Fistula-In-Ano (Anal Fistula)

What is an anal fistula or fistula-in-ano?

An anal fistula is an infected tract that is formed between the skin and the muscular opening at the end of the anus.

Most anal fistulas arise from infections in the anal gland. This infection causes an abscess that drains continuously through the skin next to the anus. An anal fistula is usually treated through surgery.

What are the causes of anal fistula?

Fistula is formed because of an abscess. If you have an anal abscess, there are good chances that you are prone to developing an anal fistula too.

Fistulas are formed due to certain conditions of the lower digestive or anal track like -

When should you consult a doctor?

If you have a history of an abscess or symptoms of fistula, you should not miss these signs and contact your doctor immediately.

How to manage an anal fistula?

If you are dealing with a fistula or recovering from a fistula treatment you can undertake the following practices for some comfort.

How is an anal fistula diagnosed?

Anal fistulas need to be treated by a specialist dealing in the colon and rectal diseases department. 

The specialist will have a check on your medical history as well as probe the sight of the fistula and recommend further diagnosis - 

Fistula probe - In this way of diagnosis, a long thin probe is guided through the outer opening. A special dye might be injected just to check where the fistula opens on the inside.

Anoscope - This scope guides through the anal tract. It is a tubular device and inserted a few inches into the anus to diagnose any anal anomalies.

Imaging studies - Fistulas might appear superficial. The imaging studies recommended for diagnosing fistulas could be an ultrasound or an MRI scanning for understanding how deep-set the fistula is.

What are the treatment options for anal fistula?

Fistulas are usually treated through surgeries for faster and better recovery. There are different types of treatment a surgeon might opt for depending on the patient's specific condition.

Fistulotomy 

The fistulotomy opens the fistula inside out and results in better and faster healing. The surgeon would cut the opening, scrape and clean the infected area, and then flatten and suture it back.

Fistulotomy usually involves cutting the sphincter muscle. 

Fistulotomy might be a complicated process when the entire channel needs to be removed, in that case, the process might be done in two stages.

Fistulotomy being an outpatient procedure the patient can go home the same day.

Filling the fistula (Collagen plus or Fibrin Glue)

This is a relatively new technique. This procedure uses a special glue or plug to close the inner opening of the fistula. The surgeon clears and cleans the channel and closes the input of the fistula with sutures. 

A special fibrous protein called fibrin is then inserted in the fistulas through the external opening of the fistula. 

The anal tract is then closed shut with a protein collagen plug.



Reconstructive surgery

Reconstruction surgery is usually done in stages and opted in some cases recommended by the surgeon.

 The reconstruction surgery is known as Ligation of the intersphincteric Fistula Tract (LIFT). This procedure is used to cure deep-seated fistulas. The procedure is done in stages several weeks apart.

Seton placement

The seton placement procedure uses a rubber band (seton), silk, or latex string inserted into the fistula to help drain out the infection.

For complex fistula, the doctor would recommend invasive procedures like-

Colostomy

 

Under this procedure, a temporary opening is made in the abdomen to divert all the waste and drain it into a collection bag. This allows time for the anal area to heal.

Muscle Flap

This procedure is out for complex anal fistulas, where healthy muscles from the thigh, buttock, or labia are used to fill the fistula channel.

Anal fistulas are more common in people with Crohn's disease. For patients with both Crohn's disease and a fistula, medical therapy is usually tried before surgery.