Anal fistula

Rectum fistula

Last Updated December 20th, 2021

What is an anal fistula?

An anal fistula is a narrow tunnel between an infected gland in the anorectal region to the skin surrounding the anus (perianal skin). Fistulas are a result of an accumulation of pus or abscess in the tissue close to the anus. Patients with this condition generally report discomfort, inflammation, skin irritation and pain in the anal region. Anal fistulas need medical intervention and do not heal by themselves. Most treatment for fistulas involves surgery and medication.

The human body excretes faeces through the external opening called the anus. The anal region contains numerous glands in small sizes that secrete mucus. It is possible that these glands can be clogged, which eventually leads to infection. The infection causes pus to form which leads to an abscess. Nearly 50% of these abscesses have the possibility of developing into a fistula.

Many people get confused between anal fissures, fistula, and hemorrhoids. Read in detail about them to know the exact causes, symptoms, and treatment.

Symptoms of an anal fistula

The following symptoms give an indication of the presence of an anal fistula :

  • Pain while having a bowel movement
  • Irritation in the skin around the anal region
  • Pus and blood in the stools
  • Foul smelling discharge from the anal area
  • Discomfort and nagging pain that increases with movement. Severe pain while sitting, sneezing or coughing.
  • Regular abscess in the anal area
  • Inflammation and redness in the anal area
  • Fever especially with an abscess
  • In rare cases, bowel incontinence also occurs
  • Hole on the skin near the anus, which marks the end of the fistula and is visible during physical examination
  • Fatigue

Take a medical opinion in case you suffer from any of the above symptoms.

What are the important causes behind anal fistula?

The anus contains many glands that produce fluid. There is a possibility that these glands can be clogged. The clogged glands can result in the growth of bacteria and the accumulation of fluid. This can lead to inflamed tissue, which is medically called an abscess.

An untreated abscess develops into a fistula. Usually, when the abscess does not heal, it needs to find a way to drain out the infected fluid or pus. This will punch a hole on the skin near the anus to drain the pus out. The fistula is a tunnel that attaches the gland to the opening on the skin in the anal region.

Although the leading cause of anal fistula is blocked anal glands and abscess, yet sometimes they can develop due to the presence of certain medical conditions or circumstances.

  • Tuberculosis
  • Sexually transmitted disease
  • Cancer
  • Crohn’s disease
  • Trauma
  • Radiation

What are the best methods adopted by medical specialists to diagnose anal fistula?

Not all fistulas are easy to spot. If your doctor suspects you have an anal fistula, a physical exam and a consultation to know your medical history will be the first few steps towards diagnosis.

During the medical examination, the doctor will check for pus and oozing. It is possible that the doctor conducts an internal anal examination by sticking a finger inside your anus.

A proctologist is equipped to perform few tests to have a confirmed diagnosis of anal fistula. The following tests may be conducted:

Anal ultrasound

In this process, high-frequency sound waves capture the surface of the anal canal in imaging forms

Proctoscopy

Doctors perform proctoscopy to view the opening of the tract in the anal canal. In this process, the proctologist uses a specialised telescope with an attached fistula probe, which helps view inside the rectum

MRI and CT scan

In the case of a complex fistula, doctors use MRI imaging to check the anatomy of the tract. Additionally, these tests can also help the proctologist evaluate the extent of inflammation of the anal lining.

You may need to consult a colon and rectal specialist. In some cases,  a colonoscopy is also recommended. A colonoscopy is conducted under anaesthesia.

What are some of the clinical features of an anal fistula?

Generally, anal fistula presents in two ways. Either it presents as irregular or constant discharge of blood, pus, mucus or faeces into the perineum or there is repeated anal abscess. During clinical examination, your doctor may find an external opening on the perineum. The external hole in some cases could be completely open or there could be a granulation tissue cover on it. Doctors conduct a digital rectal investigation and may find the presence of a fibrous tract beneath the skin. 

What are the types of anal fistula ?

There are four types of anal fistulas.

