Introduction
A fistula is a small passage that develops within the organ. An anal fistula develops between the end of the large intestine and the skin near the anus. These fistulas are usually formed due to infection near the anus leading to the accumulation of pus in the nearby tissue. The abscess drains and leaves a small passage behind. Fistula can cause unpleasant symptoms such as skin irritation and discomfort. The treatment of choice in most cases is surgery.
What Are the Causes of Anal Fistula?
The majority of the time, the anal fistula is formed after an anal abscess. However, after the pus drainage, it forms a fistula after the abscess does not heal adequately.
Some of the diseases which cause fistula are:
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Diverticulitis: Small pouches formed in the intestinal wall, stuck outside the large intestine (colon), is known as a diverticulum. Infection of the diverticulum is known as diverticulitis.
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Crohn's Disease: Inflammation of the digestive system for a long-term duration. The symptoms include diarrhea, blood in stools, tiredness, weight loss, abdominal pain, and anal fistula.
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Hidradenitis Suppurativa: It is a painful, long-term skin condition causing skin scarring and abscess. It occurs near hair follicles around the bottom, groin, armpits, and breasts, which contain sweat glands. The symptoms include the formation of boil-like lumps, cysts, blackheads, scarring, and passages in the skin that leak pus and abscess.
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Tuberculosis: It is a bacterial infection that spreads through inhaling tiny droplets from the sneezes or coughs of an infected patient. It can primarily affect the lungs, abdomen, bones, glands, and nervous system. The symptoms of tuberculosis include a persistent cough that lasts for more than 2 to 3 weeks. The cough may contain blood. Other symptoms include high temperature, loss of appetite, and weight loss.
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HIV (Human Immunodeficiency Virus): A virus that damages the immune system and reduces the ability to fight everyday infections and diseases. The syndrome is known as AIDS (Acquired immunodeficiency syndrome). It gives rise to a number of syndromes of potentially life-threatening illnesses and infections.
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Post-surgical Complications - Usually near the anal region.
What Are the Symptoms of Anal Fistula?
The symptoms of anal fistula include:
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Constant throbbing pain can worsen while sitting, moving around, coughing, or passing stool.
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Irritation of skin around the anal region.
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Passing of blood or pus along with the stool.
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Foul-smelling discharge from the anus.
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Redness and swelling around the anus with high fever in cases of an abscess.
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Bowel incontinence is uncontrolled bowel movements. It becomes very embarrassing and upsetting and requires immediate medical help.
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The end of the fistula looks like a hole in the skin near the anus, often difficult to notice by the patient itself.
What Is the Treatment for Anal Fistula?
The treatment of choice for anal fistula is surgery. Several surgical procedures present depend on the fistula's channel, whether it is a single channel or branched. The initial examination of the area is done under general anesthesia, which helps to decide the best treatment option. The main aim of the surgery is to heal the fistula while avoiding any damage to the sphincter muscles. Sphincter muscles regulate the opening and closing of the anus, which can potentially lead to loss of bowel control. The surgical options for anal fistula are:
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Fistulotomy: The most common surgical treatment for fistula is fistulotomy. The whole length of the fistula is cut and open so that it heals as a flat scar. It is the most effective treatment option for anal fistulas, although it is recommended only in cases where fistulas do not pass through or around the sphincter muscles. The risk of incontinence is comparatively low in such cases. Even if the surgeon has to cut a small portion of the anal sphincter muscle during the surgery, they try their best to reduce the risk of bowel incontinence. In cases of very high risk of incontinence, other methods are considered.
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Seton Techniques: When the fistula passes through a large portion of the anal sphincter muscle, it is recommended to insert a section. A section is a surgical thread that is used to keep the fistula open for several weeks. It helps the seton to drain and heal without cutting the sphincter muscle. Loose setons are used only to drain the fistula; however, to cut the fistula tighter, setons are used.
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Advanced Flap Procedure: This procedure is considered when the fistula passes through the anal sphincter muscle, but a fistulotomy may cause a higher risk of incontinence. The procedure involves cutting and scraping the fistula and covering the hole with a flap of tissue taken from the rectum. Advanced flap procedure has a lower success rate than fistulotomy but avoids the need to cut the anal sphincter muscles.
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LIFT (Ligation of Intersphincteric Fistula Tract): This procedure is recommended in cases where fistulotomy is considered very risky. A cut is made in the skin above the fistula, and the anal sphincter muscle is moved apart. The fistula is then sealed on both ends and cut open so that it lies flat.
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Endoscopic Ablation: In this technique, an endoscope (a tube with a camera attached) is put in the fistula, and then an electrode is passed through it, which seals the fistula. This technique has a very low risk and a good success rate.
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Laser Surgery: A small laser beam is used to seal the fistula. There are uncertainties about the prognosis of this procedure; however, the least safety measures are required.
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Fibrin Glue: It is a non-surgical method of treatment. The involuntary injection of glue into the fistula encourages the fistula to heal. It is helpful in preventing sphincter muscles because the fistula is not cut.
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Bioprosthetic Plug: It is a cone-shaped plug made up of animal tissue that is used to block the internal opening of the fistula.
Conclusion:
An anal fistula is a passage formed near the anus due to infection. It can become a severe complication if not appropriately diagnosed or left untreated. The treatment option for the disorder is surgery to prevent the anal sphincter muscles. Prevention of the anal sphincter muscle is important during the treatment as it is responsible for closing and opening the anus.
