Anal fistula: symptoms, causes and how to treat it

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Definition of fistula ani

What is an anal fistula?

Anal fistula or anal fistula is the formation of a small tube between the end of the large intestine and the skin around the anus. The fistula itself is a connecting channel between two parts of the body or blood vessels.

In most cases, fistulas form as a result of infection of the anal gland. This infection then forms an abscess or pus-filled lump. The lump will then burst and dry up.

A burst lump can also form a hole under the skin that is connected to the infected gland. This condition needs doctor's care because it will not heal on its own.

How common is this disease?

The formation of ducts in the anus is more common in men aged 20-40 years. It is estimated that 1 to 3 people experience this condition in 10,000 people.

Most fistulas are the result of an infection that begins in the anal gland (cryptoglandular) causing tiny abscesses (collections of pus).

Signs & symptoms of fistula ani

What are the signs and symptoms of an anal fistula?

The signs and symptoms that you may experience are as follows.

• Skin irritation around the anus.
• There is persistent pain which is described as a throbbing sensation that gets worse when sitting, moving, defecating, or coughing.
• Foul smell near the anus.
• Chapter bleeding or there is pus in the stool.
• There is swelling and redness around the anus.
• Have a fever when an abscess forms.
• The body is shivering and tired.

Not everyone experiences the same symptoms. Some have experienced all the symptoms, others have experienced several symptoms. In fact, there are also those who feel other symptoms that are not mentioned above.

When should I see a doctor?

See a doctor immediately if you experience persistent symptoms that are suspected of being fistula ani. The doctor will observe your symptoms and examine the anus by inserting a finger into it.

Examination is carried out to check for signs of fistulas. If the symptoms point to anal fistula, your doctor will refer you to a colorectal specialist for further tests.

Further examination will also assist the doctor in making a diagnosis and determining a more appropriate treatment.

Causes of fistula ani

What causes an anal fistula?

The main cause of anal fistula is the formation of abscesses around the anus. Initially, this condition occurs when the glands around the anus become blocked. When the glands become blocked, bacteria will build up, causing infection in the tissue.

Over time, an abscess, aka a collection of pus, can form in the injured part of the anus. If the abscess is not treated properly and does not heal after the pus is removed, you will be at risk of developing an anal fistula.

Finally, the collection of pus that forms will make its way out on its own until a hole appears in the skin around the anus. It is estimated that 40 percent of patients with an abscess will develop a fistula.

According to the Cleveland Clinic website, the appearance of a pus-filled lump is most likely due to a number of health problems. Here are a few of them.

• Crohn's disease, which is a long-term condition that causes the digestive system to become inflamed.
• Tuberculosis (TB) infection, which is a bacterial infection that attacks the lungs.
• Human Immunodeficiency Virus (HIV), namely a viral infection that can later cause Acquired Immunodeficiency Syndrome (AIDS) and affects the immune system.
• Sexually transmitted disease that attacks the anus.
• Diverticulitis, which is inflammation of the sacs along the large intestine.
• Trauma or complications from surgery near the anus.

Risk factors for fistula ani

What increases my risk for anal fistulas?

An abscess forming around the anus increases your risk of having an anal fistula. In addition, the existence of problems in the digestive system also increases a person's chances of developing this disease.

Several health conditions that can increase the risk of anal fistula include:

• colitis which includes Crohn's disease or inflammatory bowel syndrome (IBS),
• have chronic diarrhea, and
• following radiation treatments for anal cancer.

Anal fistula complications

What are the complications of anal fistula?

Anal fistula is a disease that can recur after treatment. Without proper care and treatment, the symptoms will get worse. Complications can also occur if anal fistulas are not treated properly.

One of the complications that may occur due to fistula ani is the inability to control bowel movements. This condition can interfere with or affect bowel habits.

Diagnosis & treatment of fistulas in ani

What are the usual tests for anal fistulas?

Doctors can usually diagnose an anal fistula by examining the area around the anus. You do this by inserting your finger into the anus and looking for the fistula opening in the skin.

During the examination, the doctor also tries to determine how deep the fistula is and where it leads. Some fistulas may not be visible on the surface of the skin. If this happens, the doctor will need to perform additional tests.

The following are various additional tests that can be used to diagnose fistula ani.

• Anoscopy, namely a test that is carried out using a rigid tool and a small tube tool called anoscope (anal speculum). This tool will be inserted into the anus and rectum (the end of the large intestine).
• Scan test with ultrasonography (USG) or MRI to get a picture of the condition of the fistula tract.

If an anal fistula is found, the doctor will perform further tests to determine the cause, for example whether the fistula is related to Crohn's disease or other causes. The reason is, about 25% of people with Crohn's disease experience anal fistulas.

The doctor may also recommend a colonoscopy, complete blood count, and X-rays. In the colonoscopy procedure, the doctor will administer a light anesthetic and insert a special instrument into the colon through the anus.

What are the drug options for anal fistula?

Here are some common treatments for anal fistulas.

1. Fistulotomy

Fistulotomy is the most common surgical procedure for treating anal fistulas. This procedure requires cutting the fistula so that the skin tear heals and forms a flat scar.

This treatment is said to be the most effective, although it is not suitable for all conditions. Fistulotomy is usually most applied to fistulas that do not pass through the sphincter muscles because of the small risk of causing bowel incontinence (uncontrolled bowel movements).

If the risk of incontinence is very high, your doctor will recommend other, safer treatments.

2. Seton technique

If the fistula passes through most of the anal sphincter muscle, your doctor will recommend this treatment. The tunon technique uses a seton or piece of thread that is tight around the fistula for several weeks to keep it open.

This thread will slowly cut the fistula. This allows the tear to dry up and heal quickly without having to cut the sphincter muscle.

3. The LIFT procedure

This is a procedure ligation of the intersphincteric fistula tract (LIFT) to treat fistula ani. This procedure is chosen if the fistulotomy has a high risk of causing postoperative complications.

During treatment, the doctor makes an incision in the top of the skin. An incision is made right in the area of ​​the fistula and sphincter muscle. Then, the fistula will be closed by cutting both ends so that the wound that is formed will be flat.

In this procedure, a cut is created over the fistula so that the sphincter muscles can move apart. The fistula is then sealed at both ends and cut open so that it lies flat.

Home treatment of anal fistulas

What are the home remedies and lifestyle changes that can be done to treat fistula ani?

After the operation is complete, the doctor will give you pain relievers such as acetaminophen or ibuprofen. In addition, you also need to do additional home care that includes the following steps.

• Take the antibiotic given by the doctor and finish the drug.
• Soak in warm water 3 or 4 times a day.
• Using special dressings until the healing process is complete.
• Follow a diet recommended by your doctor or nutritionist.
• Return to activities when the doctor allows it.

Anal fistula is the formation of a channel between the end of the large intestine and the skin around the anus. You can treat it with a number of medical procedures. If you have specific questions or concerns, consult your doctor for the best solution to your problem.