What are the symptoms of anal fistula?

Symptoms of an anal fistula can include:

Skin irritation around the anus

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Constant, throbbing pain that may be worse while sitting down, move around, having a bowel movement or while coughing.

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Smelly discharge from or near anus 

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Passing pus or blood while passing stools.

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Swelling and redness around your anus and a high temperature (fever), if you also have an abscess

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Difficulty controlling bowel movements in some cases

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The end of the fistula might be visible as a hole in the skin near anus, although this may be difficult for patients to see.

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What are causes of anal fistulas?

Most anal fistulas develop after an anal abscess. They can occur if the abscess doesn't heal properly after the pus has drained away.

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It's estimated that between one in every two to four people with an anal abscess will develop a fistula.

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Less common causes of anal fistulas include:

Crohn's disease – a long-term condition in which the digestive system becomes inflamed

Diverticulitis – infection of the small pouches that can stick out of the side of the large intestine (colon)

Hidradenitis suppurativa – a long-term skin condition that causes abscesses and scarring

Infection with tuberculosis (TB) or HIV

 

When to get medical advice?

See a surgeon if you have persistent symptoms of an anal fistula.

 

How is Fistula diagnosed?

Fistula is diagnosed by examining anus and gently insert a finger inside to check for signs of a fistula.

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Proctoscopy – where a special telescope with a light on the end is used to look inside your anus

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 Magnetic resonance imaging (MRI) scan may be ordered to know the full extent of the disease.

 

Treatments for an anal fistula

Anal fistulas usually require surgery as they rarely heal if left untreated.

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All these procedures have different benefits and risks.

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The best option for you will depend on the position of your fistula and whether it's a single channel or branches off in different directions.

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We will talk to you about the options available and which one they feel is the most suitable for you.

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Surgery for an anal fistula is usually carried out under general anesthesia.

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The aim of surgery is to heal the fistula while avoiding damage to the sphincter muscles, the ring of muscles that open and close the anus, which could potentially result in loss of bowel control bowel incontinence)

 

Fistulotomy

The most common type of surgery for anal fistulas is a fistulotomy. This involves cutting along the whole length of the fistula to open it up so it heals as a flat scar.

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A fistulotomy is the most effective treatment for many anal fistulas, although it's usually only suitable for fistulas that don't pass through much of the sphincter muscles, as the risk of incontinence is lowest in these cases.

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If your surgeon has to cut a small portion of anal sphincter muscle during the procedure, they will make every attempt to reduce the risk of incontinence.

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In cases where the risk of incontinence is considered too high, one of the procedures below may be recommended instead.

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Seton techniques

If your fistula passes through a significant portion of anal sphincter muscle, your surgeon may initially recommend inserting a seton.

A seton is a piece of surgical thread or wire that is left in the fistula for several weeks to keep it open. This allows it to drain and helps it heal, while avoiding the need to cut the sphincter muscles.

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Loose setons allow fistulas to drain, but don't cure them. To cure a fistula, tighter setons may be used to cut through the fistula slowly. This may require several procedures that we can discuss with you.

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LIFT procedure

The ligation of the intersphincteric fistula tract (LIFT) procedure is a relatively new treatment for anal fistulas.

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It's designed as a treatment for fistulas that pass through the anal sphincter muscles, where a fistulotomy would be too risky.

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During the treatment, a cut (incision) is made in the skin above the fistula and the sphincter muscles are moved apart. The fistula is then sealed at both ends and cut open so it lies flat.

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This procedure has had some promising results so far, but it's only been around for a few years, so more research is needed to determine how well it works in the short and long term.

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SLOFT (Submucosal Ligation of Fistula Tract)

 It is very simple operation.

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 It doesn’t need any advanced technology.

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Under the effect of low spinal anesthesia, internal opening is defined.

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 Gently a pliable probe is passed through external opening and taken out of the anus.

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 A small incision given near internal opening, little dissection done around the probe and an aneurism needle passed to take suture around the indwelling probe. Probe removed and suture tied flush to internal opening.

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Tract transacted and distal component cored out. Anal wound closed. External wound is left open.

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No post op wound packing or dressings are required.

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Sitz bath and application of petrolatum jelly by patient himself.

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Weekly follow up, till the wound heals.

 

Fistula laser closure 

Fistula laser closure is a novel sphincter-saving procedure for the treatment of anal fistula.

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Primary closure of the track is achieved using laser energy emitted by a radial fiber connected to a laser.

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The energy causes shrinkage of the tissue around the radial fiber with the aim being to close the track.

 

Risks of anal fistula surgery

Like any type of treatment, treatment for anal fistulas carries a number of risks.

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The main risks are:

Infection – this may require a course of antibiotics; severe cases may need to be treated in hospital

Recurrence of the fistula – the fistula can sometimes recur despite surgery

Bowel incontinence – this is a potential risk with most types of anal fistula treatment, although severe incontinence is rare and every effort will be made to prevent it

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The level of risk will depend on things like where your fistula is located and the specific procedure you have.

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What Happens After Anal Fistula Surgery

Discomfort after fistula surgery can be mild to moderate for the first week and can be controlled with pain pills.

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The amount of time lost from work or school is usually minimal.

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Soaking the affected area in warm water (sitz bath) is recommended two or three times a day.

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Stool softeners or a bulk fiber laxative may also be recommended.

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It may be necessary to wear a gauze pad or mini-pad to prevent the drainage from soiling clothes.

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Bowel movements will not affect healing.