  1. Complete Fistula – Has two openings one that opens internally and another externally
  2. Horseshoe Fistula – This is close to the anus and has a semi-circular tract around the rectum
  3. Blind Fistula – The opening is only one at the end and connects two structures
  4. Incomplete Fistula – In this type of anal fistula, a tube begins from the skin that is shut on the inside and  does not have any connection with any  internal structure

What is the best form of treatment for anal fistula ?

Surgery is the best treatment option for anal fistula. Fistulas do not heal on their own. It is important to know all the treatment options available. Discuss with your surgeon about the potential risks of any procedure they advise. Most of the treatment procedures can be performed in a doctor’s clinic.

Doctors generally use a plug during the surgery to close a simple fistula  after cutting open the skin and muscle surrounding the tunnel. The opening heals faster this way.

In cases where the fistula is more complicated, the specialist uses a tube called the seton. This tube is put into the opening and it drains out the infected fluid before surgery. The position of the fistula is important. The decision to cut into the sphincter muscles (muscles in charge of opening and closing the anus) will depend on the position of the fistula. Though doctors try their best not to damage them, the surgery may hamper the ability to control bowel movements.

There are various procedures to treat anal fistula but the type of procedure is dependent on the position of the fistula. Initially, your doctor may need to conduct the preliminary examination under the influence of anaesthesia to decide the best way to treat anal fistula.

Some of the options in the treatment of anal fistula are listed below:

Fistulotomy

Fistulotomy is the common surgery for anal fistulas. During this procedure, doctors cut the complete length of the fistula. This way the fistula is fully opened up. It appears like a flat scar and promotes faster healing. This form of treatment is only possible if the fistula does not pass through much of the anal sphincter muscles. Doctors always want to minimise the risk of bowel incontinence.

Seton techniques

This technique is used by the surgeon if the fistula passes through a major part of the anal sphincter muscle. Initially, the surgeon may insert a seton.   During this procedure, a piece of surgical thread called a seton is left in the fistula for many weeks. The main intention is to keep the fistula open and allow it to heal. This method intends to avoid surgically cutting the sphincter muscles.

Doctors may employ loose seton or tight ones depending upon the nature of the fistula. Several procedures may be needed until the fistula completely heals. Each time they may open a tiny part of the fistula.

Advancement flap procedure

This procedure may be in the reckoning if the fistula happens to pass through the anal sphincter and the risk of bowel incontinence is very high with a fistulotomy.

In this procedure, the surgeon cuts and scrapes out the fistula. The hole where it enters the bowel is covered with a flap of tissue. The tissue is taken from inside the rectum. The rectum is the last part of the bowel.

The advancement flap procedure helps avoid cutting the anal sphincter muscles. Compared to a fistulotomy, this procedure does not enjoy a good success rate.

LIFT procedure

LIFT which is ‘ligation of the intersphincteric fistula tract ‘ is adopted as a  treatment for fistulas that pass through anal sphincter muscles. This procedure is used if surgeons feel that a fistulotomy is a risky option.

Surgeons make an incision in the skin above the fistula. Next, the surgeon parts the sphincter muscles and then the fistula is closed at both its ends and cut open. It remains flat.  This procedure has shown a good success rate although it is a recent procedure. We still need more statistics to prove its efficacy.

Endoscopic ablation

This procedure involves inserting a tube with a camera, called an endoscope in the fistula. Through the endoscope, an electrode is passed to close and seal the fistula. Endoscopic ablation enjoys a good success rate and is also considered very safe.

Laser surgery

A laser beam that emits laser fibre radically to seal the fistulas, is the core of this treatment procedure. This form of treatment is not risky. Laser-assisted technique is in fact considered to be highly effective in treating anal fistula. Patients recover faster without the need to make frequent visits to the hospital.

Fibrin glue

This type of treatment happens to be the only non-surgical method of treatment for anal fistulas.

During this treatment method, the surgeon injects glue into the fistula under the influence of anaesthesia. The glue works to seal the fistula and promotes faster healing. This treatment is not considered as effective as fistulotomy in the management of simple fistulas. The results may not be as far-reaching too. Surgeons select fibrin glue usually to treat fistulas that are passing through the anal sphincter muscles. Surgeons try to avoid cutting the anal sphincter muscles unless it is necessary.

