Anal fistula
Anal Fistula is a medical condition that affects the anal canal and is formed by a loose connection between the inside of the rectum and the skin around the anus. These connections are formed due to infection and flocking of pus in the anal gland. If such an anal condition is not treated, then it can take the form of serious complications. Here will talk about Anal Fistula, which will include its types, its causes, symptoms, diagnosis, treatment, and prevention methods of Anal Fistula. Keeping all these in alignment, we will also discuss the role of anal health and lifestyle.
Dr Sunil Kumar Singh
What Is Anal Fistula?
It is an anal disorder that is developed due to an infected tunnel between the anal canal and the skin around the anus. It is a result of infection, typically an abscess formed in the anal gland. Such infection causes a collection of mucus and creates a tract allowing the pus to drain out, thus causing Anal Fistulas.
Low Anal Fistula
The Fistulas that are close to the anal opening are referred to as the Low Anal Fistula. These are located in the lower part of the anal canal. These are less complex and can be easily treated.
High Anal Fistula
The Fistulas that develop in the upper part of the anal canal are known as High Anal Fistulas. These are more complex and found challenging to treat.
Types Of Anal Fistulas
Anal Fistula can be of multiple types, and their classification is based on their location and complexity. But most commonly, Anal Fistula can be of 4 types that are as follows.
Intersphincteric Fistula
Intersphincteric fistula develops in the testicular glands and travels through the internal sphincter muscle.
Transsphinteric Fistula
It is a more complex type of Anal Fistula. It extends through the internal and external sphincter muscles.
Suprasphincteric Fistula
It is considered as a less common type of Anal Fistula. Though it’s a common fistula, it’s more challenging. It originates in the higher part of the anal canal, above the internal sphincter muscle.
Extrasphincteric Fistula
It is a complex kind of Anal Fistula and is rarely found in any individual. It is originated outside of the anal canal and sphincter muscles.
Anal Fistula Causes
Infection in the anal glands is the main reason behind the cause of Anal Fistula. This infection can depend upon multiple factors that include:
Digestive Conditions
A primary cause of Anal Fistula can be digestive conditions like Crohn’s disease and diverticulitis (a disorder) that increases the chances of developing an Anal Fistula.
Diarrhea
Diarrhoea or loose motions can also be the cause of Anal Fistula because frequent diarrhoea irritates the lining of the anus, due to which the chances of developing cracks in it increase.
Inflammatory Bowel Disease
Due to inflammation in the digestive system, a disorder called Crohn’s disease and colitis occurs, resulting in the development of an Anal Fistula.
Anal Abscess
It is a collection of pus or mucus that is formed in the anal gland. Inattention to such conditions may lead to a proper Anal Fistula.
Constipation
Constipation can also cause Anal Fistula because constipation may result in passing hard stools and straining during bowel movements. It can cause small cracks and result in the formation of Anal Fistula.
Symptoms Of Anal Fistula
An Anal Fistula can cause a person to suffer from different types of symptoms, which can depend upon the location and complexity of the fistula. But some symptoms which are commonly seen in most of the cases of Anal Fistulas are as follows:
Itching
Continuous discharge from the fistula can cause itching around the surrounding skin that may result in a burning sensation, thus causing discomfort and infection.
Redness
Swelling and redness around the anal opening can be noticed, after which the area becomes red. Cleaning the area properly reduces itching and discomfort.
Persistence Discharge
A continuous mucous discharge can be a symptom of an Anal Fistula that can be constant from the hole near the anus resulting in a foul smell, itching, and a burning sensation. These may be sensed around the surroundings.
Pain
An Anal Fistula can also cause pain; in this case, if a person passes stool as well as sits for a long time, this pain can be sharp and even get worse due to some activities.
Bleeding
Bleeding is one of the symptoms of Anal Fistula, but it can be noticed in fewer cases. During a bowel movement, one can see bleeding, but it can be minor. Bleeding can also be detected in toilet paper.
Chronic Anal Conditions
Chronic Anal Conditions are such anal conditions that last for a long time or are recurring. Chronic Anal Fistula causes a standard tunnel to form between the glands or the inner lining of the rectum and the surrounding skin. This tunnel is usually caused by an infection that starts as an abscess and then continues to develop. In such a situation, an anal chronic condition then develops into a final fistula in a short time.
Chronic anal conditions are capable of affecting the quality of life of any person. Ongoing medical management may be required to prevent the underlying fistula and its associated complications. Consulting a healthcare professional for accurate diagnosis and proper treatment is crucial.
