Description

An anal fistula — also called fistula-in-ano — this is a tunnel that develops between the inside of the anus and the outside of the skin around the anus. The anus is the muscular opening at the end of the digestive tract where stool leaves the body.

Most anal fistulas are the result of an infection that starts in an anal gland. The infection causes an abscess that drains on its own, or is drained surgically through the skin next to the anus. This tunnel drainage remains open and is connected to the infected anal gland or the anal canal to a hole in the outer part of the skin around the anus.

Surgery is usually necessary to treat an anal fistula. Sometimes non-surgical treatments may be an option.

Symptoms

The symptoms of an anal fistula may include:

  • An opening in the skin around the anus
  • A red, swollen area around the tunnel opening
  • Discharge of pus, blood, or feces of the opening of the tunnel
  • Pain in the rectum and anus, especially when sitting or have a bowel movement
  • Fever

Causes

Most anal fistulas are caused by an infection that starts in an anal gland. The infection results in an abscess that drains on its own, or is drained surgically through the skin next to the anus. A fistula is the tunnel that forms under the skin along this drainage pathways. The tunnel that connects the gland anal or anal canal to a hole in the outer part of the skin around the anus.

Ring of sphincter muscle at the opening of the anus to allow the control of the release of the stool. Fistulas are classified by their involvement of these muscles in the sphincter. This classification helps the surgeon to determine the treatment options.

Risk factors

The risk factors for an anal fissure include:

  • Previously drained abscess anal
  • Crohn's disease or other inflammatory bowel disease
  • Trauma to the anal area
  • Infections of the anal area
  • Surgery or radiation therapy for the treatment of anal cancer

Anal fistulas occur most often in adults, around 40 years of age, but can occur in younger people, especially if there is a history of Crohn's disease. Anal fistulas occur more often in men than in women.

Complications

Even with effective treatment of an anal fistula, recurrence of an abscess and anal fistula is possible. The surgical treatment can result in the inability to hold in feces (fecal incontinence).

Diagnosis

To diagnose an anal fissure, your health care provider will discuss your symptoms and do a physical exam. The test consists in the search in the area around and inside of your anus.

The external opening of an anal fistula can usually be easily seen on the skin around the anus. Find the internal fistula opening on the inside of the anal canal is more complicated. To know the full path of an anal fistula is important for effective treatment.

One or more of the following imaging tests may be used to identify the fistula tunnel:

  • Magnetic resonance imaging can assign the fistula tunnel and provide detailed pictures of the sphincter muscle, and other structures of the pelvic floor.
  • Endoscopic ultrasound, which uses high-frequency sound waves, you can identify the fistula, the sphincter muscles and the surrounding tissues.
  • Fistulography is an x-ray of the fistula, which uses an injection of contrast to identify the fistula anal tunnel.
  • The examination under anesthesia. One of the colon and rectum, the surgeon may recommend the anesthesia during an examination of the fistula. This allows a deep look at the fistula tunnel and can identify possible complications.

Other options to identify the internal fistula opening are:

  • Fistula of the probe. A specially designed instrument to be inserted through a fistula is used to identify the fistula tunnel.
  • An anoscope. A small endoscope is used to view the anal canal.
  • Flexible sigmoidoscopy or colonoscopy. These procedures the use of an endoscope to examine the large intestine (colon). Sigmoidoscopy can evaluate the lower part of the colon (sigmoid colon). Colonoscopy, which examines the entire length of the colon, it is important to look for other disorders, especially if the ulcerative colitis or Crohn's disease is suspected.
  • An injection of the dye solution. This can help to localize the fistula opening.

Treatment

The treatment of an anal fistula depends on the fistula of the situation and complexity and its cause. The objectives are to the repair of anal fistula completely to prevent recurrence and to protect the muscles of the sphincter. The damage to these muscles can lead to fecal incontinence. Although surgery is usually required, sometimes the non-surgical treatments may be an option.

Surgical options include:

  • Fistulotomy. The surgeon cuts the internal fistula opening, scrapes and removes the infected tissue, and then flattens the tunnel and the stitches in place. For the treatment of a more complicated form of the fistula, your surgeon may need to remove some of the tunnel. Fistulotomy can be done in two phases, if a significant amount of sphincter muscle must be cut or if the tunnel can't be found.
  • Endorectal advancement flap. The surgeon creates a flap of the rectal wall, before the removal of the internal fistula opening. The flap is used to cover the repair. This procedure can reduce the amount of sphincter muscle is cut.
  • The ligation of the intersphincteric fistula tract (LIFT). LIFT is a two-stage treatment for more complex or deep fistulas. ELEVATOR allows the surgeon to access the fistula between the muscles of the sphincter and prevent cuts. Silk or latex chain (seton) is first placed in the fistula tunnel, forcing it to widen with time. Several weeks later, the surgeon removes the infected tissue and closes the internal fistula opening.

Non-surgical options include:

  • Seton placement. The surgeon places a seton into the fistula to help drain the infection. This allows the tunnel to heal. This procedure may be combined with surgery.
  • Fibrin glue and collagen plug. The surgeon clears the tunnel, and the sutures close the internal orifice. Special glue made from a fibrous protein (fibrin) is then injected through the fistula of the external opening. The anal fistula tunnel can also be sealed with a plug of collagen protein and then closes.
  • The medication. The medication can be part of the treatment if the disease Crohn's disease is the cause of an anal fissure.

In the cases of anal fistula complex, more invasive surgical procedures may be recommended, including:

  • Ostomy and stoma. The surgeon creates a temporary opening in the abdomen to divert the intestines out of the anal canal. Waste is collected in a pouch on the abdomen. This procedure allows the anal area time to heal.
  • Muscle flap. In very complex anal fistulas, the tunnel may be filled with healthy muscle tissue of the thighs, the lips or in the buttock.

Lifestyle and home remedies

Your doctor may suggest measures to make it more comfortable during the healing process:

  • The use of the pain medication, as needed
  • Soak in a bath of hot seat
  • Add fiber to your diet and drink plenty of fluids to avoid constipation
  • Avoid straining during bowel movements

Preparing for your appointment

If you have an anal fistula, you may be referred to a specialist in diseases of the digestive system (gastroenterologist) or a colon and rectal surgeon.

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as not eating for a period of time (fasting) before being subjected to a specific test. Make a list of:

  • Their symptoms , even if they may seem unrelated to the reason for your appointment
  • Key personal information , including major stresses, recent changes in life, and personal and family medical history
  • All the drugs, vitamins, herbs, or other supplements you are taking , including the dosage
  • Questions to ask your health care provider

Some basic questions to ask include:

  • What is likely causing my symptoms?
  • There are other possible causes of the symptoms?
  • Do I need any tests?
  • Is my condition likely temporary or permanent?
  • What are some diet tips that you should follow?
  • There are restrictions that must be followed?
  • What treatment do you recommend it?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your health care provider may ask:

  • When did your symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • Where do you feel that your symptoms?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do you have other medical conditions, such as Crohn's disease?
  • Do you have problems with constipation?
Symptoms and treatment of Anal fistula