An anal fistula is a small tunnel that forms between the inside of the anus and the surrounding skin. This condition often causes significant discomfort and can interfere with daily activities if not treated properly.
Most anal fistulas occur due to an infection in the glands around the anus. The infection may develop into an abscess that bursts on its own or needs to be drained through a medical procedure. After the abscess drains, the small passage it leaves behind can remain open, forming a fistula that connects the infected area to the outer skin.
At Mandaya Royal Puri Hospital, anal fistulas are treated by a team of experienced general surgeons and digestive surgeons. Supported by complete medical facilities and the right treatment approach, patients receive safe and effective care based on the severity of their condition.
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What Are the Signs and Symptoms of an Anal Fistula?
An anal fistula often appears as a small hole in the skin near the anus. This hole is the external opening of a tunnel that connects to an internal abscess. The opening may release pus, blood, or stool, especially when the surrounding skin is touched. In older fistulas, the outer hole may temporarily close while the internal tunnel remains, causing pain and swelling until the fistula reopens to drain.
Common symptoms of an anal fistula include:
- Anal pain, often intense and throbbing, which may worsen during bowel movements, coughing, or sitting. The buttocks may also become sensitive to touch.
- Swelling and redness inside or around the anus, indicating active infection under the skin (cellulitis).
- Discharge from the area around the anus, such as pus, stool, or blood (rectal bleeding), sometimes accompanied by an unpleasant odor.
Less common symptoms include:
- Fever
- Pain during urination
- Difficulty controlling bowel movements
What Causes Anal Fistulas and What Are the Risk Factors?
Most anal fistulas are caused by an infection that begins in an anal gland. The infection forms an abscess that may burst naturally or require a surgical incision near the anus. The fistula forms as a tunnel under the skin following the drainage pathway of the abscess. This tunnel connects the anal gland or anal canal to a small opening in the skin around the anus.
The sphincter muscles surrounding the anus help control bowel movements. Anal fistulas are classified based on how much they involve these sphincter muscles, helping surgeons determine the best treatment approach.
Risk factors for anal fistulas include:
- A history of a drained anal abscess
- Crohn’s disease or other inflammatory bowel diseases
- Injury to the anal area
- Infections in the anal region
- Surgery or radiation therapy for anal cancer
Anal fistulas most commonly affect adults around age 40 but can also occur in younger individuals, especially those with Crohn’s disease. They are more common in men than in women.
How Do Doctors Diagnose Anal Fistulas?
Doctors may use several tests to diagnose an anal fistula, such as:
- MRI, which maps the fistula tract and provides detailed images of the sphincter muscles and other pelvic floor structures.
- Endoscopic ultrasound, which uses high-frequency sound waves to identify the fistula, sphincter muscles, and surrounding tissues.
- Fistulography, an X-ray exam using contrast injection to clearly show the fistula tunnel.
- Examination under anesthesia, recommended for a thorough evaluation of the fistula tract and to identify potential complications.
Anal Fistula Treatment at Mandaya Royal Puri Hospital
Anal fistula treatment at Mandaya Royal Puri Hospital is handled by skilled general surgeons and digestive surgeons. The treatment approach depends on the fistula’s location, complexity, and cause. The main goal is to fully close the fistula to prevent recurrence while preserving sphincter muscle function. Damage to these muscles may lead to fecal incontinence. Although surgery is typically the primary option, some cases can be managed with nonsurgical methods.
Surgical treatment options include:
1. Fistulotomy
In this procedure, the surgeon opens the internal fistula opening, cleans the infected tissue, and flattens the tunnel before stitching it in place. For more complex fistulas, part of the tunnel may need to be removed. A staged fistulotomy may be necessary if a significant portion of the sphincter muscle needs to be cut or if the full tunnel cannot be identified in the initial surgery.
2. Endorectal Advancement Flap
The surgeon creates a flap of tissue from the rectal wall after removing the internal opening of the fistula. This flap is then used to cover the repaired area, reducing the need to cut the sphincter muscle and helping maintain normal bowel control.
3. Ligation of the Intersphincteric Fistula Tract (LIFT)
LIFT is a two-stage procedure for deeper or more complex fistulas. It allows the surgeon to access the fistula between the sphincter muscles without cutting them. First, a seton (silk or latex string) is placed to gradually widen the tunnel. Several weeks later, the infected tissue is removed and the internal opening is closed.
Mandaya Royal Puri Hospital has a team of experienced general surgeons and digestive surgeons who specialize in treating anal fistulas—from diagnosis and surgery to postoperative care. Below are the doctors who are highly skilled in managing various fistula cases using safe, effective, and modern medical techniques.
