Information From Your Health Care Provider

ANAL FISTULA

Basic information

description

Anal fistula is a very small tube or tract that leads from the anal canal (the last part of the rectum) to the skin near the anal opening. Watery pus drains through this opening and causes irritation to the skin. Some fistulas cause no symptoms. Fistulas can affect all ages.

FREQUENT SIGNS & SYMPTOMS

Discharge from the anus. There may be bleeding.
Skin irritation or itching around the anus.
Pain when passing a bowel movement.
Tender lump near the anus.

causes

Anal fistulas are usually caused by a prior anorectal abscess. An anorectal abscess is caused by a bacterial infection of one of the glands in the anal canal. Some patients will have both an abscess and fistula.
Other anal fistulas may be caused by infection, injury (trauma), disease, or radiation therapy.

risk increases with

Inflammatory bowel disease (e.g., Crohn's disease).
Diverticulitis, tuberculosis, chlamydial infection, large intestine cancer, HIV infection, certain other disorders, or radiation therapy.

PREVENTIVE MEASURES

There are no specific preventive measures. Getting medical care for an anorectal abscess may help.

expected outcomes

Anal fistula treatment can provide satisfactory results in most cases. The goals are to heal the fistula, relieve the symptoms, avoid sphincter muscle problems and other complications, and prevent fistula recurrence. In some cases, more than one type of treatment may be needed. Healing time will vary and may take weeks to months.

possible complications

Treatment may lead to complications. Some degree of fecal incontinence (unable to control bowels) may develop. Pain, infection, bleeding, delayed healing, and other complications may occur.
Rarely, a temporary colostomy (feces is diverted to an outside opening) may be required.
Anal fistula can recur.

diagnosis & treatment

general measures

Your health care provider will ask questions about your symptoms and medical history. A physical exam of the anal area will be done. Medical studies (usually under anesthesia) are needed for diagnosis. An anoscope (a flexible tube with a lighted end) is used to see inside the anus and anal canal. Other tests may be done for complex fistulas or to look for an underlying disorder (e.g., Crohn's). These may include blood tests, MRI, sigmoidoscopy, x-rays, ultrasound, and others.
Treatment depends on the results of the medical tests and exact location of the fistula. Some anal fistulas can be simple and others are more complex and difficult to treat. There are several treatment options and each has benefits and risks. They will be discussed with you.
Treatment may involve surgery (called fistulotomy or fistulectomy) to open the fistula. Advancement flap is a surgical option. Seton procedures use a surgical thread to allow for fistula draining and healing. Fibrin glue injection and anal fistula plug are other options.
At home, sitz baths help relieve discomfort. Sit in a tub of warm water (not hot) for 10 to 15 minutes several times a day. Dry the area carefully and completely.

medications

To prevent constipation, use stool softeners.
Antibiotics may be prescribed if infection is present.
Drugs for pain may be prescribed after treatment.

activity

You will be advised about resuming work and normal activities depending on the specific treatment.