Chronic Anal Conditions May Have Some Specific Symptoms, Such As:
- Continuous drainage of pus from the anus
- Recurrent Abscesses
- Persistent Anal Pain
- Discomfort
- Infection
Fistula Complications
Fistula Complications may result in noticeable symptoms that may cause extreme discomfort. Although in some cases, it causes minimal symptoms, while in many cases, fistula can cause some significant complications. Following are some of the complications that can be related to fistulas.
Abscess Formation
A primary cause of Anal Fistula can be digestive conditions like Crohn’s disease and diverticulitis (a disorder) that increases the chances of developing an Anal Fistula.
Infections
Fistulas create pathways for bacteria or other microorganisms to enter into such body areas where they should not. This can result in repeated infections, pain, redness, and release of pus. In many cases, these infections can be severe and should be diagnosed immediately.
Fistula Reoccurrence
Reoccurrence of fistula can be caused due to fistula complications even after a perfect treatment. The reason behind the reoccurrence of the fistula is the inadequate addressing and complications during the treatment procedure. A better medical intervention or even surgery is required to manage the reoccurrence of fistulas.
Urinary Excess
One of the severe symptoms of fistula complications is the leakage of urine. This can make a difference in your lifestyle. As a result, you may feel embarrassed and socially awkward, significantly reducing your quality of life.
Anal Fistula Diagnosis
Anal Fistula is an unusual disorder that forms between the skin or inside the rectum. Diagnosis Of Anal Fistula includes a review of a thorough medical history, physical examination, and additional testing. The doctor may ask some questions about your physical activities as well as examine the anal area during your physical examination.
During the examination, a small instrument called a proctoscope may be used to visualize the inside of the rectum or assess the extent and location of the fistula tract. In the diagnosis of Anal Fistula, equipment like MRI or anal ultrasound can be used to locate your fistula tract.
Best Treatment For Anal Fistula
Anal Fistula can develop into a severe condition if you don’t treat it. The Best Treatment For Anal Fistula depends on the fistula’s complexity, location, and severity. In some cases, Anal Fistula symptoms can be treated with warm sitz baths, antibiotics, and topical medications, but these treatments may not be effective for complex or recurring fistulas. For more advanced treatment of Anal Fistula, some of the best treatments are considered, which are as follows.
Non-Surgical Treatment For Anal Fistula
Often, patients remain worried about surgical and non-surgical treatment. But there is only one available non-surgical treatment option for Anal Fistula, which is known as Fibrin Glue Injection Procedure.
Fibrin Glue Injection
Fibrin glue injection is when a particular glue-like substance is injected into the fistula tract to seal the fistula. However, this treatment is effective for some simple and low-risk fistulas.
Anal Fistula Surgery
Surgery is often required for any complex Anal Fistula that does not respond to conservative treatments. The sole goal of surgery is to resolve the affected area by removing the fistula tract. Surgical Options For Anal Fistula depend on the characteristics of the fistula and the surgeon’s experience. Still, some primary surgical techniques that are used for the treatment of Anal Fistula are as follows:
Anal Fistula Surgery Types
Fistulotomy
The first option in the surgical treatment of Anal Fistula is Fistulotomy. During Fistulotomy, the surgeon makes an incision along the length of the fistula, after which the affected tissue is removed, and the tunnel heals internally. This technique promotes drainage and prevents recurrent infections. Fistulotomy is usually performed under anesthesia and is considered an effective treatment option for Anal Fistula.
Advancement Flap Surgery
The second surgical option for anal fistula is advancement flap surgery, which is a procedure used to treat high-grade Anal Fistulas or more complex fistulas. In this procedure, a flap is placed near the anal area, and the internal opening of the fistula is covered. Apart from this, this flap is sealed to prevent the recurrence of a fistula.
During this procedure, the surgeon first identifies the fistula’s internal opening and removes infected tissue or debris. After this, a healthy tissue is placed adjacent to the fistula, ensuring a good blood supply remains intact. After this, a flap is attached to the internal opening, causing the fistula passage to be effectively closed.
Seton Placement
Seton placement is a surgical procedure to repair an Anal Fistula that involves the placement of a Seton through the Fistula Passageway. This Seton is usually a non-absorbent material such as silk thread or rubber band. The Seton is left in place to promote this process and prevent premature fistula closure.
This procedure primarily aims to divide and drain the fistula track gently. Leaving the Seton in place allows for continued drainage of any fluid build-up, reducing the risk of abscess formation. It also helps open the Seton fistula and prevents new fistula tracts from developing.
In exceptional cases, this Seton is left in place for a few weeks or months. Once the fistula passage has healed sufficiently, the Seton is removed from its place.
