A Complete Guide to Anal Fistulas: Symptoms, Causes & Treatment Options
An anal fistula is an uncomfortable, messy, condition. If you're dealing with one or more fistulas, you'll surely want them to be gone.
I've put together a basic guide to anal fistulas to help you understand this difficult condition and what options are available. Anal fistulas require surgery, but there are multiple approaches to choose, including surgical removal of the tissue track using standard general surgery techniques or using a laser for ablation of the fistula track.
What Is an Anal Fistula?
An anal fistula, also known as fistula-in-ano, is a small channel that connects the rectum to the outer skin of the buttocks. When a fistula forms, it can cause complications for the sufferer, such as irritation, infection, and draining pus and fecal material.
See a diagram of an anal fistula in the video below:
Anal Fistula Symptoms
You may experience pain with an anal fistula. Sometimes, the pain may be worse when you sit or use the restroom. The skin around your anus may feel irritated.
If you have a fistula, you may notice discharge from the opening. This can be pus, blood or even fecal matter.
Abscesses sometimes accompany fistulas. These can result in a fever.
In some cases, patients may experience fecal incontinence as a symptom of fistula-in-ano.
Anal Fistula Causes
It is not entirely clear what causes all fistulas. They often arise from an abscess in an infected anal gland. Sometimes, fistulas are associated with a current abscess. Other times, fistulas occur after the abscess has already been drained, whether naturally or by a doctor.
Anal fistulas are also associated with other conditions that can lead to their formation. Crohn's disease is a common one. Tuberculosis and diverticulitis can also result in fistulas.
Radiation therapy, too, can lead to anal fistulas.
Anal Fistula Diagnosis
Your doctor will probably begin with an exterior exam. The outer opening of the fistula is often easy to spot.
Next, the doctor will make a rectal exam in an attempt to find the interior opening of the fistula. He or she may use tools, such as an anoscope, to get a better view of the rectum.
It can be tricky to find the exact path of the fistula. Doctors use diagnostic tools to try to map out the fistula before beginning treatment. These can involve magnetic resonance imaging (MRI) or x-rays taken after applying a contrast dye.
A probe can be inserted into the fistula in an attempt to follow its path.
How Is an Anal Fistula Treated?
Anal fistulas require surgical treatment. There are not medical management options, such as taking medication, that can heal a fistula.
Although surgery is necessary, it should be noted that anal fistula surgery is not without risk. The most common concern associated with surgery is a loss of bowel continence. Particularly when a procedure involves cutting through the anal sphincter, incontinence is a serious concern.
Simple fistulas are often easier to treat without damaging the sphincter, but as fistulas become more complex, the risks increase. Unfortunately, more conservative measures designed to preserve continence are more likely to fail over time and may need to be repeated.
Seton
A seton is a thin piece of material, such as rubber or surgical thread, which is run through the fistula and around the anus to create a loop. It is usually used to help widen, heal and drain a fistula-in-ano before proceeding with another treatment method.
Sometimes, a seton is used on its own to heal a fistula. The seton is pulled tight so it will slowly cut through the tissue around the fistula and leave scar tissue in its place.
Fistulotomy
One of the most common treatment methods for fistula-in-ano, a fistulotomy is a surgical procedure in which the fistula channel is cut open. It is also known as "unroofing" the fistula.
After the doctor cleans any infection out of the fistula tract, the tunnel is flattened. The work is sewn into place to hold the channel open and promote healing.
Watch a fistulotomy procedure in action in the video below:
Fistulotomy on simple fistulas has a high success rate and can prevent recurrence. However, in more complicated cases, there is a significant risk of damage to the sphincter muscle involved with this procedure.
Fistulectomy
When the entire fistula is cut out and removed from the body, the procedure is known as a fistulectomy. The surgery can be highly effective at healing a fistula-in-ano and preventing a recurrence. It is sometimes considered the best treatment method for complicated fistulas.
However, fistulectomy does carry serious drawbacks. The recovery time--four to six weeks--is longer than for other treatment methods. Also, fecal incontinence is a risk with this surgery.
Closure Methods
There several different anal fistula closure options available. These treatments attempt to fill the space of the fistula in order to help close up the channel.
One method involves inserting a conical plug into the fistula. Another approach fills the channel with fibrin glue.
While these anal fistula closure methods are, in some ways, better because they do not involve cutting the sphincter muscles, they are also not as reliable as other approaches. They have a high rate of failure and may need to be repeated or followed up with an alternative treatment option.
Laser Treatment
Laser treatment for fistula is a promising treatment option that does not require cutting the fistula or the sphincter muscle.
Minimally invasive fistula laser treatment involves inserting a special laser probe into the fistula from the outer opening. First, the probe is slid all the way to the far end of the channel.
Then, the laser probe is slowly backed out of the tunnel. The laser treatment for fistula destroys or ablates the epithelium tissue lining the channel as it is slowly fired and moved along, and out of, the track. Removing that layer of epithelium tissue with a 360 degree array of laser energy allows the underlying tissue to heal together in a closed position.
Because minimally invasive fistula laser treatment does not involve cutting the fistula channel or the sphincter muscle, there is a lower risk of incontinence, and the recovery time is shorter than with some other methods.
Other Methods
Your doctor may also suggest another surgical approach to treating your anal fistula, especially if it is a complicated case. Some treatments involve putting a flap over the interior opening of the fistula.
Ligation of the intersphincteric fistula tract (LIFT) focuses on treating the section of the fistula that lies between the two sets of sphincter muscles. This is a relatively new procedure.
Your specialist may also recommend using a variety of treatment approaches, particularly if your fistula is a complicated case.
An anal fistula is a non-natural channel that forms between the anal canal and the skin around the anus, often related to an abscess. It can be painful or irritating, and treating it requires a surgical approach.
A doctor will diagnose fistula-in-ano through visual exams and or medical imaging tools.
The doctor may insert a seton to help heal the area before surgery.
Fistulas require surgery. One of the most common is fistulotomy.
Surgery runs the risk of damaging the anal sphincter muscles. Minimally invasive fistula laser treatment can heal the channel without cutting into or around the muscles.
