An anal fistula is an infected tunnel that runs between the skin and the anal opening. This is usually the result of an infection that originates in an anal gland and causes an abscess – a swollen pocket of infected tissue and fluid. The fistula forms a tunnel under the skin and connects with the infected gland.

The small glands inside the anus produce mucous and occasionally become infected. Infections that don’t heal in the right manner can lead to an anal fistula.

Risk factors for anal fistula

A person who has an anal abscess is at higher risk for getting an anal fistula. Health conditions that affect the bowels are other factors that increase the chances of developing a fistula. These conditions could include Crohn’s disease, sexually transmitted diseases, tuberculosis, certain cancers and diverticulitis.

Causes of anal fistula

The most common causes of an anal fistula are clogged anal glands and abscesses. Other conditions that may cause an anal fistula are Crohn’s disease, which is an inflammatory condition of the intestine, radiation received as treatment for cancer, trauma, sexually transmitted diseases,  tuberculosis and diverticulitis – a disease in which small pouches form in the large intestine and become inflamed. Patients suffering from certain cancers also develop anal fistula. 

Symptoms of anal fistula

A patient suffering from an anal fistula is likely to observe the following signs and symptoms.

• Pain and swelling around the anal area.
• Blood or foul-smelling liquid discharge from an opening around the anus.
• Irritation of the skin around the anus.
• Pain during bowel movements.
• Fever, chills and fatigue

Diagnosis of anal fistula

If a patient it is experiencing symptoms of an anal fistula the doctor will start by examining the area around the anus. The doctor will check if there is an opening on the skin, which is also called the fistula tract. She or he will aim to find out how deep this tract may be, and the direction in which it is going. Quite often there is drainage from this external opening.

In some cases, the fistula is not visible on the skin’s surface and the doctor may recommend additional tests. These tests could include:

• An anoscopy to get a view inside the anus and rectum.
• EAUS: endoanal ultrasound we can do in the clinic and diagnose the type of fistula .
• The physician may also recommend an MRI of the anal area for a better view of the fistula tract.
• In some cases, the surgeon may need to conduct an examination of the patient under anesthesia in the operation theatre for a proper diagnosis.
• If a fistula is found, your doctor may want to conduct additional tests in order to identify the cause, especially to check whether it is related to Crohn’s disease, as approximately 25% of the people who suffer from Crohn’s disease develop fistulas. In this case, you may require blood tests, X-rays and a colonoscopy, which is performed under sedation and enables the doctor to view the colon.

Treatment of anal fistula

An anal fistula usually requires a surgical procedure that will be conducted by a colorectal surgeon. The goal of the surgery will be to get rid of the fistula while protecting the anal sphincter muscles.

1-If the fistula is simple, not too close to the anus, and the sphincter muscle is not involved then a procedure called fistulotomy is usually conducted. The surgeon cuts open the skin and muscle surrounding the tunnel. This enables the opening to heal from the inside out. A plug may be used to close this.

2-In case the condition is more complicated the surgeon may decide to insert a tube, which is known as a seton, into the opening. This tube helps to drain the infected fluid before the surgery is performed. The seton is usually kept in place for at least 6 weeks. Later, a second operation is almost always performed, which may be a fistulotomy or an advancement flap procedure. In the advancement flap procedure, the fistula is covered with a flap, or piece of tissue, taken from the rectum, like a trap door. Another option is to perform a lift procedure in which the skin above the fistula is opened up, the sphincter muscles are spread, and the fistula is tied off.

If the patient is suffering from Crohn’s disease, there is a new line of treatment that involves injecting stem cells into the fistula.

Some patients may require multiple procedures in order to get rid of an anal fistula.

3-VAAFT (Video Assisted Anal Fistula Treatment):

Latest technique now for treating complicated anal fistula without surgery by using scop.

Advantages of VAAFT:
No cutting,
no pain,
no stay in hospital,
no dressing,
early go back to work,
safe for anal muscles,
4-laser treatment,
5- biological injection (plasma, collagen..)

Post-surgery your surgeon is likely to recommend that you soak the anal area in a warm bath, also known as a sitz bath. It is also advisable to take stool softeners or laxatives for some days.

Once an abscess and fistula have been treated correctly and heal, they usually do not recur.

For the best treatment of an anal fistula consult an expert colorectal proctology dr. Khaldoun Ghareb clinic.