Do you also feel a constant sharp pain, swelling, or a discharge from your anus? Perhaps this pain increases when you sit, go to the toilet, or cough. You may feel embarrassed and a little uncomfortable talking about this with anyone. But this is not a problem that only affects you. This condition occurs in many people. Today we are talking about this condition called ``Anal Fistula``.
Simply put, what is an anal fistula?
Think of it like a little tunnel. An anal fissure is something like that. Simply put, it's an unnatural tunnel-like passageway that forms from the inside of our anus to the outside of our skin. It usually occurs when the small anal glands at the top of our anus become infected. When these glands become infected and a pus-filled abscess forms, a path for the pus to drain out. That's what eventually becomes a fistula. It's also called a perianal fistula. It means "around the anus."
This condition is relatively common. Men are twice as likely to develop it as women. About one in two people who develop a fistula around the anus will develop this condition.
How do I recognize the symptoms of this?
If you have an ``Anal Fistula'', you may have one or more of these symptoms. Sometimes they are constant, and sometimes they come and go.
| Symptom | How does that feel? |
|---|---|
| Anal pain | This is the main symptom. It is a sharp pain that feels like a burning sensation, like a sharp pain. This pain can increase when sitting, going to the toilet, or coughing. It also hurts when touched. |
| Swelling and redness | There may be redness and swelling in or around the anus. This is a sign of an infection (cellulitis) under the skin. |
| Leaking fluid | There may be a discharge from the anus, which may look like pus, a little stool, or blood. Sometimes there may be a bad odor. |
Are there any other characteristics besides these?
Yes, some people may experience these symptoms, although not everyone:
- Having a fever
- Feeling pain when urinating
- Difficulty controlling bowel movements
Sometimes, if you look in a mirror, you can see a small hole in the skin near your anus (the opening of the fistula). But sometimes it can be closed. When that hole closes, pus can collect inside, causing pain and swelling, and the hole can open again with a little pus. This can be like a cycle.
Why does something like this happen?
The main cause of an anal fistula is the perianal abscess we discussed earlier. This abscess forms when a small gland in the anus becomes blocked and infected. This pus needs a way to get out. Then, the pus builds a tunnel-like path to the surface of the skin. Sometimes, even when a doctor cuts out and removes this pus, the wound may not heal completely and a fistula like this may remain.
However, not all fistulas develop for this reason. There are other reasons as well.
- Inflammatory bowel diseases, such as Crohn's disease .
- Anal STIs.
- Tuberculosis affecting the rectum.
- An accident or previous surgery to the rectum.
- Radiation therapy for cancer in the pelvic region.
- Rare infections and skin conditions like `Actinomycosis` and `Hidradenitis suppurativa`.
The important thing is, whatever the cause, it's best not to ignore it, because if left untreated, it rarely goes away on its own .
What complications can occur if left untreated?
Thinking, "It'll just get better" can be dangerous. An untreated fistula can lead to things like:
1. Recurrent infections: The infection may persist inside the fistula. Even if the pain subsides after a few days, pus may collect again and a new abscess may form, causing pain.
2. Spread of the wart: A wart that has been there for a long time can branch out, create new tunnels, and come out from other parts of the skin. Such complex wart types are also difficult to treat.
3. Cancer risk: This is very rare. However, there is a very small chance of developing anal cancer associated with a chronic fistula that has been untreated for many years.
Therefore, if you have these symptoms, see a doctor immediately.
How do you find this, Doctor?
Usually, a doctor can find the external opening of the fistula just by examining you. But the most important thing is to find the internal opening, that is, where the tunnel begins.
- Physical examination: The doctor will examine the area around your anus. This may be a little painful. If the pain is too much, you may be sedated, which means you will be slightly sedated, and the examination will be performed in the operating room.
- Special equipment: A small instrument with a camera called an ``Anoscope'' or ``Proctoscope'' can be inserted into the rectum to examine it.
- Imaging tests: Sometimes these tests are needed to see exactly where the fistula tunnel is.
- MRI scan (Magnetic Resonance Imaging): This can show very clearly the path of the fistula and how it is connected to the sphincter muscles of the anus.
- Endoscopic Ultrasound: A small camera and ultrasound device inserted into the rectum can produce images similar to an MRI.
- Fistulography: An X-ray examination of the fistula by injecting a special dye into it.
These tests will help the doctor determine the type of fistula. That is, how it has passed through the anal sphincter muscles. This will determine how you will be treated. It is very important to perform the surgery without damaging those muscles.
What are the treatments for this?
Most of the time, surgery is needed to treat an anal fissure. It is very rare for it to be cured with medication alone. However, if it is a non-infectious fissure caused by a disease such as Crohn's disease, there is a chance that it will be cured with some special medications called immunomodulators.
The type of surgery varies depending on the nature of the fistula.
| Type of surgery | Simply explained |
|---|---|
| For Simple Fistulas | |
| Fistulotomy | This is the most common and successful method (about 95%). What is done here is to cut open the roof-like part of the Bhagandara tunnel. Then it becomes like an open wound, filling from the bottom up and healing. |
| For Complex Fistulas | |
| Seton Drain | In this, the surgeon inserts a special thread-like object through the anus. This creates a path for all the pus inside to drain out. Sometimes, as this thread gradually cuts through the muscle, the wound heals behind it. |
| Endorectal Advancement Flap | Here, the opening inside the anus is closed without cutting the muscle. A piece of healthy tissue (flap) is taken from inside the rectum and the opening is closed. The wound then heals from the inside out. |
| LIFT procedure | In this procedure, the part of the muscle that runs between the two muscles is sutured closed. This method can minimize damage to the muscles. |
Your doctor will choose the treatment method that best suits your condition. It may not be possible to complete the procedure in one operation, or it may be necessary to perform several operations.
What should I do at home after surgery?
You can usually go home the same day as this surgery. You need to take care of these things after you go home.
- Painkillers: Take the painkillers prescribed by the doctor on time.
- Preventing constipation: Painkillers can cause constipation. So, as your doctor recommends, take fiber supplements and drink plenty of water.
- Sitz bath: Soak in a basin of lukewarm water for 10-15 minutes at least once a day. This will reduce pain and help the wound heal faster.
- Keeping the wound clean: If there is fluid coming out of the wound, follow your doctor's instructions to keep it clean. Change the dressing frequently.
It usually takes three to six weeks to fully heal.
The most important thing is, never ignore severe pain in the anus. Don't decide for yourself, "It must be hemorrhoids." Hemorrhoids don't usually cause this much pain. So don't be shy and see a doctor without delay. The sooner you seek treatment, the easier the treatment will be and the quicker the recovery will be.
Take-Home Message
- If there is persistent pain, swelling, or a pus-like discharge from the anus, it may be a sign of an anal fistula .
- This rarely resolves on its own . If left untreated, it can lead to the spread of infection and complications.
- Don't be shy about talking about this. See a qualified doctor immediately and get advice.
- Often the best and most permanent treatment for this is surgery. Your doctor will determine the type of surgery that is right for you.
- Following the doctor's instructions exactly after surgery is essential for a speedy recovery.
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