Anal fistula

March 2017


Definition


A fistula is an abnormal route causing a cavity to be emptied into another cavity. An anal fistula (ano-rectal fistula) generally appears after the infection of an anal gland and is an abnormal duct between the lining of the rectum and the anus. The pathway is often developed via the anal sphincter muscles that control defecation. It can be the result of an abscess of the anal area that is not taken care of. It is often seen in people with Crohn's disease, a chronic inflammatory disease of the bowel.

Symptoms


Anal fistula are manifested by:
  • purulent discharge from the anal region;
  • an anal pruritus, i.e. itching of the anus;
  • occasionally a leaking of stool through the fistula;
  • shooting pains at times of defecation that calm down before coming back several hours later.

In the absence of treatment, pus may start draining through the skin near the anus. The pain will become unbearable and body temperature may reach very high temperatures.

Diagnosis


During an initial consultation, a doctor may detect a possible abscess in the form of a reddish mass near the anal orifice, typically visible to the naked eye. The patient is then directed to a proctologist. The actual diagnosis of an anal fistula in turn is not made until after the fistula is first identified. The specialist can use different means of identification; such as the injection of a dye.

Treatment


In its early stages, the abscess may be incised. Antibiotics may be prescribed to the patient, but surgery is the only treatment of an anal fistula. The objective is to avoid the risk of recurrence. Surgical treatment can be done all at once or via several operations. The difficulty lies in the preservation of the anal sphincter in its entirety so as to eliminate the risk of incontinence. An operation on a fistula can be performed under general or local anesthesia. Treatment with laxatives and analgesics must be taken until fully healed, usually two months after surgery.

Prevention


To prevent the occurrence of an anal fistula, it is imperative to consult a professional in case of a suspected mass of anal abscess to prevent a possible progression into a fistula.

Related

Original article published by . Translated by Jeff.
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