula tract and surrounding tissues.
Causes of Anal Fistulas
The majority of anal fistulas arise following an anal abscess. If an abscess doesn’t heal properly after drainage, a fistula can develop. While anal abscesses are the primary cause, other less common causes of anal fistulas include:
- Crohn’s disease: An inflammatory bowel disease that can affect any part of the digestive tract.
- Diverticulitis: An infection or inflammation of small pouches that can form in the digestive tract.
- Sexually transmitted infections (STIs): Certain STIs can, in rare cases, lead to fistula formation.
- Trauma: Injury to the anal area.
- Cancer: Although rare, anal cancer can sometimes be associated with fistulas.
Treatment Options for Anal Fistulas
Anal fistulas typically require surgical intervention as they are unlikely to heal on their own. Treatment aims to eliminate the fistula and prevent recurrence while minimizing damage to the anal sphincter muscles, which control bowel function. Common surgical procedures include:
- Fistulotomy: This procedure involves surgically opening the entire length of the fistula tract, converting it into a groove that heals from the inside out. It is often effective for simpler fistulas.
- Seton placement: A seton, a surgical thread, is placed within the fistula tract and left in place for several weeks or months. This can help to drain the fistula, promote healing, and prepare for further surgery or, in some cases, facilitate healing on its own.
- Other surgical options: Advancements in surgical techniques offer various other approaches depending on the complexity and location of the fistula. These may include LIFT procedure (ligation of intersphincteric fistula tract), fibrin glue or collagen plugs.
The most suitable treatment approach will depend on the individual characteristics of the fistula. Discussing the benefits and risks of each option with a colorectal surgeon is essential to make an informed decision about your care. While some procedures can be performed as outpatient surgery, others may require a short hospital stay.
Seeking prompt medical attention and appropriate treatment is key to managing anal fistulas effectively and improving your quality of life.
