Anal Fistula Treatment in Delhi, India

An anal fistula, also known as fistula-in-anc, is a small tunnel that develops between the skin around the anus and the anal canal. It is usually the result of an infection that starts in an anal gland in the skin and spreads to the anal canal. Anal fistulas can cause pain, discomfort, and discharge, and require only surgical treatment for permanent cure.

Anal fistula can arise from various underlying causes, each with its own set of contributing factors. Understanding the origins of anal fistulas is crucial for effective diagnosis and appropriate treatment. Here are some common causes that shed light on the diverse nature of this condition.

• Infection in Anal Gland: This is the primary cause, where an infection in an anal gland leads to the formation of an anal fistula.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis, which fall under the umbrella of inflammatory bowel diseases, can contribute to the development of anal fistulas.
• Trauma to the Anal Region: Injuries or trauma to the anal region can result in the formation of fistulas.
• Certain Infections, including Tuberculosis: Infections caused by specific pathogens, such as tuberculosis, can be associated with the development of anal fistulas.
• Sexually Transmitted Diseases (STDs): While less common, certain sexually transmitted diseases can contribute to anal fistulas. However, this is not as prevalent as other causes.
• Radiation Therapy or Surgery for Anal Cancer: Individuals who have undergone radiation therapy or surgery to treat anal cancer may be at an increased risk of developing anal fistulas as a result of the interventions.
• Weakened Immune System: A compromised immune system, whether due to medical conditions or medications, can make individuals more susceptible to infections and the subsequent development of anal fistulas.
• Age: The risk of anal fistulas tends to increase with age, particularly in adults around 40 years old, possibly due to a combination of factors such as longer exposure to potential risk factors.
• Gender: Anal fistulas are more commonly observed in males, because they are more hairy.

The symptoms of an anal fistula may include:

• Pain on coughing, sneezing, moving or bowel movement.
• Swelling
• Tenderness around the anus.
• Discharge of pus or blood in stool or otherwise.
• Itching
• Skin irritation
• Fever
• Chills

The doctor may conduct various tests and examinations when clinically assessing the fistula for optimal examination. These include:

Medical History Review

The doctor will begin by asking detailed questions about patient’s medical history, including:

• Symptoms they are experiencing, such as pain, drainage, or swelling around the anus.
• Past medical conditions, including any surgeries or injuries to the anorectal area.
• Lifestyle factors, such as occupation, diet, and bowel habits.

Physical Examination

The physical examination will involve inspecting the anal area for any visible signs of an anal fistula, such as openings, redness, or swelling. The doctor may also use a gloved finger to gently palpate the area to feel for any underlying abscesses or tracts.

Imaging Tests

Imaging tests may be used to confirm the diagnosis and provide more detailed information about the fistula tract. Common imaging tests include:

• Anoscopy: A short, flexible tube with a light is inserted into the anus to visualise the internal anal canal.
• Proctoscopy: A longer, flexible tube with a light is inserted into the rectum to visualise the lower rectum and the opening of the anal fistula tract.
• MRI: Magnetic resonance imaging provides detailed cross-sectional images of the anal and rectal area, allowing for precise visualisation of the fistula tract and surrounding tissues.

Additional Tests

In some cases, additional tests may be necessary to rule out other conditions or assess overall health. These tests may include:

• Blood tests: To check for signs of infection or other medical conditions.
• Stool tests: To rule out other causes of anal pain or drainage, such as inflammatory bowel disease.
• Cultures: If an abscess is present, a culture may be taken to identify the type of bacteria causing the infection.

Anal fistula treatment involves a range of options, depending on the nature and complexity of the condition. Here's an overview of both nonsurgical and surgical approaches.

Nonsurgical Options

Seton Placement

A seton is a thread-like material (often silk or latex) that is placed through the fistula tract. It helps in keeping the tract open, allowing drainage of any infection or abscess and preventing recurrence.

Fibrin Glue and Collagen Plug

Fibrin glue, a biological adhesive, or a collagen plug can be injected into the fistula to seal the tract. This promotes healing by encouraging the surrounding tissues to close over time.

Medication

Antibiotics may be prescribed to manage infection, and immunosuppressive drugs could be considered to control inflammation. These medications aim to alleviate symptoms and support the healing process.

Surgical Options

Fistulotomy

This surgical procedure involves cutting open the fistula tract completely. While effective, it's typically reserved for simple, superficial fistulas and may not be suitable for complex cases.

