Anal fistula is a name not very familiar to most people. In fact, it’s a disease that can occur in patients of all ages and genders and is found fairly frequently, no less so than other intestinal and rectal disorders. Because anal fistula occur on the buttocks and near to the anus, patients often feel embarrassed or put off seeing a doctor, even when they experience symptoms or are suffering as a result. However, failing to treat the problem simply causes even more chronic or serious symptoms, making it more difficult for doctors to treat and often causing further complications as well.
An anal fistula is caused by a chronic infection in the anal area. It can be described as a narrow tunnel that connects an external opening in the skin near the anus with an internal opening in the anal canal. It can occur around the anus and the buttocks and generally looks like a red, swollen bump, often filled with pus. Anal fistula can be divided into 2 main types:
An anal fistula is caused by inflammation, blockage, and bacterial infection of the anal glands, sometimes originating in the intestines and entering through the internal opening in the anal canal. As the infection and blockage grows, the bacteria buildup causes the nearby formation of infected tissue and pus. As the pus accumulates, it gradually makes its way through layers of muscle until it forms a connecting cavity between the anal canal and the surface skin near the anus so that it can drain, resulting in an anal fistula. Sometimes a fistula is a result of a perianal abscess that was drained surgically.
Both diseases have similar symptoms: blood mixed with stools and pain in the anal area. Hemorrhoids, however, involve swollen veins in the anus and rectal area, causing a soft lump to protrude from the anus. There may be some pain from time to time but there is usually no pus discharge. In the case of anal fistulas, on the other hand, they usually look like a hard lump and generally cause a lot of pain, along with discharge or pus, and sometimes bleeding from the anal area as well. Additionally, hemorrhoids can be cured with behavior adjustment, rubber band ligation and injection treatment, while anal fistulas require surgery performed by specialized doctors.
Anal fistulas do not heal on their own and are often chronic. In order to be effectively treated and cured with a low chance of recurrence and without the possibility of incontinence, it is necessary to undergo surgery. If you experience pain or pus discharge in the anal area, you should seek medical attention as quickly as possible for the most appropriate diagnosis and treatment.
At present there is not. Anal fistula can only be treated surgically.
There are several surgical methods which can be used, depending on the fistula's location and complexity. In principle, however, the goals of the surgery are to remove the anal fistula completely, to prevent recurrence and to protect the sphincter muscles, as damage to these muscles can lead to fecal incontinence.
Simple anal fistulas can be treated with open surgery (Fistulotomy or Fistulectomy). In a fistulotomy, the surgeon makes a small cut in the fistula's internal opening to scrape and drain out all the pus and infected tissue. A fistulectomy involves the removal of the whole fistula tract. The wound will be left to heal naturally, with new tissue growing and filling the gap. It takes about one month for this tissue to heal. Fistulectomy provides about a 90% cure rate with only about a 10% chance of recurrence. However, this method can result in side effects—patients may experience fecal incontinence if the doctor is not skilled enough and the sphincter muscles are excessively cut. For this reason, it is vital that the surgery be performed by a highly skilled and experienced doctor.
In the case of deep or multi-tract fistulas, the fistula tract cannot be removed entirely, as this would require too much of the sphincter muscle to be excised resulting in fecal incontinence. For this reason, other surgical methods are necessary:
Of the 4 surgical methods outlined above, there is no method considered to be 100% effective. Rather, each of these has about 60-70% effectiveness; that is, there is still some chance of recurrence. That said, in all of these cases, a great advantage is that these treatment methods can all be repeated if they are not successful on the first try, as the anal sphincter will not have been removed or excessively cut during the procedure.
For simple fistula surgery, just a one-day hospital stay is necessary. For complex fistula surgery, patients should expect to stay in the hospital for 1-2 days. Patients can then adhere to the following post-surgical self-care methods:
A key priority for doctors will be to avoid fecal incontinence caused by the removal of too much of the sphincter muscles or cutting into them. As such, the doctor will select a surgery method that is most suitable for the patient after assessing the type of anal fistula—simple or complex, deep or shallow, etc. In addition, the expertise of the surgeon is an important consideration for this type of procedure. After the surgery is carried out, the chance of recurrence differs greatly depending on the fistula type.
Patient practices and self-care of postoperative wounds are important aspects in minimizing the chance of recurrence. Methods used for the prevention of recurrence are:
In the past, when an abscess occurred on the buttocks, it would likely be treated using perforation to drain the pus from the abscess. However, there was no additional physical examination involved, which meant that if it was punctured, the inner and outer openings still remained and could turn into a fistula. Nowadays, however, a skilled doctor will perform a physical examination beforehand and, if an abscess is found that has no external opening, the surgeon will examine it once again during surgery to see if there is any internal opening. If any such opening is found, it can be cut off immediately to prevent any cavity being left that could develop into a more chronic condition and, eventually, an anal fistula.
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