Anal Fistula
Dr. Mahesh Krishna specializes in the advanced treatment of anal fistulas, offering minimally invasive procedures for effective healing. With a focus on precision and patient comfort, he provides expert care to ensure long-term relief and recovery. Trust Dr. Mahesh Krishna for safe and specialized fistula treatment.
Anal fistula
An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the opening of the bottom (anus).
It is usually caused by an infection near the anus, which results in a collection of pus (abscess) in the nearby tissue.
When the pus drains away, it can leave a small channel behind.
Anal fistulas can cause unpleasant symptoms, such as discomfort and skin irritation, and will not usually get better on their own.
Surgery is recommended in most cases.
Symptoms
Symptoms of an anal fistula are:
skin irritation around the anus
a constant, throbbing pain that may be worse when you sit down move around, poo, or cough
smelly discharge from near your anus
passing pus or blood when you poo
swelling and redness around your anus and a high temperature if you also have an abscess
difficulty controlling bowel movements (bowel incontinence) in some cases
The end of the fistula might be visible as a hole in the skin near your anus, although this may be difficult for you to see yourself.
Investigations
Tests you may have included:
a further physical and rectal examination
a proctoscopy, where a special telescope with a light on the end is used to look inside your anus
an ultrasound scan, MRI scan, or CT scan
Cause of an anal fistula
Most anal fistulas develop after an anal abscess. You can get one if the abscess does not heal properly after the pus drains.
Less common causes of anal fistulas include:
Crohn’s disease – a long-term condition where the digestive system becomes inflamed
diverticulitis – infection of the small pouches that can stick out of the side of the large intestine (colon)
hidradenitis suppurativa – a long-term skin condition that causes abscesses and scarring
infection with tuberculosis (TB) or HIV
a complication of surgery near the anus
Treatments for an anal fistula
• Fistulotomy
The most common type of surgery for anal fistulas is a fistulotomy. This involves cutting along the whole length of the fistula to open it up so it heals as a flat scar.
• Seton techniques
If your fistula passes through a significant portion of the anal sphincter muscle, the surgeon may initially recommend inserting a seton.
A seton is a piece of surgical thread left in the fistula for several weeks to keep it open.
• Advancement flap procedure
An advancement flap procedure may be considered if your fistula passes through the anal sphincter muscles and having a fistulotomy carries a high risk of causing incontinence.
This involves cutting or scraping out the fistula and covering the hole where it entered the bowel with a flap of tissue taken from inside the rectum, which is the final part of the bowel.
• LIFT procedure
The ligation of the intersphincteric fistula tract (LIFT) procedure is a treatment for fistulas that pass through the anal sphincter muscles, where a fistulotomy would be too risky.
During the treatment, a cut is made in the skin above the fistula, and the sphincter muscles are moved apart. The fistula is sealed at both ends and cut open to lie flat.
• Endoscopic ablation
Endoscopic ablation involves inserting an endoscope (a long, thin tube with a small camera on the end) into the fistula.
An electrode is then passed through the endoscope to seal the fistula.
Endoscopic ablation works well, and there are no serious concerns about its safety.
• Laser surgery
Radially emitting laser fiber treatment involves using a tiny laser beam to seal the fistula.
• Fibrin glue
Treatment with fibrin glue is currently the only non-surgical option for anal fistulas.
It involves the surgeon injecting glue into the fistula while the patient is under general anesthetic. The glue helps seal the fistula and encourages it to heal.
