Anal fistula
Anal fistula is a common disease in surgery, second only to hemorrhoids. The disease will recur if not treated properly.
What is anal fistula?
An anal fistula is a small tunnel that tracks from an opening inside the anal canal to an outside opening in the skin near the anus. An anal fistula often results from a previous or current anal abscess. As many as 50% of people with an abscess get a fistula.
What are the symptoms of anal fistula?
Symptoms of anal fistula:
- Recurring anal abscess
- Pain and swelling around the anus
- Pain during bowel movements
- Bleeding
- Blood or foul-smelling discharge (pus) from a hole around the anus. The pain may reduce after the pus comes out.
- Irritation of the skin around the anus due to persistent drainage
- Fever, chills, and feeling tired (can be symptoms of many other illnesses).
=> if you experience any of these symptoms, call your doctor
Why anal fistula?
An anal fissure is often the result of a rectal abscess that is not treated correctly. Anal fissure and anorectal abscess are two stages of an infectious process of this area. An abscess is an acute phase; anal fistula is a chronic stage. The correct treatment of anal abscess contributes to the reduction of anal fistula in the future.
What causes anal fistula?
The most common causes of an anal fistula are clogged anal glands and anal abscesses. Other, much less common, conditions that can cause an anal fistula include:
-Crohn's disease
-Radiation
-Trauma
-Sexually transmitted diseases
-Tuberculosis
-Diverticulitis
-Cancer
Is anal fistula dangerous?
Anal fistula can last for many months and years. The disease is not fatal but makes the patient uncomfortable and can be inconvenient to live with - reducing the patient's confidence and affecting the patient’s work.
How to diagnose anal fistula?
Your doctor can usually diagnose an anal fistula by examining the area around the anus. The doctor will look for an opening out of the skin (this is usually a discharge). If visible, the doctor will try to determine the depth and direction of the fistula.
Some leaks may not be visible on the surface of the skin. In this case, your doctor may need to perform additional tests, starting with a rectal endoscopy. Your doctor may also order an ultrasound or MRI of the anal area to better identify the fistula.
If a fistula is found, your doctor may also do additional tests to see if the fistula is related to Crohn's disease. About 25% of people with Crohn's disease develop a fistula. Among these tests are blood tests, fistula X-rays, and endoscopy
Anal fissures are classified into 4 categories:
- Intersphinteric: 70% Through the dentate line to the anal verge, tracking along the intersphincteric plane, ending in the perianal skin
- Extrasphinteric: 5% Starting high in the anal canal, encompassing the entire sphincter and ending in the skin overlying the buttocks
- Transsphinteric: 23% Through the external sphincter into the ischiorectal fossa, encompassing a portion of the internal and external sphincter, ending in the skin overlying buttocks
- Suprasphinteric: 2% Through the anal crypt and encircling the entire sphincter, ending in the ischiorectal fossa
Treatments for an anal fistula?
-The only treatment method is surgery. The goal of surgery is to remove all the fibrous tissue in the fistula to treat the disease and avoid relapse completely.
Anal fistula surgery requires anesthesia; how long is the surgery?
Anal fistula surgery does not require anesthesia, just spinal anesthesia. Of course, you have absolutely no pain during the operation.
When simple fistula surgery is usually easy, surgery time is about 30 minutes. But complicated leakage of surgery is very difficult because it often recurs, the surgery is long, and it is necessary to have a specialist doctor with a lot of experience.
Concerns after surgery?
After surgery, the wound in the anus will be inserted with gauze and bandage to control bleeding. It will make you a little uncomfortable, feel like having a bowel movement. If you are uncomfortable, many doctors may give you pain relievers to ease the discomfort. The next day you can remove the bandage and shower as usual.
After about 10 hours of surgery, you can eat and sit up, but it is best to lie in bed until the effects of the drug are gone.
The day after surgery, you will be given a laxative to soften your stools and stimulate bowel movements. You probably won't have a bowel movement for the first day or two. When you have a bowel movement, it will feel a bit painful and may bleed less. It's best to take pain relievers 15 - 20 minutes before your bowel movements.
How long do I need to stay in the hospital after surgery?
Duration of hospital stay after surgery is about 1 - 2 days for simple fistula; for complicated fistula, time of hospital stay can last from 5 - 7 days.
When can I work again?
You can return to work after one week, at which point you will no longer feel pain in the incision, but you also need to avoid walking a lot and sitting for long periods.
After surgery, how do I eat and take care of my wound?
After surgery, you can eat and drink normally, but you should attempt to eat many vegetables, fruits, and drink water to have a bowel movement easily.
After surgery, you need to clean the spot by soaking your anus in warm water mixed with antiseptics or salt several times a day, especially after having a bowel movement.
There will usually be little bleeding from the wound or when you have a bowel movement after surgery. You don't need to worry. This can take 1-2 weeks. However, if the bleeding is heavy, you need to immediately go to the hospital for a follow-up. Anal wounds can heal after 2 - 4 weeks, depending on the fistula, simple or complicated.
Feb 12, 2021
HUNG M. DO, MD, Ph.D