Anal Fistula & Its Treatment
What is anal fistula?
A fistula is an irregular tube-like connection between two organs or blood vessels that develops within the body.Fistulas usually grow as a result of an infection or inflammatory response to trauma or surgery. They can happen in many different body parts and can seriously affect someone’s health and well-being.
The most prevalent type of fistula is anal fistula. An anal fistula (also called a fistula-in-ano) is a small, narrow tunnel that runs from an opening inside the anal canal to an external orifice in the skin close to the anusIt is an aberrant tract that joins a primary opening inside the anal canal to a secondary opening on the perianal skin. Typically, an infection adjacent to the anus causes the problem, which leads to a buildup of pus (abscess) in the tissue nearby. There’s a strong likelihood that almost half of these abscesses might turn into a fistula.
Courtesy: WSM Medic
What are the causes of anal fistula?
An anal fistula develops when an infection develops in the tissue lining the anal canal. Bacteria commonly found in the rectum may spread, resulting in infection. This could be due to a variety of reasons, including:
- A recovered rectal wound.
- Large intestinal cancer
- Ulcerative colitis – a condition marked by a persistent tissue breakdown that results in a sore on the colon’s lining.
- Crohn’s disease – a chronic disorder that causes inflammation of the digestive system.
- Diverticulitis – a condition where tiny pouches develop in the large intestine and become inflamed.
- A chronic skin disorder called hidradenitis suppurativa that results in abscesses and scars
- HIV or tuberculosis (TB) infection
- a surgical side effect close to the anus
What are anal fistula symptoms?
Some telltale signs and symptoms of Anal Fistula include:
- Frequently occurring anal abscesses.
- A feeling of pain, swelling, or redness around the anus.
- Smelly discharge (pus) from an opening surrounding the anus.
- Anus-related cutaneous irritation caused by drainage.
- Painful bowel movements and tissue irritation around the anus.
- The discharge of pus or blood during defecation.
- High body temperature, particularly if there’s a presence of abscess.
- Having trouble controlling bowel motions, or bowel incontinence.
- Although the abscess heals up momentarily, it almost always returns after a while.
Diagnosis of Anal Fistula
Typically, the doctor can identify an anal fistula by looking at the area around the patient’s anus.He or she will search the skin for an opening (the fistula tract). The doctor will then make an effort to ascertain the tract’s depth and direction. There will be drainage from the external opening in most cases.On the skin’s surface, some fistulas might not be discernible. The doctor might need to order extra tests in this situation:
- Anoscopy/Proctoscopy: It is a procedure in which an anoscope (also known as a proctoscope) is inserted into the rectum to examine the anus and lower portion of the rectum.
- Fistula Probe:A long, thin probe is inserted via the fistula’s external orifice. The location of the fistula’s opening may be determined by injecting a specific dye.
- Sigmoidoscopy:A flexible or rigid scope is used during this procedure to look for inflammation and/or disease in the lower region of the intestine.
- A biopsy to check for cancer or inflammation.
- Lower gastrointestinal (GI) series:A treatment that makes the intestines easier to see on X-rays by using a specific fluid.
- Imaging Tests:One of these could be an ultrasound, which uses sound waves to provide an image of the anal area. They might consist of an MRI, which uses specialized magnets and a computer to create images of the area.
Anal Fistula Treatment
Anal fistulas almost often require surgery to be treated.An expert in colon and rectal surgery performs the operation. The procedure aims to eliminate the fistula while also safeguarding the anal sphincter muscles, which could get injured and result in incontinence. Certain surgical treatments include:
- Fistulotomy:The fistula is opened up during this operation, allowing it to recover inside out. It’s often an outpatient procedure. This implies that the patient will leave the hospital on the same day of treatment.There is minimal to no involvement of the sphincter muscle in it. The skin and muscle covering the tunnel are ripped open during this treatment to change it from a tunnel to an open groove. As a result, the fistula tract can recover from the bottom up.
Courtesy: Kaizen Gastro Care
- Filling a particular plug or glue in the fistula:This newer kind of treatment seals the fistula’s internal entrance.The doctor afterwards inserts a substance that the patient’s body will eventually absorb into the fistula tunnel over a period of time.
- Seton Technique:During this technique, a suture or rubber band (seton) is inserted into the fistula and is gradually tightened. It permits the fistula behind the seton to drain and heal. It reduces the chance of incontinence.
- Advancement Flap Procedure:The advancement flap procedure is advised if the fistula passes past the anal sphincter. With this method, the fistula is removed, and the depression is subsequently filled up with tissue from the rectum. Although this approach is less successful than a fistulotomy, it’s able to do away with the need to cut the anal sphincter muscle.
- LIFT: LIFT, also known as“ligation of the intersphincteric fistula tract,” is another possibility if the fistula travels via the anal sphincter muscle. Making a cut in the skin above the fistula and separating the sphincter muscle are required steps in this procedure. The fistula is sealed before being cut open later.
- Endoscopic Ablation:An endoscope with a camera attached is inserted into the anal fistula during this surgery. The fistula is treated with an electrode that is inserted through the endoscope. Given that there are no significant safety issues, this procedure is effective.
- Bioprosthetic plug:The goal of inserting a bioprosthetic plug is to stop the fistula from opening. This cone-shaped plug, which is manufactured from animal tissue, effectively blocks an anal fistula without posing any risks.
- FiLaC (Fistula-tract Laser Closure):The sphincter is preserved by a minimally invasive fistula-in-any procedure.Using laser radiation, this procedure aims to gently eliminate the anal fistula. The flexible fibre-optic probe is introduced into the fistula tract from the outside. It radiates all around. The laser is then gradually removed.The fistula tract contracts when the inflammatory tissue is carefully removed. The anal gland that first led to the fistula has been disabled.
- VAAFT: A brand-new endoscopic procedure called “video-assisted anal fistula treatment” (VAAFT) for complex fistulas is minimally invasive and sphincter-saving. A fistuloscope is inserted through the external opening to locate the internal fistula and the fistula tract. The internal opening is then sealed by stapling, suturing, or a cutaneous-mucosal flap after the internal fistula tract is eliminated from the inside.
Follow-up Post Treatment
Surgery is usually successful in treating fistulas and is the best alternative for a permanent cure for it.After the procedure, the doctor may advise the patient to take a sitz bath, which involves soaking the affected area in warm water and to take laxatives or stool softeners for a week.As the patient might experience some pain or discomfort in the area after surgery, the doctor will inject a local anaesthetic, such as lidocaine, to lessen thepatient’s discomfort. The doctor may also prescribe painkillers. The use of opioids is usually limited to a short period of time.In most cases, if the abscess and fistula are treated properly and healed, they will not recur.