Bioprosthetic plug

In this procedure, surgeons insert a bioprosthetic plug. This plug is shaped like a cone and is made of animal tissue. This plug is used to block the fistula opening. This procedure is mostly successful and is also considered fairly safe.

What are the most significant risks of anal fistula surgery?

Treatment for anal fistula, like other forms of treatment, carries few risks of complications.  The extent of risks will largely depend on the position of the fistula and the type of surgical procedure undergone. Before you decide on the treatment option, always know the risks and complications of the surgical procedure envisaged.

The risks hover mainly around infection post-treatment or major side effects. Complications post-surgery can include adverse reactions to the anaesthetic, bleeding and risk of infection.  

Some of the major risks of fistula surgery are as follows:

  • Prolonged healing time post-surgery: Most wounds heal within 6 weeks of surgery. In some cases, wounds may take longer to heal and this is one of the risks of surgery for anal fistula.
  • Difficulty in bowel movements due to narrowing of the anal canal
  • Infection – The risk of infection after the surgery to treat anal fistula cannot be ruled out. Doctors usually treat any infection with a course of antibiotics. If the infection is severe, the patient may require hospital admission.
  • Relapse or reappearance of fistula – even though surgery was performed, sometimes the fistula can resurface.
  • Bowel incontinence or losing the control over bowel movement – This is a real risk present with most forms of treatment for anal fistulas. In very rare cases, patients suffer severe bowel incontinence.

What are the steps to follow for post-operative care and recovery?

The recovery time after a surgery for treatment of anal fistula is largely dependent on the type of surgery as well as its complexity. The position of the fistula also plays a role.

Usually, the specialist recommends guidelines to be followed during post-operative care. In most of the cases post-surgery, the wound heals within 6 weeks.

Some of the post-operative guidelines are as follows :

  • For pain relief, patients can take over-the counter pain relievers. Ibuprofen or Paracetamol is adequate
  • Any pain during bowel movements should not be ignored and needs medical attention
  • Clean the wound by washing it many times during the day. Take care to softly  pat it dry and no force or rubbing is advisable on the operated area. Sometimes discharge can leak and can spoil the clothes. An extra gauze cover may be used to protect
  • The wound dressing needs to be changed regularly
  • For first few weeks after the surgery, avoid sexual intercourse
  • Gentle exercise is recommended so that there is no pressure on the healing process

Are there any side effects after the treatment for anal fistula?

Patients that have undergone treatment for anal fistula may experience the following side effects, which may disappear in few days once the healing process kick starts.

  • Site of the wound may feel sore
  • Diarrhoea
  • Constipation
  • Cramping
  • Nausea

Any severe pain while passing motion or a bowel movement should be reported.

Can anal fistula be prevented?

The main cause of anal fistula is the formation of abscesses. Although there is very little one can do to prevent an anal fistula, there are certain steps that can be followed to prevent the formation of abscesses in the anorectal area.

  • Maintain good hygiene and cleanliness in the anal region
  • Do not clean the anal region excessively
  • Consume a high fibre diet with plenty of fruits and vegetables
  • Adopt a habit of regular bowel movements to prevent  constipation

How to ensure emotional well-being for those undergoing treatment for anal fistula?

It is not easy for anyone living with an anal fistula. The entire process right from diagnosis to recovery is gradual and this can be quite frustrating. The condition can negatively affect a person’s quality of life. It may be heartening to know that fistula surgery is mostly successful. Further, the rates of recurrence of anal fistulas are relatively low.  There are many surgical treatment options for this condition. The positive aspect is, this condition is not permanent.

People going through this condition can get a lot of support from others with similar experiences.

Best treatment options for anal fistula

Treatment for anal fistula is done in two ways. It can be treated with open surgery or using laser technique.

Anal fistulas heal well after surgery, and it is, therefore, the go-to treatment for this medical condition.  A number of hospitals, nursing homes and clinics offer surgeries for anal fistula.

Further, hospitals offering surgery for anal fistula are well equipped with the latest technology and tools that help deliver best care to patients. Medical surgeons treating fistula are highly experienced and can effectively manage any complications related to the fistula.  Patients can avail the best treatment without worrying about medical bills.

