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October 17, 2017
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Anal Fistula and Treatment Options: Your Questions Answered

What is an anal fistula?

It is an abnormal connection between your anal canal (back passage) to the surrounding skin. It can occur due to various reasons explained below.

What causes anal fistula?

Most fistulas are caused by simple hair follicle infection that was not treated completely/properly.

There are millions of hair follicles in one’s body. Any one of them around the anal canal can get infected. Infection is more in people who sit for long time and more so among those who sit in unhygienic or hot/sweating environments (e.g., long-distance drivers). When the infection occurs and there is pus collection, the pus needs to be drained properly for the chances of fistula formation to decrease drastically.

If pus is not drained properly, then the body has to discharge the pus, and there are only two directions. If it bursts out of skin and infection gets completely cured, then a fistula does not form. If it bursts into the anal canal, then a fistula is formed. Worst case is when it bursts into the skin but residual infection spreads slowly in different directions. In such a case, a complex fistula is formed. There are certain conditions such as Crohn’s that predispose one to having fistula. These conditions are rare in India.

Are there different kinds of fistulas?

Fistulas can be classified depending on the involvement of sphincter muscles and internal opening as shown in the picture.

What are the symptoms of  a fistula?

A fistula might be characterized by recurrent discharge of pus around the back passage, which stops and starts. People end up taking antibiotic each time, and with time, the fistula will become more complex and difficult to treat. If there is a collection of pus, then it can be present at in the form of an abscess. In this case, the abscess needs to be treated first and then fistula at a later stage.

How is fistula treated?

The only way to cure a fistula is by surgery. Most fistulas are simple and do not involve sphincter muscles, so cutting it out fully will cure the fistula. If a fistula involves sphincter muscles, then cutting out the fistula in one operation is not a solution as it might cure the fistula, but it will cause one incontinence. If sphincters are damaged, one would loose control over the passing of stool and might have to run to toilet every time one gets sensation. There might also be involuntary passing of stool. In these scenarios, the patient will need to keep clam and undergo two/three operations.

Is there LASER surgery for anal fistula?

Yes now there is laser which is safe and very effective.