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Anal fistula

Overview

Anal fistulas are tunnel-like connections between the inner lining of the anus or rectum and the skin surrounding the anus. These abnormal structures typically develop as a result of infection in an anal gland, leading to the formation of an abscess. If the abscess doesn't heal properly, it can form a fistula.

  • Anal abscesses: Infections of the anal glands that become walled off and then drain through an abnormal passage.
  • Inflammatory bowel disease (IBD): IBD Conditions like Crohn's disease or ulcerative colitis can increase the risk of developing anal fistulas.
  • Trauma or injury: A previous injury or surgery in the anal region can lead to fistula formation.
  • Sexually transmitted infections: Some infections, like HIV, may increase susceptibility to anal fistulas.
  • Cancer: In rare cases, rectal or anal cancers can lead to fistula formation.

The symptoms of anal fistula include:

  • Pain around the anal region, especially when sitting, during bowel voiding, or when passing gas.
  • Persistent drainage of pus, blood, or stool from the opening of the fistula.
  • Irritation or itching around the anus.
  • Fever and chills (in cases where the fistula is associated with an infection).
  • Swelling or redness around the anus, indicating inflammation or infection.

  • Physical examination: This involves investigation of the anal area for visible signs of infection, abscesses, or openings.
  • Anoscopy or proctoscopy: These modalities help look inside the anus and rectum for signs of abnormalities like fistulas.
  • Fistulography: In this imaging test, a contrast dye is injected into the fistula tract, and this is followed by X-ray to visualise the path taken by the dye.
  • MRI or ultrasound: Thes modalities help assess the length and complexity of the fistula, particularly in cases that involve multiple tracks or are difficult to diagnose.

Treatment often involves surgery to drain the abscess and repair the fistula, as conservative methods like antibiotics are generally not effective in healing fistulas. There are several surgical options depending on the fistula's complexity:

  • Fistulotomy: This is most common procedure for treating anal fistulas. In this procedure, the fistula is cut open and allowed to heal from the inside out.
  • Seton placement: For more complex fistulas, a piece of thread (seton) is inserted through the fistula to help drain it and promote healing.
  • Advancement flap procedure: This is often used when the fistula involves a significant amount of tissue and there is concern about damaging the sphincter muscles (which control bowel movements).
  • LIFT procedure (ligation of intersphincteric fistula tract): In LIFT, the fistula tract is closed off to prevent drainage.
  • Fibrin glue or collagen plugs: A less invasive approach may be used to seal the fistula tract.

  • Maintaining proper anal hygiene
  • Avoiding trauma to the anal area
  • Managing underlying conditions
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