A fistula is a small channel or tube like passageway between two or more body parts that are usually not connected.
What is Anal Fistula?
An Anal Fistula is a defective tunnel like connection between anal canal (internal opening) and the perianal skin (external opening). Anal abscess is an infected cavity filled with pus, around the rectum and anus. The tract formed below the abscess is the fistula. A fistula is formed because the abscess is not drained completely. Abscesses can recur if the Fistula seals over, allowing the accumulation of pus. It then points to the surface again and the process repeats.
What are the symptoms of Anal Fistula?
Pain is the most common symptom. It could be mild or throbbing, while sitting or opening the bowel.
Swelling, redness of skin and skin irritation around the anus
Irritation due to pus or blood discharge
Recurrent abscess formation
In rare cases fever.
How Anal Fistula is diagnosed?
Detecting the external opening of an Anal Fistula is usually easy through the diagnosis, while finding the internal opening can be challenging. Knowing the fistula's complete tract is critical for effective treatment.
Doctors use Fistula Probe to find the tract. It is a specially designed instrument that can be inserted into Fistula.
Digital Rectal Exam is one of the common way.In rare cases, other procedures used are –
Diluted methylene blue dye: Injected into a fistula
Fistulography: Injection of a contrast solution into a fistula and then X-raying it
Magnetic resonance imaging (MRI)
Flexible sigmoidoscopy: A thin, flexible tube with a lighted camera inside the tip allows doctors to view the lining of the rectum and sigmoid colon as a magnified image on a television screen
What are the surgical options availale?
Surgery is the only cure for Fistula. However, choosing the right surgery is very important. The goal of a surgery is to repair the anal fistula completely, prevent recurrence and to protect anal sphincter. Depending on the location and complexity of the fistula the surgery can be decided.
Fistulotomy - One of the common procedures used in more than 80% of cases. This surgery unroofing over the whole length of the fistula in order for the surgeon to flush out the contents.
Seton technique - A seton is a string of silk or latex which is left into the fistula tract to drain out infection. This may be considered if you are at high risk of developing incontinence when the fistula crosses the sphincter muscles. This procedures require many sittings.
Advancement flap procedure- This procedure is used when there is a high risk incontinence. In this procedure a piece of tissue (flap) is removed from the rectum or from the skin around the anus. During surgery, the fistula tract is removed and the flap is reattached where the opening of the fistula was.
Fibrin glue- The only non-surgical treatment option available. Special formulated glue is injected into the fistula to seal the tract, then the opening is stitched closed. It is a simple, safe and painless procedure, but long term results for this method are poor and patient may require another sittings.
Video Assisted Anal Fistula Treatment (VAAFT) - This is one of the latest and improved surgical technique for simple and complex anal fistulas. In this procedure a fistuloscope called Karl video equipment is used to view the fistula tract. Once the internal opening is identified, it is stitched and the fitsula is removed using electric current and the external opening is shut using fibrin glue. This procedure is painless with very low risk of incontinence and the chances of recurrence are also less.
The most crucial thing is to maintain anal hygiene, toilet hygiene, having sex with protection, avoiding spicy food and excessive sedatives and pain killers.
What are the chances of recurrence?
Despite proper treatment and apparent complete healing, fistulas can potentially recur, with recurrence rates dependent upon the particular surgical technique utilized. With the conventional surgery method, the chances of recurrence after surgery are as high as 20% even in simple fistulas largely because of a failure to identify these secondary tracks and the site of the internal opening.
Will I have any pain?
-You will feel pain for the first couple of days, but the pain will ease over the time.
What should I expect when I go to the toilet?
-You will feel little discomfort and probably little bleeding while opening the bowel. Your urosurgeon may prescribe some pain killers that you can take about 15-20 minutes before to minimize the pain.
When can I return to work and normal activities?
-Almost all the procedures are day care procedures, however, you might be required to take a few days off depending upon the surgery. It may vary from 3-5 days.