ANAL FISTULAS
An anal fistula is an abnormal, infected tunnel that forms between the skin near the
anus and the anal canal or rectum.
What Are Anal Fistulas?
An anal fistula is an abnormal, infected tunnel that forms between the skin near the
anus and the anal canal or rectum. It typically occurs when an anal gland becomes
blocked and leads to an abscess, a pocket of pus. If the abscess does not heal
properly, it can turn into a fistula, creating a continuous pathway that may discharge
blood or pus. Fistulas are often painful and may cause recurrent infections.
What Are the Types of Anal Fistulas?
Anal fistulas can vary in their complexity and location relative to the anal sphincter muscles. They are classified into the following types.
1.Intersphincteric Fistula
This is the most common type of anal fistula. It runs
between the internal and external sphincter muscles and opens near the
anus.
2.Transsphincteric Fistula:
This type of fistula crosses both the internal and external sphincter muscles and may open on the skin farther away from the
anus.
3.Suprasphincteric Fistula
This fistula originates above the internal sphincter and travels over the external sphincter, exiting on the skin.
4.Extrasphincteric Fistula:
The rarest and most complex type, this fistula begins above the sphincter muscles (in the rectum) and runs outward to the
skin. It is often caused by other conditions, such as Crohn’s disease, trauma, or surgery.
5.Superficial Fistula:
This type does not involve the sphincter muscles and runs just below the skin surface, making it the simplest type of fistula to treat
How Can Anal Fistulas Be Diagnosed?
Anal fistulas can be diagnosed through various methods, typically starting with a
physical examination and additional tests if needed:
Physical Examination:
A doctor will examine the area around the anus for
visible signs of a fistula, such as an external opening that drains pus or fluid.
They may also check for tenderness, swelling, or redness.
Digital Rectal Exam:
The doctor may insert a gloved finger into the anus to
feel for any internal fistula tracts or abscesses.
Anoscopy:
An anoscope, a small tube with a light, can be used to view the
inside of the anal canal to locate the internal opening of the fistula.
Fistulography:
This is a contrast X-ray study in which dye is injected into the
fistula, allowing it to be seen on the X-ray to determine its path and
complexity.
Imaging Tests:
Magnetic Resonance Imaging (MRI) or endoscopic
ultrasound may be used to assess complex or deep fistulas, especially if
surgery is planned.
CT scan:
In cases of recurrent abscesses or if the fistula is not easily
detected, a CT scan may be helpful to visualize the fistula tract.
What Are the Treatment Options for Anal Fistulas?
Treatment for anal fistulas is primarily surgical, as they rarely heal on their own. The goal of treatment is to eliminate the fistula, prevent recurrence, and preserve anal sphincter function to avoid incontinence. The following are common treatment options:
Fistulotomy:
This is the most common procedure for treating anal fistulas.
The surgeon cuts open the entire length of the fistula to allow it to heal as a
flat scar. This procedure is usually effective for simple, low-lying fistulas but
can carry a risk of incontinence if the sphincter muscles are involved.
Seton Placement:
For complex fistulas involving the sphincter muscles, a seton (a thin, flexible thread) is placed through the fistula to help drain
infection while keeping the tract open. This allows the fistula to heal gradually
and may reduce the risk of incontinence.
Advancement Flap Surgery:
This procedure involves closing the internal opening of the fistula with a tissue flap. It is often used for more complicated
fistulas where a fistulotomy may compromise continence.
LIFT Procedure (Ligation of Intersphincteric Fistula Tract):
In this
technique, the fistula is accessed between the sphincter muscles, and the
tract is tied off and removed, reducing the risk of damage to the sphincter
muscles and subsequent incontinence.
Fibrin Glue or Plug:
Fibrin glue or a fistula plug made of biologic material can
be injected into the fistula to seal the tract. This is a less invasive option, but it
has lower success rates compared to surgical interventions.
Endoanal Advancement Flap:
For recurrent or complex fistulas, this
procedure involves covering the internal opening with a flap of rectal tissue to
promote healing while minimizing the risk to the sphincter muscles.
Antibiotics:
While antibiotics alone cannot cure a fistula, they may be
prescribed to control infection and reduce inflammation, especially if the fistula
is associated with an abscess.
Conclusion:
Anal fistulas can be a distressing condition that causes pain, infection, and
discomfort. Early diagnosis and proper treatment are crucial to prevent
complications. While some simple fistulas may respond to relatively straightforward
surgical procedures, more complex cases may require specialized treatments.
Consulting with a colorectal surgeon is important to determine the best approach
based on the type and severity of the fistula, as well as the patient’s overall health
and needs.
For specialized care and advanced treatment options for anal fistulas,
visit Rutvik Hospitals today for comprehensive solutions and
personalized care.
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