Anal Fistula

What is Anal Fistula?

An anal fistula is an abnormal connection between the epithelialised surface of the anal canal and (usually) the perianal skin.

Anal fistulae originate from the anal glands , which are located between the two layers of the anal sphincters and which drain into the anal canal . If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.

Abscesses can recur if the fistula seals over, allowing the accumulation of pus . It then points to the surface again, and the process repeats.

Anal Fistula Causes

An anal fistula is usually caused as a complication of an anal abscess that has burst. It may also occur after incomplete surgical drainage of an abscess. The reason why some people get abscesses is unknown.

Anal fistulas are also associated with conditions that result in inflammation of the intestines. These include IBS, diverticulitis, ulcerative colitis, Crohn’s disease, tuberculosis, gonorrhea, and rarely, cancer of the rectum.

Anal Fistula Symptoms

Anal Fistulae can present with many different symptoms:

  • Pain
  • Discharge – either bloody or purulent
  • Pruritus ani-itching

Anal Fistula Diagnosis

Diagnosis is by examination, either in an outpatient setting or under anaesthesia

Possible findings:

  • The opening of the fistula onto the skin may be seen
  • The area may be painful on examination
  • There may be redness
  • An area of induration may be felt – thickening due to chronic infection
  • A discharge may be seen

It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both opening of the fistula

Anal Fistula Treatments

The relationship of the fistula tract and anal sphincters will be determined via a careful diagnosis from a proctologist followed by an anoscopy, endorectal 3D ultrasound, and MRI. The surgical procedure will depend on the complexity of the case.

  • Laser Treatment
  • Treat Anal Fistula by Scoop (VAAFT, FALIC)
  • Advanced Rectal Flap
  • Inject Natural Collagen
  • Inject Stream Cells

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