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Fistula in Ano

An anal fistula is a short tunnel that connects an abscess, a cavity in the anus that is diseased, to a skin hole around the anus.
About the disease

What Is
Fistula In Ano?

The external orifice via which faeces are discharged from the body is known as the anus. A number of tiny glands that produce mucus are located just inside the anus. These glands can occasionally become clogged and infected, resulting in an abscess. A fistula can form in about half of these abscesses.


Fistula in Ano

Causes

Clogged anal glands and anal abscesses are the most common causes of an anal fistula. An anal fistula can also be caused by the following less prevalent conditions:

  • Crohn’s disease (an inflammatory intestinal disease)
  • Cancer
  • Radiation treatment for cancer STIs (sexually transmitted infections).
  • Tuberculosis
  • Trauma
  • Diverticulitis (disease that affects the digestive system)

Symptoms

  • Anal abscesses are common.
  • Drainage (pus) from a hole surrounding the anus that is bloody or foul-smelling.
  • After the fistula drains, the pain may subside.
  • Swelling and pain around the anus.
  • Fever, chills, and a general sense of exhaustion
  • Constipation along with pain.
  • Skin irritation around the anus due to discharge.
  • Bleeding.

Diagnosis

An anal fistula is usually diagnosed by examining the area around the anus. The doctor will search the skin for an opening (the fistula tract). He will then attempt to assess the depth of the tract as well as its direction of travel. There will almost always be drainage from the external hole. Some fistulas are not visible on the surface of the skin. In this instance, your doctor may need to order the following tests:

  • An anoscopy is a technique that involves looking inside your anus and rectum with a specific device.
  • An ultrasound or MRI of the anal area may be ordered by your doctor to acquire a better image of the fistula tract.
  • To diagnose the fistula, your surgeon may need to examine you in the operating room (known as an exam under anaesthesia).

If a fistula is discovered, the doctor may order more testing to evaluate if the problem is related to Crohn’s disease, an inflammatory bowel disease. Fistulas develop in about 25% of persons with Crohn’s disease. Blood tests, X-rays, and colonoscopies are among the tests used in these studies. A colonoscopy is a technique that involves inserting a flexible, illuminated device into the colon through the anus. It’s done with conscious sedation, which is a type of light.

Diagnosis

An anal fistula is usually diagnosed by examining the area around the anus. The doctor will search the skin for an opening (the fistula tract). He will then attempt to assess the depth of the tract as well as its direction of travel. There will almost always be drainage from the external hole. Some fistulas are not visible on the surface of the skin. In this instance, your doctor may need to order the following tests:

  • An anoscopy is a technique that involves looking inside your anus and rectum with a specific device.
  • An ultrasound or MRI of the anal area may be ordered by your doctor to acquire a better image of the fistula tract.
  • To diagnose the fistula, your surgeon may need to examine you in the operating room (known as an exam under anaesthesia).

If a fistula is discovered, the doctor may order more testing to evaluate if the problem is related to Crohn’s disease, an inflammatory bowel disease. Fistulas develop in about 25% of persons with Crohn’s disease. Blood tests, X-rays, and colonoscopies are among the tests used in these studies. A colonoscopy is a technique that involves inserting a flexible, illuminated device into the colon through the anus. It’s done with conscious sedation, which is a type of light.


Treatment

Anal fistulas are usually typically treated with surgery. A colon and rectal surgeon performs the procedure. The purpose of the procedure is to strike a balance between removing the fistula and maintaining the anal sphincter muscles, which, if injured, could lead to incontinence.

Fistulotomy– A fistulotomy is used to treat fistulas that have no or little involvement of the sphincter muscle. The skin and muscle over the tunnel are sliced open to change it from a tunnel to an open groove in this surgery. The fistula tract can then repair from the bottom up.

Seton implanting– In the case of a more complicated fistula, the surgeon may need to use a seton, which must be left in place for at least 6 weeks. A second procedure is nearly often performed once a seton is implanted:

  • A fistulotomy
  • An advanced flap operation
  • Lift procedure (the doctor opens the skin above the fistula and ties the fistula)

Injecting stem cells– This is a new treatment for Crohn’s disease fistulas. Before the procedure, your colorectal surgeon will go over all of your options with you.

Fistula surgery– It is typically performed as an outpatient procedure, meaning the patient can return home the same day. Patients with big or deep fistula tunnels may need to stay in the hospital following surgery for a while. The removal of some fistulas may necessitate multiple procedures.

Surgery works successfully for the majority of fistulas. Your surgeon may advise that you soak the damaged area in a warm bath, known as a sitz bath, and take stool softeners or laxatives for a week after the surgery.


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