Anal fistulas are tube-like passages that connect an infected anal gland to the outside of the skin near the anus. They do not usually heal on their own, and often require surgery. Here’s what you need to know about the condition.
Causes
Typically, anal fistulas originate from an anal abcess. Anal abcesses are collections of pus. These can form when anal glands become infected. Then, a tunnel can form from the abscess to an opening on the skin. This tunnel is an anal fistula. Other less common causes include Crohn’s disease, cancer, trauma, and diverticulitis.
Symptoms of Anal Fistulas
Anal fistulas typically cause a few symptoms. These include pain and swelling around the anus and painful bowel movements. There is often drainage from an opening around the anus, and pain may decrease after drainage. The drainage may be pus and be bloody or foul-smelling. You may also experience fatigue, fever, and chills. Any of these symptoms are good cause to see a doctor.
Diagnosis
Doctors diagnose anal fistulas by first performing a physical exam to identify an opening or boil on the skin near the anus. If there is no visible opening, they may need to perform an anoscopy, MRI, or ultrasound to visualize the fistula tract and determine the severity and size of the fistula.
Treatment
If you have an anal fistula, you will need surgery. Anorectal surgeons will evaluate your fistula to determine how the fistula is affecting your anal sphincter muscle and then minimize the surgery’s effect on anal function. A procedure called a fistulotomy allows doctors to open the fistula tunnel and allow it to heal. Doctors usually prefer this approach if a small amount of the anal sphincter muscle is involved with the fistula. If a significant amount of the muscle is involved, another viable approach is placing a band called a seton through the fistula to promote drainage. The seton stays in place for at least 6 weeks. There is typically a follow-up procedure in this case to get rid of the fistula. Another common surgical technique is the advancement flap procedure. This, like the seton approach, is also useful if a large amount of the sphincter muscle is involved. Here, surgeons cut or scrape out the fistula and then cover the hole where it enters the bowel with a flap of skin from the rectum.
Prognosis and Disease Management After Surgery
Unfortunately, some fistulas may require several surgeries to eliminate them. Following surgeries, you may need to take stool softeners and soak the affected area in a warm bath. Plus, to help with pain, your doctor may inject a local anaesthetic and prescribe pain pills for a short time. The good news is that when properly treated, fistulas rarely come back.
Our experienced team at GHP has years of experience treating anal fistulas. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.
