Understanding Anal Fistula

A fistula is abnormal passageway that connects two organs or vessels that usually do not connect. They can develop anywhere between an intestine and the skin, between the vagina and the rectum and other places. Fistula may be caused by injury or surgery. But in some they are naturally created like anal fistula and vaginal […]

A fistula is abnormal passageway that connects two organs or vessels that usually do not connect. They can develop anywhere between an intestine and the skin, between the vagina and the rectum and other places. Fistula may be caused by injury or surgery. But in some they are naturally created like anal fistula and vaginal fistula. Artificial fistula is created for the purpose of surgery like renal fistula for renal dialysis. The type of fistula depends on the site of occurrence and organs involved which are as follows:

  • Anal
  • Arteriovenous
  • Biliary
  • Cervical
  • Craniosinus
  • Enterovaginal
  • Gastric
  • Metro peritoneal
  • Pulmonary
  • Umbilical

It is estimated that around 50,000 to 1,00,000 people suffer from fistula every year. Out of all the fistulas, the most common are the fistulas of anal and vaginal which occur naturally. Vaginal fistula is prominent among women after child birth, because of long unattended labor. In general fistulas are treated using antibiotics, lifestyle changes, food habits and the last option is surgery.

Anal fistula is a small tunnel that develops between the end of the bowel and skin near the anus which can cause bleeding and discharge when passing stool and can be very painful. Laser treatment has been very successful in treating this condition.

Symptoms:

  • Bad discharge smell near anus
  • Bleeding or discharge while passing stool
  • Bowel incontinence
  • Constant, throbbing pain that worsens when you sit down, move around, cough or after having bowel movement
  • Fever when there is abscess
  • Skin irritation around anus
  • Swelling and redness around anus

Diagnosis:

Fistulas are very difficult to diagnose, unless the doctor is very much experienced. Typically, doctor can identify fistula by examining the area around anus. Digital rectal examination is sufficient to diagnose an anal fistula, but some patients may require tests to screen for

  • Diverticular disease
  • Inflammatory bowel syndrome
  • Rectal cancer
  • Sexually transmitted disease

In rare cases, examination may be done under anesthesia. The doctor may advice for ultrasound, CT scan or MRI.

Causes:

Most anal fistulas develop after an anal abscess. They can occur, if abscess has not healed properly and the pus has dried out. It is estimated that 25% people with Crohn’s disease suffer from anal fistula. Rare causes of anal fistula are TB, HIV and diverticulitis.

Treatment:

Surgery is necessary to cure an anal fistula. The main options include:

  • Fistulotomy – a procedure that involves cutting open the whole length of the fistula so it heals into flat scar
  • Seton procedure – where a piece of surgical thread called a seton is placed in the fistula and left there for several weeks to help it heal before a further procedure is carried out to treat it
  • Other technique includes filling the fistula with special glue, blocking it with special plug or covering it with a flap of tissue

In some patients with high fistula and with recurrent or complex fistula, there is risk of potential damage to the anal sphincters during fistula procedures. Therefore, with a goal to minimize injury to anal sphincter, a number of newer sphincter saving procedures are used like:

  • Laser treatment of anal fistula (Filac) – this is safest, fast and minimal invasive method which is done within 15 minutes. There is less hospital stay and doesn’t affect continence function. This procedure is widely used technique with 80 to 90% success rate all around the world. This procedure is done using Diode laser.
  • LIFT (ligation) – in this technique after identification of internal sphincter, an incision is made at fistula tract and infected tissue is removed through inter-sphincteric approach. Defect is sutured.
  • Video assisted anal fistula treatment (VAAFT) – this is minimally invasive and sphincter saving endoscopic treatment. In this procedure, tract and internal fistula is localized using fistuloscope inserted through external opening and under direct vision fistula tract is destroyed from inside and closure of internal opening is done by stapling or suturing. The recovery is faster and painless.

Following the surgery, physician would recommend patient to take hot water bath and would prescribe laxatives for few weeks. In case, there is bleeding or pain, it is necessary to see the physician. Most of the fistula responds well to surgery and laser treatment. The cost of fistula surgery using new techniques is costly, but the results are fruitful with minimum pain and stay time in hospital. The estimated cost in India is approximately 1 lakh rupees, while in countries like US, UK, Dubai, etc., the cost of treatment is very high.

What you eat is what you are, especially when it comes to taking care of internal organs like intestines, stomach, liver, rectum, etc. Anal fistula can be prevented with a healthy diet and lifestyle.

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Radha K. Iyer is a contributing writer on Treatum Blog. When she is not writing, she can be found reading health and food blogs or experimenting with her culinary skills.

Disclaimer: The entire content of this article is for information purpose only and is not intended to replace a one-on-one relationship with a qualified health care professional. It is intended as a sharing of knowledge and information. It is not a substitute for professional care and should not be used for diagnosing or treating a health problem and disease.

5 comments

  1. Muthusaran N

    Useful article..

  2. Soundariya

    Nice one

  3. Sudhan

    Nice article

  4. Poonam

    Very useful article

  5. Ashutosh

    Nice explanation.. just simplified the topic

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