By Dr. Laxman Salve, Proctology
Anal Fistula is a tunnel that runs from inside the anus to the skin around the anus and the faecal matter or some kind of fluid flows out of the anus through this opening. This tract does not heal in of its own or with antibiotics. It needs surgery to cure the disease.
Causes of Anal Fistulas:
There are several glands present in the anus that make some lubricating fluid. Sometimes, these glands get blocked or clogged. When this happens, bacteria start building up inside the gland and create swollen pockets and infected tissue. It forms an abscess and then it ruptures on the skin around the anus. Some other causes are specified below:
● Long term conditions where the digestive system becomes swollen (Crohn’s disease).
● A person suffering from TB (Tuberculosis) or HIV, can develop Fistula.
● When one had a complicated surgery near the opening of the anus.
● A continuing illness which affects bowel movements.
● The most common symptoms are pain, redness, swelling around the anus and discharge from the perianal wound or bursted boil.
● One may notice the bleeding in that area.
● One will notice an awful smelling liquid flowing near the area of the anus.
How is it Diagnosed?
● First the doctor will ask about medical history.
● Some fistulas are easy to spot while others are not because the internal or the external opening may be hidden.
So, in this case the doctor will examine the patient and after clinical examination he will come to diagnosis or he may take help of certain investigations like fistulogram or MRI.
Treatment of Fistulas
There is no proper or designated medication for this problem. One has to go through surgery. Different types of surgeries are discussed below.
● This is one of the most common surgeries. It includes a cut along the length of a fistula to open the fistula and flatten it up.
● This is also one of the most effective methods as risk of recurrence is very low in this surgery but it has high chance of incontinenece in high fistulas.
This is another effective method of surgery. It can be performed using different modalities like LASER, VAAFT. LASER has advantage of low chance of incontinence and recurrence with less pain after surgery.
● A seton or thread is placed in the fistula if it passes through a significant large portion of sphincter muscle.
● It allows fistulas to drain by loosening up the thread, but doesn’t cure fistula completely in most of the cases.
Another option is the insertion of a bioprosthetic plug. The opening of the fistula is blocked by a cone shaped plug that is made up of tissues of animals.
● This is the only non-surgical procedure for Anal Fistulas.
● It involves insertion of a special glue into the fistula, this glue helps seal the fistula and uplift it to recover. It has very high failure rate.
There are certain risk levels which totally depend on where the fistula is located. Surgeon has to balance the issues like pain incontinenece and recurrence, while treating the fistula. It is a challenging surgery in most of the cases and therefore patient has to be in skilful and expert hands to get rid of this disease Before undergoing any treatment or medication, consult the doctor, he will recommend the best alternative by examining the condition.