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Anal Fistula in a Nutshell
An anal fistula is a small channel that makes an abnormal connection between the end of the bowel and the skin near the anus. More often than not, anal fistulas start from an infection near the anus that causes a collection of abscesses (pus) in the nearby tissue.
“The collection of pus grows and stretches the skin or through the lining of the anus. Thus, forming a connection between the skin and anus. Surgery to drain away the pus may also leave a small channel behind. This is known as anal fistula, and it may cause bleeding and discharge when passing motion and can be painful.” – Dr Ganesh Ramalingam
When 30-year-old Gillian Kane developed an abscess and underwent emergency surgery, she thought her worries were over. That was until she discovered that she had an anal fistula”.
Most anal fistulas develop as a result of anal abscesses. Anal fistulas are formed as a reaction to an anal gland with a pus-filled infection (anal abscesses). They can occur if the abscess does not heal properly after the pus has drained away on its own.
A small number of fistulas are less frequently caused by other conditions such as Crohn’s disease, sexually transmitted diseases, tuberculosis, diverticulitis, cancer or surgery near the anus. These affect your lower digestive tract or anal area and increases your risk of anal fistula.
Anal Fistulas have an increased risk of development under certain conditions. They are:
The end of the fistula may be visible as a hole in the skin near the anus, though it may be difficult for you to see it yourself.
Common symptoms of anal fistula include:
Anal fistulas can be prevented by practising good dietary, lifestyle and bowel habits. These habits include:
Eating fibre-rich foods may help prevent constipation. This helps prevent the formation of large, hard, or dry stools, which may lead to an anal fissure. At the same time, consuming sufficient fibre allows your stools to be softer while promoting more frequent bowel movements.
Staying hydrated and drinking enough water is another key that may help prevent constipation. By adding sufficient fluid to your system, it makes stools softer and easier to pass.
A lack of physical activity is one of the most common causes of constipation. Keeping active may help ensure that your digestive system is kept in good condition while promoting bowel movement.
Holding your bowels in when it is time to pass may lead to harder stools. As stools get dryer and harder with time, they get tougher to pass if held in the body for too long.
Our doctor will perform a physical and rectal examination for you to check for signs of an anal fistula. This is done by examining the skin around your anus and looking for an external opening in your skin. If it is possible, the depth and direction of your fistula tract will then be determined.
Otherwise, an anoscope, a special instrument, may be used to help him see inside the anal canal. Further imaging tests such as ultrasound scan, CT scan or MRI scan may provide images of the affected area for the doctor to diagnose.
Complications of an anal fistula may result in a recurring fistula even after treatment.
Anal fistulas, when untreated, may also lead to faecal incontinence (an inability to control bowel movements). This condition occurs when some of the muscle around the anal sphincter is removed.
An anal fistula is most often diagnosed by a physical examination of the affected area. Our doctor may check for pain, redness, and swelling in the anal region while observing if further investigations are required. If a patient is experiencing severe pain and drainage near the area of the fistula, it could be a sign of an infection.
For anal-rectal fistulas, our doctor may deploy a sigmoidoscope to conduct an internal examination of the fistula. This investigation not only helps our doctor to determine the actual location and cause of the fistula, but it also helps identify signs caused by Crohn’s disease. Depending on the situation, surgery may be recommended. This procedure is known as fistulectomy.
In some instances of deeper perianal abscesses, where the signs are not immediately visible, an instrument called the endoscope may be used to look inside the anal canal and lower rectum.
Our doctor may also arrange for an imaging test such as a CT scan, ultrasound or MRI. This is such that a more accurate diagnosis can be made.
Treating anal fistulas can be challenging when they get too large. Such was the case of a 36-year-old patient suffering from a 25-cm fistula. While the average size of an anal fistula is about 3 – 5cm, the patient, Siraj Ahmed, suffered from a rare kind of fistula, which had reached into his scrotum and the root of his penis.
Thankfully, despite the complexity of his procedure, doctors were able to deploy a technique called Video Assisted Anal Fistula Treatment (VAAFT) to treat his condition.
A fistulectomy is performed to remove an anal fistula completely. This procedure removes the entire fistulous tract but may pose a risk of damage to the anal sphincter.
For patients who are experiencing a high likelihood of recurrence or have a large amount of tissue blocking the normal function of the sphincter, this procedure may be recommended.
The procedure does not require an inpatient stay, so patients are usually discharged within the day.
For conditions where the fistula is assessed to be small or shallow, the procedure may be done at the doctor’s clinic with the administration of local anaesthesia.
Recounting his experience with what he calls an enormously painful perianal abscess, Brandon shares his story with Crohn’s & Colitis Foundation.
He was directed to a colorectal surgeon who attempted to cut and drain the abscess.
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