Overview
An anal fistula is a tunnel that develops between the inside of the anus and the outside skin around the anus. It usually occurs as a result of an infection that starts in an anal gland, causing an abscess that drains on its own or is drained surgically through the skin next to the anus. This drainage tunnel remains open and connects the infected anal gland or the anal canal to a hole in the outside skin around the anus. Surgery is typically needed to treat an anal fistula, and symptoms may include an opening on the skin around the anus, redness and inflammation around the tunnel opening, oozing of pus, blood, or stool from the tunnel opening, pain in the rectum and anus, and fever.
Understanding the disease
Symptoms
Symptoms of an anal fistula include:
- An opening on the skin around the anus
- A red, inflamed area around the tunnel opening
- Oozing of pus, blood, or stool from the tunnel opening
- Pain in the rectum and anus, especially when sitting or passing stool
- Fever
Risk Factors
Risk factors for developing an anal fistula include a previously drained anal abscess, Crohn's disease or other inflammatory bowel disease, trauma to the anal area, infections of the anal area, and surgery or radiation for the treatment of anal cancer. Anal fistulas are more common in adults around the age of 40, but they can also occur in younger people, particularly those with a history of Crohn's disease. Males are more likely to develop anal fistulas than females.
Development
Anal fistulas develop as a result of an infection that starts in an anal gland. The infection causes an abscess that drains on its own or is drained surgically through the skin next to the anus. This drainage tunnel remains open and connects the infected anal gland or the anal canal to a hole in the outside skin around the anus. The tunnel is called an anal fistula.
Assessment and Diagnosis
Triage
You should see a doctor if you suspect an anal fistula, especially if you experience symptoms such as an opening on the skin around the anus, redness and inflammation around the tunnel opening, oozing of pus, blood or stool from the tunnel opening, pain in the rectum and anus, fever, or other concerning symptoms. It is important to seek medical attention to receive proper diagnosis and treatment, as anal fistulas usually require surgical intervention to prevent complications and recurrences.
Diagnosis
To diagnose an anal fistula, a healthcare provider will discuss the patient's symptoms and perform a physical exam, which includes examining the area around and inside the anus. Imaging tests such as MRI, endoscopic ultrasound, or fistulography may also be used to identify the fistula tunnel. In some cases, an examination under anesthesia or a specialized instrument may be recommended to identify the fistula's internal opening.
Management and Treatment
Complications
Potential complications of anal fistula include recurrence of an abscess, recurrence of the anal fistula, and fecal incontinence after surgical treatment.
Treatment
Treatment for an anal fistula typically involves surgery, although nonsurgical options may be considered in some cases. The type of surgery depends on the severity and location of the fistula, as well as the patient's overall health. Surgical options may include:
- Fistulectomy: This procedure involves cutting out the fistula tract, typically under local anesthesia. This is often the first choice for simple fistulas.
- Fibrin glue: In this procedure, a medical grade adhesive is used to seal the internal opening of the fistula. This may be an option for certain types of fistulas or as an adjunct to other surgical procedures.
- Seton placement: A seton is a surgical thread that is inserted into the fistula tract to prevent fluid drainage and promote healing. This procedure may be used for more complex fistulas.
- Lengthening the anal sphincter muscles: In some cases, if the anal sphincter muscle is involved in the fistula, the surgeon may perform a procedure to lengthen the muscle, which can help restore continence.
- Advancement anal flap: This surgery is used to cover a large fistula or a fistula that is difficult to close. A piece of tissue from another part of the body is used to cover the fistula. Nonsurgical treatments, such as antibiotics or drainage of the abscess, may be considered in some cases, usually for simple fistulas. However, surgery is generally recommended to prevent complications and ensure effective healing. Consult a healthcare professional for personalized advice and treatment options.
Preparing for medical consultation
To prepare for an appointment for anal fistula, you should:
- Ask about any pre-appointment restrictions: At the time you make the appointment, inquire if there are any specific instructions you need to follow before the appointment, such as fasting for a specific test.
- Make a list of symptoms: Compile a list of your symptoms, including any that may seem unrelated to the anal fistula.
- Gather key medical information: Prepare a list of any other medical conditions you have, past surgeries, and a record of the medications, vitamins, herbs, or supplements you are taking, including dosages.
- Prepare a list of questions: Compile a list of questions to ask your healthcare provider, such as the causes of your symptoms, potential treatment options, and any alternative treatments available.
- Be ready for a physical exam: Expect your healthcare provider to examine the area around and inside your anus during the appointment. They may also recommend one or more imaging tests, such as MRI, endoscopic ultrasound, or fistulography, to help identify the fistula tunnel. Remember to follow any instructions provided by your healthcare team and bring your lists of symptoms, questions, and medical information to your appointment.