LIFT Procedure
The fourth surgical option for the treatment of Anal Fistula is the LIFT procedure, also known as Ligation Of The Inner Sphincter Fistula Tract. The LIFT procedure is considered an effective treatment option for complex Anal Fistulas, specifically treating Anal Fistulas of inter-sphincteric types.
Through this surgical technique, the fistula tract is removed in a minimally invasive manner while preserving the sphincter muscles. During this procedure, the surgeon incurs the skin near the fistula’s opening and dissects the passage’s level. After this, the fistula tract is identified, and its internal ligature is placed in the anal canal. This technique seals the tract and prevents further infection or fluid growth.
Laser or Radiowave Surgery
The final option to treat Anal Fistula is Radiowave Surgery Technique which is brought into action through laser treatment. This technique is also known as radiofrequency ablation. During this procedure, a particular radio wave device delivers controlled energy into the fistula tract, causing the radio waves to generate heat that effectively cuts the tissue and seals the blood vessels.
Diagnosing Anal Fistula through Radio wave Surgery includes a minimally invasive procedure that has its own benefits, which goes like causing less tissue destruction and a faster recovery period as well. Moreover, such treatment requires lesser recovery time as compared to other surgical methods of treating Anal Fistula.
Anal Fistula Surgery Cost
The Cost Of Anal Fistula Surgery depends on many factors, such as geographical location, complexity of the fistula, health care provider, and the experience of the surgeon. One should always consult a surgeon to get accurate information regarding the cost of Anal Fistula Surgery. However, it has been seen in many cases that the cost of Anal Fistula surgery falls approximately between INR 30 thousand to INR 40 thousand.
Anal Fistula Surgery Recovery
The Recovery Period After Surgical Treatment For Anal Fistula may depend on the surgical method used. However, if we talk about the recovery period, it can range from 5 – 7 weeks to a few months.
Remedies Of Anal Fistula
Apart from surgical treatment of Anal Fistula, some remedies are available and helpful in restricting the symptoms generated by Anal Fistulas. Some Common But Proven Remedies for Anal Fistula are stated below:
Warm water bath:
This remedy says to soak the affected area for 10 to 15 minutes at least four times a day so that the patient may notice pain relief and healing can quickly be promoted.
Good hygiene:
It is essential to clean the affected area well to lessen the infection. It is also recommended to keep the anal area clean using warm water and washing shop after the defecation.
Using Stool Softener:
The use of stool softener is considered to be the best remedy for Anal Fistula, and in many cases, stool softener is used to make bowel movements more accessible, due to which there is less pressure on the fistula.
High Fiber Diet:
A high-fibre ingredient may help soften your stool, thus preventing constipation, which helps reduce the strain during bowel movement.
Anal Fistula Diet
Although there is no specific diet to consider unique to Anal Fistula, you can make some changes in your diet to limit the symptoms of Anal Fistula. The Anal Fistula diet includes the following diet.
- High Fiber Food: fruits, vegetables, whole grains, and legumes
- Drinking Plenty Of Fluids: stay hydrated by drinking plenty of water and fruit juice
- Avoiding irritants: Avoid drinking alcohol, caffeine, and consuming spicy foods and all such foods that can irritate the digestive system and worsen the symptoms
- Consuming Probiotic Food: Yogurt, Kefir, Sauerkraut and Kimchi
Anal Fistula Vs Anal Fissure
Both Anal Fissure and Anal Fistula possess the involvement of the anus and can cause the same symptoms, but these conditions are different. The Anal Fissure is a small cut in the lining of the anus, while an Anal Fistula is a tunnel that gets formed between the anal canal and the skin around the anus. Anal fissures can heal on their own, but Anal Fistula needs medical treatment.
FAQ
An anal fissure is a small tear in the lining of the anus, while an anal fistula is an abnormal tunnel connecting the anal canal to the skin near the anus.
Symptoms of anal fistula include persistent anal pain, drainage of pus or blood, swelling, and sometimes the appearance of a lump near the anus.
Treatment options include topical ointments, dietary changes, warm baths, and, in some cases, surgical procedures like sphincterotomy.
Diagnosis involves a physical examination, medical history review, and sometimes imaging studies like MRI or ultrasound to determine the extent and location of the fistula.
Recovery time varies depending on the type of surgery, but patients can generally expect improvement within a few weeks to months.
Yes, natural remedies include warm sitz baths, dietary changes, and maintaining good anal hygiene. To perform a working remedy, one must consult with a healthcare professional.
Prevention involves maintaining good bowel habits, staying hydrated, and including fibre-rich foods in your diet to prevent constipation.