Endorectal Advancement Flap

In this approach, a flap of tissue, often from the rectal wall, is created and used to cover the internal opening of the fistula. This helps in promoting healing and closing off the tract.

Ligation of the Intersphincteric Fistula Tract (LIFT)

LIFT involves tying off the fistula tract with the aim of promoting healing. It is a sphincter-preserving technique and is considered for certain types of fistulas.

In Cases of Complex Anal Fistula

For more complex situations where conventional treatments may not be sufficient, surgical interventions may be considered:

Ostomy and Stoma

Creating an ostomy involves surgically diverting the flow of stool away from the affected area (if intense opening is in rectum) through a stoma, providing relief and allowing the affected tissues to heal.

Muscle Flap

A muscle flap, often taken from nearby tissue, can be used to cover the fistula. This method is particularly employed in cases involving extensive damage or multiple tracts.

The treatment for anal fistula depends on various factors such as:

1. Its location
2. Complexity
3. Comorbidities
4. Age and the overall health of the patient.

The choice of surgical options depends on various factors and is determined through a collaborative discussion between the patient and their healthcare team.

To mitigate the risk of developing anal fistulas, one can adopt several preventive measures. Here are some of the most common ones:

• Maintaining good hygiene: Regular cleansing of the anal region with warm water and mild soap following bowel movements is crucial. Gentle drying with a soft towel and avoiding harsh soaps or rubbing are essential.
• Managing bowel habits: Avoid straining during bowel movements, as this can exert pressure on the anal glands and increase the risk of infection. Consuming a balanced diet rich in fibre promotes regular and soft stools, preventing constipation and diarrhoea, which can irritate the anal area.
• Addressing underlying health conditions: In the case of inflammatory bowel disease (IBD) such as Crohn's disease or ulcerative colitis, close collaboration with a doctor to effectively manage the condition is essential. Controlling IBD can reduce the risk of anal fistula formation.
• Seeking prompt treatment: If an anal abscess develops, seeking prompt medical attention is crucial. Early drainage of an abscess can prevent its progression into a fistula.
• Practising safe sex: Safe sex practices can reduce the risk of sexually transmitted infections (STIs), which can contribute to anal fistulas in rare cases.
• Maintaining a healthy weight: Obesity is a risk factor for anal fistulas. Maintaining a healthy body weight can help reduce the risk of developing this condition.
• Limiting alcohol consumption: Excessive alcohol consumption can weaken the immune system and increase the risk of anal fistulas. Moderating alcohol intake or avoiding it altogether is beneficial.
• Managing stress levels: Excessive stress can weaken the immune system and increase susceptibility to infections. Practising stress-management techniques such as exercise, relaxation techniques, or yoga can help reduce stress levels.

By adhering to these prevention strategies, one can lower their risk of developing anal fistulas and maintain overall anal health.

The prognosis of anal fistula is generally favourable with timely and effective treatment. Most people can expect a full recovery and return to their normal activities after surgery. The success rate of anal fistula surgery is high, with approximately 90% of cases resolving after one procedure. Factors that can affect the prognosis include the type of fistula, overall health, and compliance with treatment. In some cases, anal fistulas may recur, but the overall prognosis is positive with proper care.

Q. What is recovery like after Anal Fistula surgery?

Recovery involves postoperative care, pain management, and dietary adjustments. It varies from patient to patient, but all patients need to avoid strenuous activities during the healing process.

Q. How can I prevent Anal Fistulas from recurring?

To prevent recurrence, maintain good hygiene, follow a high-fibre diet, and adhere to postoperative instructions provided by your surgeon.

Q. How can I manage the pain and discomfort of an Anal Fistula?

Pain management includes prescribed medications, sitz baths, and avoiding activities that strain the surgical area. Consult your healthcare provider for personalised advice.

Q. What lifestyle changes can I make to cope with an Anal Fistula?

Adopt a high-fibre diet, engage in regular low-impact exercise, and avoid prolonged sitting to help manage and cope with an anal fistula.

Q. How can I maintain good hygiene with an Anal Fistula?

Gently clean the area with mild soap and water, consider using moist wipes, and follow any hygiene recommendations provided by your healthcare provider.

Q. What kind of exercise is safe for people with Anal Fistulas?

Low-impact exercises like walking are generally safe; however, consult your doctor for personalised advice on suitable exercises for your specific situation.

Q. How can I protect my skin around the Anal Fistula?

Keep the area clean, avoid irritants, and consider using a recommended barrier cream to protect the skin around the anal fistula.