Hospitals offer complete treatment right from consultation to prepare for surgery and post-operative care. Patients approaching hospitals for advice get the following:

  • Patient profiling or getting the complete medical history of the patient
  • Selecting experienced specialist and slotting the appointment for consultation
  • Discussing current trends in treatment of anal fistula with the best form of treatment  
  • Facilitating   medical insurance if any
  • Enabling post-surgery care to expedite healing
  • Enabling consultation on diet and nutrition
  • Tips to prevent fistulas from recurring

 

 

Dos and Don'ts

Dos

Maintain anal hygiene
Regularly exercise for 30 minutes at least
Keep well hydrated
Consume a healthy diet with adequate fruits and vegetables

Don'ts

Strain while passing stool
Put off the urge to poo
Delay medical advice for anal fistula
Attempt self-care for anal fistula
Ignore pain during bowel movements after surgery for anal fistula
Ignore constipation

 

 

 

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Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
waterchestnut
Water Chestnuts: The tastiest ways to include this healthy tuber in your diet Water chestnut is not a nut after all. It is a tuber (much like the potatoes) growing close…
Surgery or home-remedy; what is the right way to treat a burn The treatment of a burn injury depends on its severity. You can save a life by offering the…
Sputum test Sputum test is a commonly used diagnostic tool that is used to examine the presence of pathogens in…
LFT-test
Liver Function Test – LFT LFT or Liver Function Test is a blood test used to determine the levels of hepatic enzymes which…
ASTtest-liver
AST- Aspartate Aminotransferase Test AST test is a blood test that is used to measure the level of a particular liver enzyme…
lp-pla2
LP-PLA2 Test The LP-PLA2 test is a test which is carried out to assess the levels of Lipoprotein-Associated Phospholipase A2…
Pescatarian Diet 101: What are the inherent health advantages of this diet? People opt to become a pescatarian in order to enrich their bodies with the essential health benefits that…
shiitake mushrooms healthy
What are Shiitake Mushrooms and why should you eat them? Shiitake Mushrooms are well known for their smoky and robust taste. However, did you know they are replete…
Low fat diets
A complete list of low-fat diets and how to follow them Low-fat diets help you lose weight in a healthy way, but it works only with regular exercise and…
Piaget stages: Do they accurately describe the way the human brain develops?  A common assumption was that children are less competent thinkers as compared to adults, but this was refuted…
gallbladder diet tomato
Gallbladder surgery :Tips on post-operative care and diet What to eat post a gallbladder surgery? What are the key things to avoid if you had a…
free thyroxine ft4
Free thyroxine test (FT4) The FT4 or free thyroxine test is used to detect the level of free thyroxine of FT4 thyroid…
L-theanine attention
L-Theanine: Better sleep, higher focus, and many other benefits Did you know that L-theanine found in green tea can make you sleep better and be focused at…
immunoglobulin M
Immunoglobulin M Test Immunoglobulin M is the largest and the first produced antibody which helps in the prevention or fighting of…
HSV-IgM test
Herpes Simplex Virus (HSV)-IgM Test The HSV-IgM class antibody is produced by the body a few days after an initial HSV infection and…
blood ketone test
Blood Ketone (D3HB) Test The Blood Ketone Test measures and monitors the levels of ketone in the blood which is usually performed…
Hymenoplasty
Hymenoplasty Read on to find out all about hymenoplasty, the procedure, post-surgery care, the risks, and the benefits.
hidden causes obesity
8 hidden causes of obesity you probably didn’t know! Did you know that around 2 billion people worldwide are either overweight or obese? Are you too a…
Hepatitis A virus infected liver
Hepatitis A Virus (HAV) Total Blood test to look for IgM antibodies to know if you are infected with Hepatitis A virus (HAV),…
amylase test
Amylase Test Amylase test is done by checking the level of this protein in the blood sample and also in…
BRAT Diet: What is the right way to follow this diarrhea-relieving diet? BRAT diet, a simple diet consisting of just bananas, rice, applesauce, and toast, can help you combat the…
Rheumatoid Arthritis xray
Arthritis Profile Arthritis profile is a panel of primarily blood tests used to detect the presence of arthritis or check…
