Do you often have pain or swelling around your anus (the opening where your body excretes waste)? Do you sometimes notice a pus-like fluid or a little blood coming out? I know it can be a little awkward and embarrassing to talk about these things with someone. But this is a condition that many people experience and can be successfully treated. So today, let's talk openly about this condition called an anal fistula, or as it is medically called, an ``Anal Fistula''.
Simply put, what is an anal fistula?
Imagine that a small tunnel or culvert forms inside our anus, opening out into the surrounding skin. That's what we call an anal fissure. This is not something that should normally be in our body, it is something that forms unnaturally.
This often starts with an infection of the small glands inside our anus. When these glands become infected, a pus-filled abscess, called a perianal abscess, forms. This pus creates a path for the pus to drain out. Over time, that path becomes a tunnel called a perianal fistula. Sometimes this is also called a perianal fistula. That means around the anus.
How common is this condition?
This is not as rare as you might think. It is a relatively common condition among anal diseases. It is seen about twice as often in men as in women. On average, only about half of people who have an anal gland infection will develop an abscess. As mentioned earlier, 75% of anal fistulas are caused by an abscess.
Do you also have these characteristics?
There are several main and common symptoms of an anal fissure. Let's take a look at what they are.
| Symptom | Description |
|---|---|
| Anal pain | This is not just any ordinary pain. It is a sharp, nauseous pain that comes from within. This pain may increase when you sit, cough, or have a bowel movement. You may even feel pain when you touch the area. |
| Swelling and redness | There may be redness and swelling in or around the anus. This indicates an active infection under the skin, such as cellulitis . |
| Leaking fluid | There may be a discharge from the anus, a small amount of pus, or even blood (rectal bleeding) . Sometimes this can also have a bad odor. |
In addition to these main symptoms, some people may also experience symptoms like:
- Fever
- Pain when urinating
- Difficulty controlling bowel movements
Sometimes, if you look in a mirror, you may or may not see the hole in the outside of the scrotum. It's like a small hole in the skin. If you touch the skin around it, something like pus may come out. In some old scrotums, this hole in the outside may be closed. Then the pus collects again, causing pain and swelling, and the hole opens again to let the pus out. This can be like a cycle.
Why does this anal fissure occur?
As we have discussed before, the main and most common cause of an anal fissure is an infection of a gland in the anus, forming a pus-filled sac (perianal abscess). The fissure becomes the path for this pus to drain out.
However, anal fissures can also occur for other rare reasons.
- Inflammatory bowel diseases: For example, Crohn's disease.
- Sexually transmitted diseases (STS) that occur in the anus
- Tuberculosis affecting the rectum.
- An accident or previous surgery involving the rectum.
- Radiation therapy for cancer of the pelvic region
- Rare bacterial infections like actinomycosis.
- Hidradenitis suppurativa is a skin condition that occurs in the sweat glands.
The most important thing is to definitely seek medical advice if you have these symptoms, regardless of the cause.
What happens if left untreated?
This is a question that many people ask. An anal fissure will not heal on its own if left untreated.If that happens, long-term complications may occur.
- Recurrent infection: The infection can remain active through the vagina. Even if the pain seems to subside for a few days, pus may collect again and a new abscess may form, causing pain.
- Spread of the cyst: If left untreated for a long time, this tunnel can branch out and form new paths and come out from other parts of the skin. Treating such complex cysts is even more difficult.
- Cancer risk: This is very rare, but there have been reports of anal cancer developing in people with long-standing anal fissures that have been left untreated for many years.
So don't take this situation lightly. Don't just endure the pain, see your doctor as soon as possible.
How does a doctor detect this?
Most of the time, a doctor can identify this opening during a physical exam. However, sometimes the opening on the outside may be blocked, so it is necessary to find where the opening on the inside of the opening begins.
If this test is painful for you, the doctor may decide to perform this test in the operating room under anesthesia.
You can also try these tests to find the full path of Bhagandara:
- MRI scan (Magnetic Resonance Imaging): This can clearly see where the anal canal passes and where it connects, and how it affects the sphincter muscles.
- Endoscopic Ultrasound: A small camera and ultrasound device are inserted into the rectum to obtain clear images similar to those obtained with an MRI.
- Fistulography: A special fluid is injected into the vagina and an X-ray is taken. The path of the fluid can then be clearly seen.
These tests will greatly help the doctor determine the type of hernia and the most appropriate treatment.
How is it treated? Is surgery necessary?
Yes, most anal fissures require surgery to heal. Waiting for them to heal on their own will only lead to recurring infections and abscesses. However, if the fissure is caused by a medical condition such as Crohn's disease, and there is no infection, it can sometimes be cured with medication.
Types of surgery
The nature of the surgery depends on how simple or complex the hernia is.
1. For Simple Fistulas
The main surgery for simple fistulas that do not involve major damage to the muscles of the rectum and do not have branches is a fistulotomy . This is the most successful (about 95%) and easiest method. Here, the surgeon opens the tunnel of the fistula and allows it to heal from the inside out.
2. For Complex Fistulas
A hernia that crosses a large area of the rectum, branches, or is in someone with other medical conditions is considered complex. This may require surgery in several stages.
| Surgical method | What simply happens |
|---|---|
| Seton Drain | This is like a special thread. It is inserted through the vagina. What it does is that the tunnel remains open until all the pus inside the vagina is drained and emptied. Sometimes, monks use this thread to cut the vagina and allow it to heal. |
| Endorectal Advancement Flap | This does not involve cutting the muscles of the rectum. Instead, the infected tissue around the opening inside the anus is removed, and a piece of healthy tissue (flap) is pulled from inside the rectum to close the hole. |
| LIFT Procedure | Here, the part of the vagina that passes between the two muscles of the rectum is sutured and closed (ligation). This method reduces the risk of damage to the muscles. |
Recovery time after surgery
Most of the time, these surgeries are done in a way that allows you to go home without having to stay in the hospital. You will be given painkillers to use and a set of instructions to follow when you go home.
- Water and fiber supplements: Since painkillers can cause constipation, it is recommended to take fiber supplements to prevent it. You should drink plenty of water with these.
- Sitz bath: Sitting in a basin of warm water for a few minutes at least once a day can reduce pain and help the wound heal faster.
- Wound care: Keep the wound clean by using gauze pads to absorb fluid from the wound, changing them frequently.
It usually takes three to six weeks to fully recover.
When should you see a doctor?
If you have severe pain in your rectum, always tell your doctor. Don't assume it will go away on its own. Many people think it's hemorrhoids. But hemorrhoids don't usually cause this much pain. Even if your regular doctor says it's hemorrhoids, if the pain persists, be sure to see a specialist, such as a gastroenterologist or surgeon.
Living with this type of pain can be very stressful, both physically and mentally. But don't be embarrassed about it and delay seeking treatment. The sooner you get treatment, the easier it is to manage.
Take-Home Message
- An anal fistula is an abnormal tunnel that forms from the inside of the anus to the outside of the skin.
- The main symptoms are severe pain, swelling, and pus-like discharge from the anus. Do not mistake these for hemorrhoids.
- Since this condition does not heal on its own, it is very important to seek medical advice.
- Surgery is often required as treatment. The sooner treatment is sought, the simpler the surgery may be.
- Don't be ashamed or afraid to talk about this. This is a condition that can be treated and completely cured.
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