Anal Fistulas Explained: Causes, Complications, and Treatment
Anal fistula:
An anal fistula is a tiny channel between the anal canal (the end of the bowel) and the skin near the anus. The fistula termination can show up as a hole in the skin around the anus. The anus is the exit point for waste from the body. Fistulas require surgery because they do not heal on their own. Fistulotomy, Seton methods, LIFT operation, and other surgical procedures treat fistulas. An abscess is an infected tissue that drains into a tiny channel or hole.
What is a fistula?
A gastrointestinal fistula is an unwanted opening in your digestive tract that sanctions gastric fluids that leak through the stomach or intestine lining. When these fluids leak into your skin or other organs, it can increase the risk of infections. Fistula is most frequent following intra-abdominal surgery or surgery on the inside of your abdomen. Fistulas are more likely to occur in those who have persistent digestive difficulties.
What are the different gastrointestinal fistulas?
The happy couple after anal fistula treatment
There are four main types of gastrointestinal fistula.
- Intestinal fistula
- Extraintestinal fistula
- External fistula
- Complex fistula
What are the causes of gastrointestinal fistula?
In around 90 per cent of cases, it developed a gastrointestinal fistula after intra-abdominal surgery. Clogged anal glands and anal abscesses are the most common causes of anal fistula.
If you have any of the following, you are more prone to develop a fistula:
- Crohn's disease (an inflammatory disease of the intestine)
- Malignant melanoma
- Treatment for ionizing radiation in your abdomen
- Obstruction of the bowels
- Suture issues in surgery
- Problems with the incision site
- An abscess is a type of infection.
- Trauma
- A condition like a hematoma (blood clot beneath the skin)
- A growing tumour
- Diverticulitis (a disease in which diminutive pouches form in the sizably voluminous intestine and become inflamed)
- Ulcerative Colitis
- Sexually transmitted diseases (STDs)
What are the Symptoms of an anal fistula?
Symptoms of an anal fistula are as mentioned below,
- Irritation of the skin around the anus,
- The pain may subside once the fistula discharges.
- Smelly discharge from around your anus.
- When you poop, you may pass pus or blood.
- If you also have an abscess, you will notice swelling and redness around your anus
- Controlling bowel movements is often (bowel incontinence).
- Fever, chills, and exhaustion
When to see your doctor in a fistula?
If you experience the following signs or symptoms, we request you contact your surgeon urgently.
- Changes in your significant bowel habits
- Extreme Diarrhea with bleeding
- Leakage of fluid from a hole in your abdomen or near your anus
- Curious abdominal pain and irritation of the skin around the anus.
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How is an anal fistula diagnosed?
Your surgeon can usually evaluate an anal fistula by examining the area around the anus. The doctor will determine how deep the tract is and its movement. Most of the time, there will be drainage from the external opening. It may hide some fistulas underneath the skin surface.
Here, your physician may need to perform additional tests:
- Perform an anoscopy procedure using a technical instrument to examine the interior of your anus and rectum.
- To gain a sharp look at the fistula tract, your doctor may also conduct an ultrasound or MRI of the anal area.
- To diagnose the fistula, your surgeon may need to examine you in the operating room (we know this as an exam under anaesthesia).
If a fistula gets discovered, your doctor may order additional testing to determine whether it concerns the problem with Crohn's disease, an inflammatory disease of the gut. Blood tests, X-rays, and colonoscopies are examples of these studies. A colonoscopy is a procedure that involves inserting a piece of flexible, lighted equipment through the anus or into the colon. They conduct it under conscious sedation, which is a type of light anaesthesia. They widely performed a colonoscopy to investigate gastrointestinal symptoms such as bleeding, abdominal pain, or changes in bowel habits.
What are the treatments for anal fistula?
Surgery is virtually always indispensable to remedy an anal fistula. A colon and rectal surgeon performed the surgery. The purpose of the procedure is to maintain balance while removing the fistula and maintaining the tone of the anal sphincter muscles, which could cause incontinence if damaged. Fistulotomy effectively treats fistulas with minimal or no sphincter muscle involvement. They cut the skin and muscles over the tunnel open to change it. The fistula tract can then be repaired from the bottom up.
For rough fistula and complex fistula surgery, it may be necessary to insert a draining section, which should remain in position for a minimum of six weeks.
They always undertake a second procedure once surgeons place a seton:
- A fistulotomy, in which doctors cut the skin and muscles over the tunnel open to change it. A fistulotomy is a surgery to open and drain an anal fistula, helping the fistula to heal.
- The advanced flap treatment involves covering the fistula with a flap or tissue piece extracted from the rectum.
- A fistula LIFT method in which the skin above the fistula opens, the sphincter muscles spread, and surgeons tie it with the fistula off.
Injecting stem cells into the fistula is a new treatment for Crohn's disease fistulas. Before the procedure, your proctologist will go through your options with you. Skilled surgeons do fistula surgery as an outpatient procedure so the patient can go home the same day. Patients with large or severe fistula tunnels may need to stay in the hospital for a short period following surgery. - Certain fistulas may require multiple surgeries for complete removal.
FAQs:
Can experts cure obstetric fistulas?
100% Yes, an obstetric fistula can be closed with corrective surgery. If a surgeon operates, a woman with a fistula can often return to routine life, with her continence and hope recuperated.
Is it possible for a fistula to heal on its own?
Fistula tracts are not self-healing and require medical attention. Neglecting treatment of the fistula tract for an extended period can lead to the development of cancer. However, most fistulas are easily treatable.
What is the best fistula treatment?
A fistulotomy is the most successful treatment for many anal fistulas, and it is usually only appropriate for fistulas that do not pass through much of the sphincter muscles, as the risk of incontinence is low in these circumstances.
References:
https://my.clevelandclinic.org/