Things to know about anal fistula
An anorectal fistula is an abnormal connection between the anus and the skin around it. The anus is the external opening of the digestive tract through which the food wastes are expelled from the body. Commonly, an anal fistula arises from an anal abscess, infected cavity filled with pus. A fistula may be present with or without an abscess. While fistulas may not be dangerous, they carry on discharging and cause more painful abscesses.
Based on their location around the sphincter, anal fistulas are classified into:
Around 50% of the anal fistulas arise from an anal abscess. Other causes of anal fistula include:
A fistula may cause complications such as drainage, sepsis, perforation and peritonitis:
The physician will carefully evaluate the medical history & anorectal symptoms and perform a rectal examination under anesthesia. Any draining pus (or blood or stool) and heaped up tissue seen in the external opening is related to the anal fistula. When the fistula is not visible on the skin surface, your physician may order an endoscopic ultrasound or MRI to define the fistula tract. Internal fistulas may be evaluated using barium contrast X-ray, MRI or CT scan.
If the anal fistula is suspected to be caused due to digestive diseases such as Crohn’s disease, the patient may need to undergo certain blood tests, X-ray & colonoscopic examination.
Treating anal fistula can get very complicated. Mostly they are treated using medication for pain but eventually, patients almost always need a surgery to cure an anal fistula. Fistula surgery is done as an outpatient procedure. However, very large and deep fistula tunnels may require a short hospital stay.
Treating fistulas in patients with Crohn’s disease: These patients are at increased risk of fecal incontinence, thus the primary treatment involves medication. Surgery is reserved only to treat infection and as a supplement to medication.
Some of the surgical options available for anal fistulas are:
Fistulotomy: Anal fistula involving minimal sphincter muscle is cured by fistulotomy. It has a success rate of 92 – 97%. The surgeon cuts through the skin and muscles over the tunnel to form a groove that heals inside out.
Seton placement & surgery: Complex fistulas are treated with a special drain, seton for at least 6 weeks followed up with a definitive surgical repair. Seton helps to drain the fistula & resolve inflammation in a controlled manner, with minimal pain and normal bowel function.
Laser surgery for Fistula: Laser energy is transmitted by using radial fiber and fistula epithelium is destructed. The procedure may be performed within half an hour via expert surgeon only. An expert surgeon will be able to diagnose the problem and treat the same with great care.
It is important to discuss the post-surgery care and recovery. Some pain and discomfort in the area after surgery is common. Most fistulae respond well to surgeries and for easy recovery doctor may recommend:
The cost of surgery is governed by several factors, such as
Check if the hospital is enrolled with the majority of Third-party Administrator (TPA) and insurers. If you have an insurance policy, seek help from the TPA desk at the hospital to determine whether your policy covers the surgery or not.
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