Do you feel swelling around your anus and passage of pus or blood from your stool? Are you aware that these symptoms can be a cause of anal fistula? A fistula is an opening which is found around the anus. It can be very distressing and may make one feel very embarrassing too! Well! There may be very home remedies and other treatment options available for anal fistula. But only a surgery can bring a symptomatic relief from it.
What is an anal fistula?
An anal fistula is a connection between an abscess, a pus-filled tissue, in the anus and the skin around the opening of the anus.
Causes
There are mucus-forming glands on the inside of the anus. When these glands get clogged, they develop abscesses. The clogging is a result of an infection or bacteria buildup that occurs. Most of the abscesses become fistulas if the abscesses are left untreated and hence, they grow.
Some of the rare reasons for having a fistula can be health conditions that affect the bowel, tuberculosis and even sexually transmitted diseases.
Symptoms
Some of the common symptoms of an anal fistula are:
- Swelling around the anus
- Redness around the anus
- Skin irritation around the anus
- Pus or blood passing with stool
- Pain when sitting, coughing or passing stool
- Foul smell around the anus
- Bowel incontinence i.e. difficulty controlling bowel movement
Diagnosis
If any of the symptoms are noted, it is important to visit a doctor. Tackling the fistula at the abscess stage can prevent letting it turn into a fistula, which cannot be reduced via medication.
The doctor will ask about bowel conditions to find the root cause for the abscess or fistula. They can conduct a rectal examination to check the presence of a fistula. If a fistula is suspected, it is confirmed with either a proctoscopy (used to do imaging inside the anus), ultrasound, CT scan or MRI.
Is surgery always a necessary option?
You may be reluctant to undergo surgery for anal fistula. But there is no alternative treatment available that can treat anal fistula and can only be treated with surgery. The fistula grows in size if it is left untreated and the infection can worsen. There is no medication that can reduce the size of the fistula or dissolve it. The surgery to remove the fistula is a short surgical procedure and the recovery time is fast. The surgical procedures are conducted under general anaesthesia.
Treatment
Options for anal fistula surgery are:
- Fistulotomy – It is a procedure in which the surgeon cuts open the length of the fistula so that it can turn into a flat scar and then heal.
- Flap procedure – This procedure is done if fistulotomy has the risk of causing bowel incontinence in a patient. In this procedure, the fistula is cut and removed and the hole is covered with a flap of tissue taken from the insides of the rectum.
- Seton procedure – A surgical thread called seton is placed in the fistula. It is left there for a few weeks to let the infected fluid in the fistula drain, after which further surgical procedures are done. It can take up to 6 weeks. This method is for more complicated fistulas.
- LIFT, or litigation of the intersphincteric fistula tract – It is done when fistulotomy has the risk of causing possible complications. In this procedure, the cut is made above the fistula, moving apart from the sphincter muscles. The fistula is cut open so that it becomes flat. It’s a comparatively newer procedure.
- Laser surgery – Laser surgery aims at using heat in the form of laser to seal the fistula.
- Endoscopic ablation – This is similar to endoscopy. A tube is inserted, along with a camera, into the fistula. Through the tube, electrodes are passed to then seal the fistula.
- Bioprosthetic plug – This plug blocks the opening of the fistula. The fistula is not removed in this process.
- Fibrin glue – This is a non-surgical method in which glue is injected into the fistula, under general anaesthesia. The glue seals the fistula and promotes healing.
Usually, a patient can go home on that very day after anal fistula removal surgery. If there arise some complications only then the patient will be asked to stay at the hospital for a few more days.
Risks associated with Anal fistula surgery.
There are, however, some health risks associated with the surgery for anal fistulae, such as:
- Infection
- Recurrence of fistula
- Bowel incontinence
If you note any of the symptoms of anal fistula, as easily noticeable due to bowel incontinence or pain, visit a doctor immediately. A fistula can be removed only via surgery, so be prepared for your doctor to suggest the same if a fistula is diagnosed.
