Anal Fistula

Understanding Anal Fistula

Anal Fistulas, a common but often misunderstood condition. An anal fistula often begins as an anal abscess, an infection near the anus that leaks pus. This infection can create a channel from the anus to the surrounding skin, leading to symptoms such as discomfort, irritation, and swelling. In this article, we will explore how these conditions develop and the primary surgical treatments used to resolve them.

What is an Anal Fistula?

An anal fistula is a chronic condition that develops most commonly following an anal abscess. A fistula is a tunnel or channel connecting the inside of the anus with the surrounding skin

While symptoms of an abscess are pain and swelling, the primary symptoms of an anal fistula is drainage of pus from the external skin opening. Patients may experience pain when the fistulous tract becomes blocked, the pain is often relieved when the pus drains again.

This condition is chronic, and individuals may suffer symptoms for years before electing for surgical intervention, the only definitive cure.

Anal Abscess

An anal abscess is an acute condition characterized by painful swelling near the anus, often accompanied by fever. When glands within the anus become blocked, it results in a bacterial infection. The inflammation fills with pus and rapidly progresses, usually within two to three days, causing the surrounding skin to turn red, swell, and become extremely tender. Patients experiencing these symptoms should seek medical attention promptly.

What Causes an Anal Fistula?

Anal fistulas often result from an infection near the anus, which leads to an abscess. This abscess, once drained, leaves behind a persistent channel or fistula, exhibiting symptoms such as pain, discomfort, and a foul-smelling discharge. The fistula may appear as a small lump or visible hole near the anus. Less commonly, the fistulas can be caused by Crohn’s disease and other infectious or inflammatory conditions.


Anal Abscess Treatment

The treatment of an anal abscess is relatively simple. The pus needs to be drained. This can often be done under local anesthetic or occasionally under a general anesthetic. Post-procedure, patients typically experience immediate relief, with significant improvement in overall condition and subsidence of fever. Treatment may include antibiotics and is generally short, allowing patients to quickly resume their daily activities.

Anal Fistula Treatment

By comparison, the treatment of anal fistula is a lot more complex than that of an abscess. There are no medications that can cure a fistula, leaving surgery as the only option. The most successful surgery for a fistula is a fistulotomy, where the roof of the tunnel is cut open, turning it into a ditch, allowing it to heal from the bottom up. However, this requires some division of anal muscle, and while some muscle can be divided without changing one’s ability to hold on to stool, there has to be a balance between the cure and maintenance of continence. When a fistula goes through too much muscle to perform a fistulotomy, often a drain will be placed.

Diagnosing an Anal Fistula

If you have symptoms suggestive of an anal fistula, your doctor may refer you to a specialist in colon and rectal diseases. The diagnosis process involves a detailed medical history and a physical examination, where the doctor looks for fistula openings near the anal area. Diagnostic tools may include:

  1. Endoscopy – This procedure uses a special instrument to look inside the anus and rectum.
  2. Imaging tests such MRI to better visualize the fistula tract.
  3. Surgical exploration under anesthesia.

When to Seek Help

Any persistent anal pain should be medically evaluated, as it could indicate a serious underlying condition. While hemorrhoids are common and typically not extremely painful, persistent pain needs further investigation.

If your discomfort continues even after being assessed for hemorrhoids, consider consulting a specialist like a colorectal surgeon or gastroenterologist.
Severe anal pain can significantly affect your quality of life, impacting daily activities and mental health.

Discussing such symptoms with a healthcare provider might feel uncomfortable, but it is crucial for proper diagnosis and treatment of any anorectal conditions.