An anal fistula is a communication (tunnel) between the skin surrounding the anus and the inside of the rectum. Sometimes anal fistula occurs as a manifestation of other pathologies, such as Crohn’s disease.
Causes of anal fistula
The origin of anal fistula is usually an abscess that has drained into the skin, causing a communication between the skin and the inside of the anus or rectum. Only half of the cases of abscess drainage will result in an anal fistula.
How to diagnose anal fistula
Anal fistula is manifested by the chronic outflow of pus or stool through the fistula opening located in the skin of the anus.
For the diagnosis of the fistula, the most important criterion is the anal exploration by a surgeon specialized in Coloproctology. Occasionally imaging tests, such as anal ultrasound or pelvic MRI, may be needed.
Treatment for anal fistulas
Anal fistulas are classified as simple or complex, depending on the degree of involvement of the anal sphincters.
The treatment to be used is surgery, and the technique varies according to the type of fistula and according to the patient’s history and local conditions (history of anal surgery, inflammatory disease or other risk factors for the development of anal incontinence). In most cases the fistula is simple and can be treated on an outpatient basis. Thus, the patient only stays a few hours in a hospital center. In these cases, the patient can usually return to work within a short period of time.
When fistulas are complex, fistula treatment is more laborious and requires a great deal of experience on the part of the specialist in Coloproctology to decide which of the current techniques is the most appropriate for the patient and for the type of fistula. Currently there are treatments such as LIFT (minimally invasive surgery of the anus), plugs, glues, lasers, clips and even, in very selected cases, the use of stem cells.
Not all options are ideal for all fistulas and for all patients. In order to minimize the risk of complications such as recurrence, incontinence or others, it is vitally important that the surgeon who evaluates and treats patients has extensive experience in this pathology.