Q. How often do I need to follow up with my doctor after Anal Fistula surgery?

Follow-up appointments are typically scheduled based on your surgeon's recommendations to monitor healing and address any concerns.

Q. What signs should I watch for that could indicate a recurrence of my Anal Fistula?

Watch for signs such as pain, swelling, or discharge; promptly report any unusual symptoms to your doctor to address potential recurrence.

Q. Are there any potential side effects of medications used to treat Anal Fistulas?

Potential side effects of medications for anal fistulas vary; consult your healthcare provider for specific information based on your prescribed treatment.

Q. What is the typical recovery process after Anal Fistula surgery?

The recovery process typically takes 4-6 weeks, with initial discomfort and pain. Sitz baths and pain medication can help manage symptoms. Regular follow-ups are crucial to monitor healing and prevent complications.

Q. What measures can I take to reduce the risk of Anal Fistula recurrence?

Maintain good hygiene, avoid straining during bowel movements, manage bowel consistency with a healthy diet and fibre intake, and avoid excessive alcohol consumption.

Q. How can I effectively manage the pain and discomfort associated with an Anal Fistula?

Sitz baths, pain medication, and stool softeners can help alleviate pain and discomfort. Warm compresses and over-the-counter pain relievers may also provide relief.

Q. What lifestyle modifications should I make to improve my well-being while coping with an Anal Fistula?

Maintain a healthy weight, eat a balanced diet, stay hydrated, avoid strenuous activities, and manage stress levels through relaxation techniques.

Q. How do I maintain proper hygiene to keep the Anal Fistula area clean and minimise complications?

Gently cleanse the area with warm water and mild soap after each bowel movement. Pat dry with a soft towel and avoid harsh soaps or rubbing.

Q. What types of exercises are considered safe and appropriate for individuals with Anal Fistulas?

Low-impact exercises like walking, swimming, and yoga are generally safe. Avoid strenuous activities that put strain on the anal area.

Q. What precautions can I take to protect the skin around the Anal Fistula from irritation or further damage?

Wear loose-fitting, breathable clothing, avoid sitting for extended periods, and maintain proper hygiene to prevent irritation.

Q. What is the recommended frequency of follow-up appointments with my doctor after Anal Fistula surgery?

Regular follow-ups are essential to monitor healing and prevent complications. The frequency depends on the individual's recovery progress and the surgeon's recommendations.

Q. What are the potential warning signs that could indicate a recurrence of my Anal Fistula?

Signs of recurrence include persistent pain, swelling, redness, or drainage around the anal area. Fever, chills, and fatigue may also indicate an infection.

Q. Are there any potential side effects associated with medications used to treat Anal Fistulas?

Potential side effects include nausea, vomiting, diarrhoea, abdominal pain, rash, and headache. Consult your doctor about any concerns regarding medication side effects.

Q. What are the potential complications of an untreated Anal Fistula?

If left untreated, an anal fistula can lead to complications such as abscess formation, septicemia, recurrent infections, and in rare cases, it may even develop into anal cancer. It is crucial to seek medical attention promptly to prevent these complications.

Q. Can walking aggravate a fistula?

No, walking is generally considered safe and beneficial for people with fistulas. It can help reduce pain and improve overall health.

Q. Can a fistula spontaneously open and drain?

Yes, in about half of cases, the area of the original abscess infection may periodically swell and rupture, releasing pus or fluid. This can happen repeatedly, or the fistula opening may remain open, allowing for continuous drainage.

Q. What is the best sleeping position for someone with a fistula?

Sleeping on your back with the arm affected by the fistula elevated on a pillow can help reduce discomfort. Avoid using that arm for dialysis or blood pressure measurement.

Q. How painful is Anal Fistula to the touch?

An anal fistula can cause significant pain and swelling around the anus, which may worsen during bowel movements. In some cases, there may also be discharge from the fistula opening.

Q. Can piles develop into a fistula?

No, piles and fistulas are distinct conditions, although they share the same location. Piles are swollen veins in the rectum or anus, while fistulas are abnormal connections between organs or tissues.

Q. Can a person return to normal life after fistula surgery?

Yes, most people can resume their normal activities within a day or two after fistula surgery. They may experience some pain and drainage from the wound, but this should subside with time. Heavy lifting and sexual activity should be avoided for a few weeks following surgery.

Reviewed by Dr. Chandresh Gupta, Principal Consultant - General Surgery, Laparoscopic / Minimal Access Surgery on 23 Jan 2024.

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