Fistula Expert in Perumbakkam
Your Trusted Partner in Anal fistula
Anal fistulas are abnormal tunnels or passages that form between the anal canal or rectum and the skin near the anus. They can cause symptoms such as persistent pain, swelling, discharge of pus or feces, and recurrent abscesses. At our facility, we offer comprehensive care and guidance to effectively diagnose and manage anal fistulas, providing personalized treatment plans to alleviate symptoms and promote healing.
Understanding Anal fistula
Types of Anal Fistula
Inter-sphincteric Fistula:
- Inter-sphincteric fistulas originate in the anal canal and extend through the internal sphincter muscle before opening into the skin near the anus. They are often characterized by a narrow tract that runs parallel to the anal canal within the internal sphincter muscle. Inter-sphincteric fistulas may be relatively straightforward to treat compared to other types of fistulas due to their simpler anatomy and location.
Trans-sphincteric Fistula:
- Trans-sphincteric fistulas traverse both the internal and external sphincter muscles, extending from the anal canal to the skin around the anus. These fistulas typically form a curved or oblique tract that passes through both layers of the anal sphincter complex. Trans-sphincteric fistulas are among the most common types of anal fistulas and may require surgical intervention for effective treatment, especially if they are complex or recurrent.
Supra-sphincteric Fistula:
- Supra-sphincteric fistulas originate in the anal canal and travel upwards, passing over the external sphincter muscle before opening into the skin. These fistulas typically form a more vertical tract that extends above the level of the anal sphincter complex. Supra-sphincteric fistulas may be associated with deeper abscesses or inflammation and can be challenging to diagnose and treat due to their location and potential proximity to critical structures.
Extrasphincteric Fistula:
- Extrasphincteric fistulas originate in the rectum or anal canal but do not pass through the anal sphincter muscles. Instead, they travel around the outside of the sphincter muscles before opening into the skin. These fistulas often form a curved or serpentine tract that extends around the anal sphincter complex. Extrasphincteric fistulas are less common than other types but may be more complex to treat due to their atypical course and potential for recurrence.
Horseshoe Fistula:
- A horseshoe fistula is a complex type of fistula that extends from one side of the anal canal, loops around the rectum, and connects to the other side of the anal canal. These fistulas typically form a U-shaped or horseshoe-shaped tract that encircles the anal canal. Horseshoe fistulas are among the most challenging types to treat due to their complex anatomy and tendency for recurrence. They often require specialized surgical techniques to effectively address the entire tract and prevent complications.
Causes of Anal Fistula
Anal Abscess: Anal abscesses are often the primary cause of anal fistulas. These abscesses develop when anal glands become blocked, leading to the accumulation of pus and bacteria in the tissues surrounding the anus.
Inflammatory Bowel Disease (IBD): Conditions such as Crohn’s disease and ulcerative colitis, which are characterized by chronic inflammation of the digestive tract, can increase the risk of developing anal fistulas.
Infection: Infections of the anal region, such as sexually transmitted infections (STIs) or bacterial infections, can cause inflammation and tissue damage, leading to the formation of abscesses and, in some cases, fistulas.
Trauma or Injury: Trauma to the anal area, such as trauma from childbirth, anal surgery, or penetrating injuries, can disrupt the normal anatomy of the anal canal and increase the risk of developing fistulas.
Anal Surgery: Previous anal surgeries, such as hemorrhoidectomy or fistulotomy, can sometimes result in the formation of new fistulas or recurrence of existing ones. .
Chronic Constipation or Diarrhea: Chronic constipation or diarrhea can contribute to the development of anal fistulas by causing repeated trauma to the anal canal or by increasing pressure on the anal glands, leading to blockage and abscess formation.
Symptoms of Fistula:
- Anal Pain
- Swelling
- Itching or Irritation
- Discharge
- Skin Changes
- Recurrent Abscesses
- Difficulty Sitting/Moving
- Fever
Treatments
Supportive Therapies:
- Sitz Baths: Soaking the anal area in warm water to reduce pain, inflammation, and promote drainage.
- Dietary Modifications: Increasing fiber intake and staying hydrated to prevent constipation and promote regular bowel movements.
- Pain Management: Over-the-counter pain relievers or topical treatments may be used to alleviate discomfort associated with the fistula.
Complementary and Alternative Therapies:
- Herbal Remedies: Some herbal preparations may have anti-inflammatory or antimicrobial properties that can help reduce symptoms of anal fistulas.
- Acupuncture: Traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body to stimulate healing and reduce pain.
Non-Surgical Treatments:
- Fibrin Glue Injection: Injection of fibrin glue into the fistula tract to seal the opening and promote healing.
- Electrocautery: Use of heat to destroy the lining of the fistula tract and promote closure.
- Platelet-Rich Plasma (PRP) Therapy: Injection of concentrated platelets from the patient’s blood into the fistula tract to stimulate healing.
- Medications: Antibiotics or immunosuppressive drugs may be prescribed to treat underlying infections or inflammatory conditions contributing to the fistula.
Surgical Intervention:
- Fistulotomy: Surgical cutting of the fistula tract to remove infected tissue and promote drainage.
- Seton Placement: Insertion of a material (e.g., thread, rubber band) through the fistula tract to maintain drainage.
- Fistula Plug Insertion: Placement of a biologic or synthetic plug into the fistula tract to seal the opening and promote healing.
- Advancement Flap Procedure: Creating a flap of healthy tissue near the fistula opening to cover and seal the tract.
- LIFT Procedure (Ligation of Intersphincteric Fistula Tract): Ligation of the fistula tract at its internal opening to promote healing while preserving anal sphincter function.
Frequently Asked Question on Fistula
An anal fistula is an abnormal tunnel or tract that forms between the anal canal or rectum and the skin near the anus. It typically develops as a result of an untreated anal abscess and can cause symptoms such as pain, swelling, discharge, and recurrent abscesses.
Anal fistulas are commonly caused by conditions that lead to the formation of anal abscesses, such as infection of the anal glands, inflammatory bowel disease (IBD), trauma, or previous anal surgery. These abscesses can progress to form fistulas, which are abnormal connections between the anal canal and surrounding tissues.
Anal fistulas are typically diagnosed through a combination of physical examination, medical history review, and imaging studies such as an ultrasound, MRI, or fistulogram. During the examination, the healthcare provider will look for signs of inflammation, swelling, or discharge around the anus and may gently probe the area to identify the fistula tract.
Treatment for anal fistulas depends on the type, location, and severity of the fistula. Common treatment options include surgical procedures such as fistulotomy, seton placement, fistula plug insertion, or the LIFT procedure. Non-surgical treatments such as fibrin glue injection or supportive therapies like sitz baths and dietary modifications may also be recommended.
Untreated anal fistulas can lead to several complications, including recurrent abscesses, chronic pain, fecal incontinence, and the formation of fistula tracts extending into deeper tissues or organs. In some cases, fistulas may become chronic or recur despite treatment, requiring additional interventions to manage symptoms and prevent complications.