Anal Fistula

An anal fistula is a small duct that develops at the end of the gut (bowel) and the skin near the anus (the passage of excreta).

Causes
It is most commonly caused by an infection near the anus, which results in bleeding and discharge while defecating accompanied by pain. It is caused by the deposition of pus, called abscess, in the surrounding tissue, which can take place after a surgery. When the pus drains out, it leaves a channel behind. In certain cases, the anal fistula may cause persistent drainage. While in other cases, when the outer opening is closed, it results in recurrent anal abscesses. The only option here is a surgery. There are other less common causes of an anal fistula, which include:

• Tuberculosis (TB) or an HIV infection
• Diverticulitis- infection of the small sacks that come out of the side of the colon (large intestine).
• Crohn’s disease- a condition, occurring over a long period of time, in which the digestive system gets inflamed.
• Hidradenitis suppurative- a skin condition which results in abscesses and scarring.
• An after-math complication of a surgery around the anus.

Symptoms
The most common symptoms include:

• Constant, throbbing pain which gets worse when sitting, walking or even coughing.
• Irritation of the skin around the anus, which includes redness, tenderness and swelling.
• Pus and blood discharge.
• Pain during bowel movement and constipation.
• High temperature (fever) if it is accompanied by an abscess.
• Smelly discharge from the anus.
• Bowel incontinence, where the person has difficulty controlling his or her bowel movements.

Diagnosis
Mostly, a clinical evaluation, that is, a rectal examination is sufficient.

If your physician at Apollo Spectra thinks you have a fistula, they may refer you to a specialist (colorectal surgeon) for further confirmatory tests and treatments.

These tests generally employ an ultrasound scan, an MRI (Magnetic Resonance Imaging) scan, or a CT (Computerized tomography) scan. A proctoscope may also be used where a specialised telescope that has a light at the end of it is used to look inside the person’s anus. We at Apollo Spectra, ensure that the tests are performed with maximum precision, and deliver the best results.

Treatment
Anal fistula necessarily requires a surgery because they don’t heal on their own if they are left untreated.

There are various options available for the surgery which will depend on the position of the fistula and the branches it has. The surgeon may have to perform an initial examination of the area under local or general anaesthesia to pinpoint and determine the best treatment. The suitable option is then determined.

At Apollo Spectra, the surgery is generally done under general anaesthesia and the person is discharged soon after. We also aim to fulfill all the patient’s needs by providing them with state-of-the-art facilities, pertaining to anal fistulas. The surgery is focused on the treatment of the fistula without damaging the sphincter muscles and thereby causing a bowel incontinence.

The main options are given below:

Surgical options:

Fistulotomy– this is used in most of the cases (85% to 90%). It is a process in which the surgeon cuts open the whole length of the fistula and flushes out the content. It takes about a month or two to heal as a flattened scar. Although it is only suitable for the fistulas that have not passed through much of the sphincter muscles as this increases the risk of bowel incontinence.

Seton techniques– this is usually done when the fistula crosses through a large part of the anal sphincter muscle. The surgeon inserts a seton, which is a piece of surgical thread, inside the fistula and leaves it there for several weeks so as to keep the fistula open. This allows it to drain the content inside and slowly heal. It avoids operating on the sphincter muscles. A tighter Seton can be used to cut through the fistula gently. Although this requires multiple procedures and operations.

Advancement flap procedure– this procedure is only carried out when the fistula’s location is troublesome and it passes through at the sphincter muscles in the anus which makes Fistulotomy a risky procedure and it may cause incontinence. A tissue called the advancement flap is taken from the rectum or the skin around the anus. This flap is attached to the opening of the fistula after it (the fistula) is removed. This procedure is effective in most of the cases (about 70%) although it has a lower success rate as compared to fistulotomy.

LIFT procedure– It stands for the Ligation of the Intersphincteric Fistula Tract. It is recommended for the fistulous that pass through the sphincter muscles of the anus. In this treatment the sphincter muscles remove the part and a small incision is made along the skin just above the fistula. The two ends of the fistula are then ligated and is cut open.

Bioprosthetic plug– This too is an option when fistulotomy has a risk of bowel incontinence. It involves the insertion of a bioprosthetic plug, a product of animal tissue made into a cone, into the internal opening of the fistula. A few doctors believe it to be an effective treatment but there is no solid evidence available as of yet proving that claim. It is only carried out as a medical research as of now.

Non-surgical options:

Fibrin Glue– Fibrin glue treatment is initially the only non-surgical way available. A glue is used to seal the tract by injecting it inside the fistula and the opening is stitched closed. Although, it is not a permanent cure and not as effective as other treatments and surgeries. It still can be a useful option where fistulotomy is risky and the fistula passes through the sphincter muscles. It is carried out while the patient is under general anaesthesia.

Results

The treatment of anal fistula is usually successful without any more problems.

Risks of a surgery

There are certain risks that should be considered before going for a surgery.
• Infection- a course of antibiotics generally heals it.
• Bowel incontinence-it is the involuntary defecation and is a potential risk. Although, it is rare.
• Recurrence of anal fistula- the fistula at times may recur even after surgery

People with an anal fistula seeking care at Apollo Spectra, will be provided with the best specialists and services. We also provide the patients with the best care, pre and post the surgery. Using the latest technology, all our experts at Apollo Spectra come together to give you the best possible outcome from your treatment option.

Our topmost priority at Apollo Spectra is the patient’s safe treatment and post-surgery care. Our team works in the most efficient way, so as to prevent the chance of an anal fistula from recurring. The patient’s comfort and health is the most important for us.

FAQs
What causes an abscess?

It can happen when the stool is stuck or trapped inside a small gland inside the anus or when it gets infected by bacteria. Diarrhoea, constipation, colitis, etc may make it likely.

Does an abscess become a fistula always?

An abscess becomes a fistula in only the 50% of the cases. It is unpredictable though.

Can the fistula recur?

It doesn’t recur if it has healed properly and the bowel movement is normal.