sodium chloride
Halotherapy: How inhaling salt can work wonders for your body Halotherapy is quickly gaining popularity amongst those with respiratory diseases. It has shown promise in its treatment.
Diabetes blood test
Diabetic Profile The diabetic profile is a set of tests used for testing and monitoring the various kinds of Diabetes…
DHEA wrinkles
DHEA: Now get unbelievable age defiance with this wonder hormone! DHEA is known popularly as the age-defying hormone. This supplement is widely used to slow down aging and…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
colposcopy
Colposcopy Colposcopy is a simple, quick and non- invasive diagnostic tool to look closely inside the vulva, vagina, and…
free testosterone test
Free testosterone Free Testosterone Test measures and monitors the level of the free testosterone in the blood. Less than 4%…
Propolis: Yet another amazing gift by the bees to the humans Bee propolis is yet another generous gift by the bees bestowed on the human race. They utilize substances…
liver biopsy procedure
Liver Biopsy Liver biopsy or hepatic biopsy is a diagnostic tool that collects a sample of live tissue from the…
Hysteroscopy_procedure
Hysteroscopy Hysteroscopy is a minimally invasive tool to help specialists view the uterus to diagnose and even treat several…
Astaxanthin: Why experts believe it could be 550x more potent than vitamin E! What is astaxanthin and why is this new supplement on the block touted as the most powerful antioxidant…
carrageenan seaweed
Carrageenan: How a simple seaweed extract could better your gut health & immunity Eat more ice cream to prevent cold and flu? –With carrageenan you get one simple seaweed extract that…
Hydroquinone: Is it the best topical treatment for hyperpigmentation? Darkening of the skin due to high melanin levels is called hyperpigmentation.  Hydroquinone interferes with melanin production thus treating…
Salt dangers
Sodium chloride: The wonders and dangers of the simple table salt Sodium chloride is a salt containing sodium and chlorine ions at a 1:1 ratio. It is edible and…
dandelion weight loss
Caralluma Fimbriata: How to eat this cactus to lose weight Caralluma fimbriata is a miracle cactus that can be safely consumed by most for losing weight and boosting…
Urologist: When should you visit one and why? A urologist can treat not only genitourinary problems of both men and women but also can treat various…
6 arguments in favour of glucosamine and where can you find it Studies have shown that glucosamine works by preventing the breakdown of cartilage of the joints. This is usually…
Psyllium Husk: More than just an effective natural laxative Psyllium husk, or isabgol, is a popular natural laxative . But did you in addition to regulating bowels,…
Miracle extract from the root of maca: 10 ways it can help you! Maca root has been used for years in herbal medicine. Today scientific research is unearthing fresh evidence in…
Lauric Acid: 8 health benefits you can derive from coconuts Appropriate use of saturated fats containing lauric acid can provide you numerous health benefits. This is the main…
kshar sutra
Kshar sutra treatment for piles, fissures and fistula Read to know the benefits and side effects of kshar sutra to treat anal piles, fissures, and fistula…
Cordyceps: How the Caterpillar fungus works as a proven cancer-shield Strange as it may sound, but cordyceps or "caterpillar fungus", a fungus variety native to the Himalayas may…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
green poop causes
Green poop : What are the reasons and how can you correct it Ever sneak a peek down the toilet only to shockingly find green poop? Why does our poop turn…
hYdroxycut pills
Hydroxycut: How safe are these so-called weight loss supplements? Hydroxycut is a blend of several different ingredients formulated to promote weight loss; powered by a key weight…
superfoods quinoa probiotics
10 fantastic Superfoods you need to include in your diet from today! What exactly are superfoods and how do they battle diseases? From losing weight to looking ravishing- these superfoods…
thyroid_scan
Thyroid Scan Thyroid scan is a diagnostic procedure that aims to view the thyroid gland and detect any growths or…
creatinine
Creatinine Test The level of creatinine in the blood is a significant indicator of the health of your kidneys. This…
Pelvic_ultrasound
