Fistula

A fistula is a condition in which two body parts or blood vessels are connected together abnormally, typically as the result of injury or surgery. Fistulas are a fairly common occurrence. They can form in many parts of the body, such as between the throat and neck, cervix and vagina, bowel uterus and peritoneal cavity etc.

An anal fistula is a small tube that connects a cavity containing pus (an abscess) to the skin around the anus. Most anal fistulas are caused due to an anal gland infection. The anus opens up to the rectum. In it are glands that make an acidic, wet substance that which lubricate and protect the opening.

These glands can get blocked by dirt and lead to an abscess (or collection of pus). And these abscesses can lead to the development of fistula. Fistula can also form due to inflammation.

An anal fistula can cause a number of different symptoms. Some of the most common anal fistula symptoms are:

1. Pain around the anal area
2. Swelling
3. Frequent anal abscesses
4. Redness around the anus
5. Skin Irritation Around the Anus
6. Discharge of blood and pus (a foul-smelling liquid) through the anus
7. Fatigue
8. Fever and chills

An anal fistula is a common complication after an anal abscess. An abscess develops when pus doesn’t drain properly. Some of the common causes of an anal fistula are:

1. An anal fistula can develop due to a chronic inflammatory disease called Crohn’s disease. It is a long-term condition that affects the digestive tract.

2. Exposure to a high dose of radiation while treating cancer can also lead to an anal fistula.

3. Diverticula may also lead to the formation of anal fistulas. It is a condition that affects your digestive tract and causes small pouches to form. These bulging pouches can become inflamed.
4. Chronic constipation can also cause an anal fistula due to the tearing of the skin around your anus.
5. Sustained or repeated trauma to the anal area may also lead to an anal fistula.
6. Sexually transmitted diseases such as HIV can cause an anal fistula.
7. Anal Tuberculosis (TB), an extremely rare form of TB, can also be a cause of anal fistula.
8. Anal sex can also be another cause of anal fistula.
9. Frequent diarrhea is also another cause of anal fistula.
10. A decrease in the blood flow to the anorectal area may also lead to an anal fistula.

For the diagnosis of anal fistula, your doctor will ask about your medical history and examine the area around the anus. When diagnosing fistulas, the doctor will measure where it is and in which direction it is going. The examiner might also insert a finger in your rectum (rectal examination) to look for signs of an anal fistula.

Some fistulas are easy to spot, while others may not be visible on the skin’s surface. In the latter case, you will be asked by your doctor to take additional tests such as:

1. Anoscopy – This is a medical procedure that follows a small tube called ‘anoscope’, and it allows the medical examiner to see the inside of your rectum and anus.
2. An ultrasound or MRI may also be performed on the anal area to identify the fistula tract.

If your doctor detects an abscess, they may want to further test you for Crohn’s disease, an inflammatory disease that causes intestinal problems. For this, the required tests include colonoscopy, blood tests and x-rays.

During a colonoscopy, the doctor makes use of a lighted, flexible instrument to look at the inside of your rectum and colon. You’ll be given a light anesthetic that keeps you conscious and sedated.

The doctor may prescribe antibiotics to improve your immune system or prevent the spread of any infection, but medication is not a permanent fix for the condition, so surgery is almost always necessary to cure an anal fistula.

The surgery aims to strike a balance between removing the fistula and saving the muscles that make up your anal sphincter. If these were damaged, then you may experience incontinence issues afterwards.

The most common surgical options for fistula treatment are:

1. Fistulotomy – This procedure enlarges the opening of your fistula so that it heals on a surface level. Since fistulotomy is usually an outpatient procedure, you will be released from the hospital the same day.
2. Seton procedures – In the case of more complex fistulas, the surgeon may choose to put in a special drain called a seton. This is done by placing a suture or rubber band around it, which can be tightened over time until it heals. This also eliminates the risk of incontinence.
3. Filling the fistula – In this treatment, the doctor will close the inner opening of your fistula with a piece of surgical material and then fill the fistula tunnel with a substance that your body will break down and absorb naturally over time.
4. If your anal fistula is caused due to Crohn’s disease, then the doctor will inject stem cells into the fistula.

Although prevention of anal fistula is not always possible. However, you can still take certain precautions to avoid developing it. Here are some things you can do:

1. Try to keep the anal area dry
2. If you are suffering from diarrhoea, get treated immediately.
3. Always drink plenty of fluids, and eat fibrous foods.
4. Exercise regularly
5. Protect yourself from sexually transmitted diseases during anal sex by using condoms or other barrier methods.
6. If, by chance, you get infected with a sexually transmitted infection (STI), then seek immediate treatment.
7. Keep the anal area clean. Use warm water and mild soap for such purposes.
8. If your infant is showing such conditions, change their diapers frequently.

An anal fistula can be a tough condition to manage, but it is treatable. In order to avoid complications, you should understand the risk factors and monitor your health accordingly. If any or multiple symptoms mentioned above arise, then seek a doctor as soon as possible.

The multidisciplinary care team at the CK Birla Hospital provides expert care regarding fistula treatment. To know more about this issue, visit CK Birla Hospital or book an appointment with Dr. Anukalp Prakash.