An anal fistula is a formation of a canal from the anus through the buttock, to the outside of the body. It is almost like another small anal cavity. It is typically described as a channel that forms between the skin of the buttock and the bowel. A lot of times it is connected to an abscess. When the channel does not open all the way, it will cause an abscess. When it channel develops all the way through, from the outside, it looks like you have a tiny hole in your bottom. Anal fistulas are very painful, yet easy to diagnose. The only treatment available is surgery.
Anal fistulas are not necessarily common unless you have an abscess in the anal cavity. The presence of an abscess gives you a 50% chance of having an anal fistula. The anal cavity has different glands. They are like little sacs throughout the anal cavity. The purpose of these glands is to secrete substances necessary for the intestine to work properly. The glands have tiny holes that make secretion possible. When these glands are blocked, they typically create an abscess. This abscess may then lead to a fistula.
If you have an anal fistula, you have an infection. There is never a time where you get an anal fistula, and it is not infected. Bacteria and fecal matter usually block the glands creating an infection. To fully understand an anal fistula you have to understand what an abscess is. An abscess is a small infected cavity. It normally contains pus. Typically abscesses occur in the anal cavity once the glands become infected. The abscesses form wherever there are glands. This is important to understand because anal fistulas are usually a result of an abscess. Sometimes instead of forming between the skin of the buttock and the anus, it forms between the glands and the abscess.
Types of Anal Fistulas
There are five different types of fistulas categorized based on their location in regards to the sphincter. The sphincter is the muscle that controls the opening and closing of the anal cavity. This is important to understand because it determines the method of treatment the doctor will use.
- Superficial sphincteric fistula– cuts on the inside of both sphincter muscles
- Transphincteric fistula– cuts through both sphincter muscles
- Intersphincteric fistula– only cuts through the internal sphincter muscle
- Extrasphincteric fistula– only cuts through the external sphincter muscle
- Suprasphincters fistula– cuts around the outside of both sphincter muscles
Symptoms of an Anal Fistula
- Bleeding– with pus which is then found in the stool
- Swelling of the anus– with visible redness
- Bowel movements become difficult
- Irritation in the area
- Urinary incontinence
Diagnosis & Treatment of an Anal Fistula
Diagnosis only involves a rectal scan. Physicians may run another test just to rule out sexually transmitted diseases. Ultrasounds and CT scans look through the inside of the anal cavity to see if irritable bowel syndrome or cancer is the cause of the problem.
Treatment nearly always requires surgery and antibiotics. Sometimes when treating an abscess, you create an anal fistula. There are about five different types of procedures for an anal fistula. Each is dependent upon the location of the anal fistula. Fistulotomy is the most common type of surgery. A fistulotomy opens up the fistula and completely cleans it out. The fistula ends up closing and becoming a scar. Advanced flap procedure takes tissue from the rectum and puts it where the fistula was a way to close the channel. The bioprosthetic plug is a procedure that uses a plug made of tissue, and it closes up the fistula. It takes some time, but new tissue forms around the plug. The drainage will stop eventually. Seton technique uses a thread; it is placed through the fistula. This procedure typically requires multiple doctors visits. The last treatment is fibrin glue; this is a non-surgical method. Fibrin glue is placed into the fistula to help close the fistula. The opening is then stitched together. It is an easier method but the least successful. After this procedure, you typically have to have other procedures. Medications are given to help relieve the pain, and if the infection has spread, you may also need medication to get rid of the rest of the infection.
Anal fistulas are not something you hear about every day. If you have one, you understand the pain and discomfort associated with the condition. Anal fistulas are not typically life-threatening, but if you do not get the treatment you need, it can be. Anal fistulas are not a condition that will just go away on its own. If you have any symptoms described above, make sure to see a physician. Make sure to get the fistula plugged so you can go back to feeling healthy again.
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