Pelvic Ultrasound Pelvic ultrasound is a process where sound waves are used to create image of your pelvic region organs…
Mood swings
The real reasons for your mood swings and how to overcome them Are you prone to heated moods frequently? Do you also feel bouts of depressive feeling creeping up on…
Find all the instant ways to get rid of blackheads Blackheads - Not only are they aesthetically unappealing but if left untreated these can cause bacterial overgrowth on…
Did you know drinking alkaline water could be the healthier choice for you? Ever wondered how safe is your drinking water in terms of pH? Recent studies have revealed that Alkaline…
Ultrasound
Abdominal Ultrasound An abdominal ultrasound is used to visualize the organs inside your abdominal cavity including the liver, spleen, gall…
Crossfit with rope
CrossFit: Now get the perfectly sculpted body with this explosive gym routine CrossFit is a fitness regimen that makes use of high-intensity exercises in a shorter period to achieve muscle…
Is it possible to achieve full body detox with Master Cleanse? Master cleanse is a diet consisting of a lemonade based beverage, a salt water drink and a herbal…
Optavia diet
The features of an Optavia diet The Optavia diet endorses pre-packaged meals and snacks called "fuelings" that are tasty, low in calorie, and incorporates…
Tart Cherry: The healthiest excuse for taking that second serving of pie Tart cherry has been traditionally used in delectable desserts such as pies. Recent studies have revealed that its…
Hot cups for detox? Read all about the ancient technique of cupping Did you know inverted hot cups on your back can squeeze out and eject toxins from your body?…
carbamazepine
Carbamazepine / Tegretol test The carbamazepine is a drug that is used to treat epilepsy and the carbamazepine test is performed to…
Bromelain: 11 reasons why you should start adding pineapple to your pizza! If you didn't love pineapples already, here are some of the top health benefits that bromelain can bring…
Electric toothbrush vs manual toothbrush: Who wins the dental war? Manual brushes are ideal for kids as it is important to start slowly unlike the electric brushes which…
Chlorella: Therapeutic powers of the billion-year-old algae now within your reach Chlorella - A billion year old nutrient-rich algae that can potentially ward off cancers and high cholesterol; the…
How to correctly perform nasal irrigation using a Neti Pot? Neti pot has been a part of Ayurveda since centuries. This ancient tool is extremely effective in treating…
leptospira Igm test
Leptospira-IgM Test A Leptospira-IgM test is a blood test which is carried out to detect anti-Leptospira IgM antibody. Leptospirosis is…
Coffee Enema: Turn your favorite morning beverage into a powerful colon cleanser The wonders of coffee are not just limited to waking you up every morning. You can now use…
Helicobacter pylori IGA
Helicobacter Pylori – IgA Test The H.pylori IgA test is a blood test used to identify the level of IgA antigen in the…
Milk Thistle skin
Milk Thistle: Find possible cures for fatal diseases in these purple blooms Milk thistle is well-known for treating liver conditions. However, did you know that it comes with a plethora…
sleep deprivation
Don’t let your sleep deficit grow into memory loss or heart attack Why is sleep important for us? How could sleep deprivation harm you? We bet you didn't know about…
piles fissure fistula
Allopathy vs homeopathy vs ayurveda treatment for piles, fissures, and fistula Read to know the best form of treatment among allopathy, homeopathy,or ayurveda for piles, fissures, and fistula
myelogram
Myelography Myelography is an important diagnostic tool that is used to investigate and identify abnormalities in the spine and…
cytomegalovirus igm test
Cytomegalo Virus (CMV) – IgM Test The CMV antibodies include both IgM and IgG antibodies which are the immune system's response to a CMV…
glucose-tolerance
Oral Glucose Tolerance Test – GTT Glucose tolerance test (or Oral GTT) is used to detect the onset of diabetes or prediabetes conditions. It…
The right way to prepare Alfalfa sprouts at home Alfalfa or lusan ghas is not just a nutritious animal fodder. This flavonoid-rich herb has some amazing health…
woman with abdominal pain holding ovulation calendar
Ovulation – facts to know about ovulation Learn how and when ovulation occurs, demystify common misconceptions, identify symptoms, methods of detection and right period for…

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