An anal fistula is an infected tunnel that runs between the skin and the anal opening. This is usually the result of an infection that originates in an anal gland and causes an abscess – a swollen pocket of infected tissue and fluid. The fistula forms a tunnel under the skin and connects with the infected gland.
The small glands inside the anus produce mucous and occasionally become infected. Infections that don’t heal in the right manner can lead to an anal fistula.
Risk Factors for Anal Fistula
A person who has an anal abscess is at a higher risk of getting an anal fistula. Health conditions that affect the bowels are other factors that increase the chances of developing a fistula. These conditions could include Crohn’s disease, sexually transmitted diseases, tuberculosis, certain cancers, and diverticulitis.
Causes of Anal Fistula
The most common causes of an anal fistula are clogged anal glands and abscesses. Other conditions that may cause an anal fistula are Crohn’s disease, which is an inflammatory condition of the intestine, the radiation received as treatment for cancer, trauma, sexually transmitted diseases, tuberculosis, and diverticulitis – a disease in which small pouches form in the large intestine and become inflamed. Patients suffering from certain cancers also develop an anal fistula.
Symptoms of Anal Fistula
A patient suffering from an anal fistula is likely to observe the following signs and symptoms.
Pain and swelling around the anal area.
Blood or foul-smelling liquid discharge from an opening around the anus.
Irritation of the skin around the anus.
Pain during bowel movements.
Fever, chills, and fatigue
Diagnosis of Anal Fistula
If a patient is experiencing symptoms of an anal fistula, the doctor will start by examining the area around the anus. The doctor will check if there is an opening in the skin, which is also called the fistula tract. She or he will aim to find out how deep this tract may be and the direction in which it is going. Quite often, there is drainage from this external opening.
In some cases, the fistula is not visible on the skin’s surface, and the doctor may recommend additional tests. These tests could include the following:
An anoscopy to get a view inside the anus and rectum.
EAUS: endoanal ultrasound we can do in the clinic and diagnose the type of fistula.
The physician may also recommend an MRI of the anal area for a better view of the fistula tract.
In some cases, the surgeon may need to conduct an examination of the patient under anesthesia in the operation theatre for a proper diagnosis.
If a fistula is found, your doctor may want to conduct additional tests in order to identify the cause, especially to check whether it is related to Crohn’s disease, as approximately 25% of the people who suffer from Crohn’s disease develop fistulas. In this case, you may require blood tests, X-rays, and a colonoscopy, which is performed under sedation and enables the doctor to view the colon.
Surgical Treatment of Anal Fistula
Open Fistula Pathway Fistulotomy
An anal fistula usually requires a surgical procedure that will be conducted by a colorectal surgeon. The goal of the surgery will be to get rid of the fistula while protecting the anal sphincter muscles. If the fistula is simple, not too close to the anus, and the sphincter muscle is not involved, then a procedure called fistulotomy is usually conducted. The surgeon cuts open the skin and muscle surrounding the tunnel. This enables the opening to heal from the inside out. A plug may be used to close this.
In case the condition is more complicated, the surgeon may decide to insert a tube, which is known as a seton, into the opening. This tube helps to drain the infected fluid before the surgery is performed. The seton is usually kept in place for at least six weeks.
Fistulotomy or an Advancement Flap Procedure
In the advancement flap procedure, the fistula is covered with a flap, or piece of tissue, taken from the rectum, like a trap door. Another option is to perform a lift procedure in which the skin above the fistula is opened up, the sphincter muscles are spread, and the fistula is tied off. If the patient is suffering from Crohn’s disease, there is a new line of treatment that involves injecting stem cells into the fistula.
Post-surgery, your surgeon is likely to recommend that you soak the anal area in a warm bath, also known as a sitz bath. It is also advisable to take stool softeners or laxatives for some days.
After Anal and Rectal Surgery
Take pain medicine every three to four hours as needed for pain.
Apply lidocaine gel to the anus (inside and out) every two to four hours as needed
Take a hot bath in plain water and soak for at least 20 minutes three times a day. This is a minimum, and there is no maximum limit. You can soak as long as you wish. It is the most effective method of controlling pain.
Expect the pain to get better at about seven to 14 days after surgery.
Caring for the Surgery Site
Remove the dressing the morning after the surgery and then get in a warm tub.
After bathing, pat dry or use a hair dryer.
After each bowel movement, gently cleanse the area with water or bathe/shower to keep the area clean.
If you have been told to place a moist gauze pad on the wound, do so several times a day. Tuck the gauze into the wound so that it covers all the surfaces.
You may do what you feel comfortable doing after surgery. Do not sit for longer than 10 to 15 minutes at a time. You may sit on a foam pillow but avoid rubber rings or “donuts.”
Avoid driving a car while taking pain medication.
You may go back to work when you feel ready to do so. This may take several days to several weeks, depending upon the procedure. Ask your doctor for specific limitations.
Make an appointment with your surgeon for ten days after surgery.
What to Expect After Surgery
The pain medication can cause constipation, and passing a hard stool will just add to the pain. Take a stool softener if you are taking pain medicine. (Movicol –fibrilax-fybogel….) Twice a day is the recommended stool softener.
Be sure to drink six to eight glasses of water or other non-caffeinated beverage a day.
Do not give yourself an enema unless you get approval from your surgeon.
If two days pass without a bowel movement, take a tablespoon duphalac 30 ml in the evening. If you still have had no results after three days, call your surgeon.
Some bleeding with each bowel movement is expected. If the bleeding does not stop within an6 hour after a bowel movement, if the amount of bleeding is worse with time, or if you are passing clots of blood, call your surgeon.
It may be difficult to urinate after the surgery. You may strain to urinate — this will not harm the area that was operated on. If you are not able to urinate, try sitting down (men) or try urinating in a warm bathtub. If you are still unable to urinate 18 hours after surgery, go to the Emergency Department. They may need to place a catheter into your bladder to empty it. Do not wait longer than 12 to 18 hours.
Our specialized proctologist offers effective treatments and support to help you overcome this condition.
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