Just inside the anus, there are a number of small glands. If one of these glands becomes blocked, an abscess (an infected cavity) can form. About 50% of these abscesses develop into a fistula. A fistula is a small tunnel that connects the infected gland inside the anus to an opening in the skin around the anus. Symptoms include pain and swelling around the anus, as well as pain during bowel movements. Treatment for an anal fistula is typically surgery.
What is an Anal Fistula?
The anus is the external opening through which stool is expelled from the body. Inside the anus, there are small glands. If one of these glands becomes blocked, an abscess – an infected cavity – can form. Anal abscesses are usually treated with surgery, though some may heal on their own. Approximately 50% of these abscesses can develop into a fistula, where a small tunnel connects the infected gland inside the anus to an opening in the skin around the anus.
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Most fistulas result from an anal abscess. A small number of fistulas can be caused by other conditions, such as Crohn’s disease, sexually transmitted infections, trauma, tuberculosis, cancer, or diverticulitis.από άλλες αιτίες.
Symptoms of an Anal Fistula
The following may be symptoms or signs of an anal fistula:
- Recurrent anal abscesses
- Pain and swelling around the anus
- Pain during bowel movements
- Bleeding
- Discharge or foul smell from the anus, with pain possibly decreasing after drainage of the fistula
- Irritation of the skin around the anus
- Fever, chills, and a general feeling of fatigue (though these symptoms can occur with many conditions)
You should see your doctor if you notice any of these symptoms.
How is an Anal Fistula Diagnosed?
A gastroenterologist can usually diagnose an anal fistula by examining the area around the anus. They will look for an external opening on the skin. If visible, the doctor will try to determine the depth and direction of the fistula. Often, drainage may be observed from the external opening.
In some cases, the fistula may not be visible on the skin surface. In this case, your doctor may need to perform additional tests, starting with an anoscopy, which involves using a special instrument to view inside the anus and rectum. Your doctor may also order an ultrasound or MRI of the anal area to better determine the fistula’s path.
If a fistula is detected, your doctor might also want to conduct further tests to check if the condition is related to Crohn’s disease, an inflammatory bowel disease. Around 25% of people with Crohn’s disease develop fistulas. These tests may include blood tests, X-rays, and a colonoscopy. A colonoscopy, where a flexible instrument is inserted into the colon through the anus, is performed under conscious sedation, a form of light anesthesia.
What are the treatments for an anal fistula?
Surgery, performed by a surgeon, is usually necessary for managing an anal fistula. During the procedure, the doctor will assess the depth and extent of the fistula. Most fistulas are treated with a fistulotomy, where the skin and muscles over the tunnel are cut open, turning it into an open groove. This allows the fistula to heal from the inside out. A more complex fistula may require the placement of a special drainage system, known as a seton, for at least six weeks, after which definitive surgery is performed. Surgery is generally done on an outpatient basis, but very large or deep fistula tracts may require a short hospital stay.
Is follow-up necessary?
After fistula surgery, your doctor may recommend soaking the affected area in a warm bath and taking stool softeners for a week. Since you may experience some pain or discomfort in the area after surgery, the doctor will also prescribe pain-relieving medications. Most fistulas respond well to surgical treatment.