Symptoms of an anal fistula
Symptoms of an anal fistula can include:
- skin irritation around the anus
- a constant, throbbing pain that may be worse when you sit down, move around, have a bowel movement or cough
- smelly discharge from near your anus
- passing pus or blood when you poo
- swelling and redness around your anus and a high temperature (fever), if you also have an abscess
- difficulty controlling bowel movements (bowel incontinence) in some cases
Treatment
Treatment of anal fistulas depends on (1) the location of the fistula, (2) evidence of sepsis or a large abscess, or (3) worrisome findings on physical examination. Treatment options include:
Fistulotomy
The surgeon cuts the fistula’s internal opening, scrapes and flushes out the infected tissue, and then flattens the channel and stitches it in place. To treat a more complicated fistula, the surgeon may need to remove some of the channel. Fistulotomy may be done in two stages if a significant amount of sphincter muscle must be cut or if the entire channel can’t be found.
Seton procedures
Seton procedure where a piece of surgical thread called a seton is placed in the fistula and left there for several weeks to help it heal before a further procedure is carried out to treat it. This technique is a good option for patients who have a high risk of bowel incontinence following surgery, due to the close proximity or involvement of the anal sphincter muscles.
Advancement rectal flap
For a complex procedure, or for patients with a high risk of bowel incontinence following conventional fistulotomy, the advanced flap surgical technique may be a good option. This involves advancing a piece of tissue or skin, called the advancement flap, from the rectum or around the anus. The flap is then attached to the fistula opening after healing to assist healing. It does not require dividing the sphincter.
Bioprosthetic plug
This is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. This is kept in place with stitches. Since it does not seal off the opening completely, it allows the fistula to continue draining. Eventually, new tissue grows around and into the plug and the tract is closed.
This technique is associated with a greater risk of complications such as pain, formation of an abscess or plug displacement. Some studies have suggested this may be an effective treatment for anal fistulas, but more evidence is needed to be certain.
Fibrin glue
The only non-surgical treatment for anal fistula that is currently in use is fibrin glue. This involves an injection of the glue into the fistulous tract to approximate the sides closely together and prevent the space from persisting. Eventually the cells from the surrounding tissue will grow into the glue and the tract will be obliterated. It is a simple, safe and painless procedure, but long term results for this method are poor.
