Anal Fistula: Causes, Symptoms and Treatment

Written by Medicover Team and Medically Reviewed by Dr M Kalyan Ravi Teja , General Surgeons

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

An anal fistula is an abnormal opening between the external skin of the buttocks and the anal canal. It occurs in around 30-40% of patients with an anal abscess.

An anal fistula develops when an anal abscess bursts before it is treated or is not entirely cured. An anal abscess is a painful, pus-filled lesion caused by a bacterial infection in the tissues surrounding the anus.

What Are The Different Types Of Anal Fistula?

Anal fistula types are classified based on their location and relation to the anal sphincter muscles. This classification helps determine the treatment approach.

The complexity and position of the fistula tract influence surgical planning and recovery.

Suprasphincteric Fistula: Located above the anal sphincter muscles
Transphincteric Fistula (Horseshoe Fistula): A fistula that passes through the anal sphincter muscles
Intersphincteric Fistula: Occurs between the internal and external sphincter muscles
Extrasphincteric Fistula: Located outside the anal sphincter muscles

What Are The Symptoms And Warning Signs of an Anal Fistula?

Anal fistula symptoms can be painful and persistent, often affecting daily activities like sitting or passing stool. Early identification helps in timely treatment.

These symptoms are usually related to infection, inflammation, and discharge from the affected area.

Irritation of the skin surrounding the anus
Excruciating pain while sitting, moving, and passing stool
An unpleasant discharge from the anus
Pus or blood in the poop
Swelling and redness around the anus, as well as fever, if you have an abscess.
Controlling bowel movements may be difficult in some instances.
The end of the fistula may be visible as a hole in the skin around the anus; however, patients may be unable to see it.

What Are The Common Causes Of Anal Fistula?

The most common cause of anal fistula is an anal abscess that does not heal completely. This leads to the formation of a tract between the anal canal and skin.

Other medical conditions and infections can also contribute to its development.

Crohn's Disease: Crohn's Disease causes intestinal inflammation and is the main cause of anal fistula.
Diverticulitis: Diverticulitis is another cause of anal fistula. Swelling and infection in one or more diverticula lead to fever, nausea, etc.
Hidradenitis Suppurativa: Hidradenitis suppurativa is a skin condition that leads to scarring and abscesses. It leads to the formation of an anal abscess.
Other factors: Sexually transmitted infections (like syphilis and chlamydia), diabetes, radiation therapy, and smoking can increase the risk.

What are the Risk factors of Anal Fistula?

Certain health conditions and lifestyle factors can increase the likelihood of developing an anal fistula. These often contribute to infections or poor healing. Understanding these risk factors helps in prevention and early management.

Syphilis and Chlamydia
Radiation therapy
Diabetes
Dermatosis
Excessive spicy food intake
Smoking
Tuberculosis
Sedentary lifestyle
Hyperlipidemia
HIV Aids
Alcohol consumption

When Should You See A Doctor for an Anal Fistula?

Persistent symptoms of anal fistula require medical evaluation to prevent complications. Early consultation helps in confirming the diagnosis and starting appropriate treatment.

Timely care reduces the risk of infection spreading and improves recovery outcomes.

Consult a General Surgery specialist if symptoms like pain, discharge, or swelling persist
Seek immediate care if there is fever, severe pain, or worsening infection
Visit a doctor if bowel control issues or recurrent abscesses occur

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How Is Anal Fistula Diagnosed?

Diagnosing anal fistula involves a combination of physical examination and imaging techniques. Doctors assess the location, depth, and complexity of the fistula.

Advanced imaging may be required for recurrent or complex cases.

Physical Examination: Doctors will check for visible openings, pain, or pus around the anus. Gentle pressure helps identify signs like blood or discharge
Rectal Examination: A doctor may insert a gloved finger into the anus to check the fistula's depth, the condition of the sphincter muscles, and the area of infection.
Proctoscopy: A specialized scope is used to examine the rectum for internal fistula openings, often done under general anesthesia.
Anal Endosonography (Anal Ultrasound): This test uses sound waves to capture images of the anal canal to assess the fistula's extent.
MRI Scan: For more complex or recurring fistulas, an MRI or Magnetic Resonance Imaging Scan may provide detailed images of the affected area.
CT Scan: A CT or Computerised Tomography Scan may be used to get detailed cross-sectional images of the body, helping to detect inflammation and other issues.

What is the Treatment of an Anal Fistula?

The strength and complexities of the sphincter muscles are used to anal fistula treatment. However, no medications are available to treat this condition; the following surgical procedures must be performed:

Fistulotomy: This is the most common and effective surgical operation used to drain and open an anal fistula.
Seton Techniques: This procedure involves inserting the surgical thread into the fistula tract, allowing it to drain and heal entirely.
Advancement Flap Procedure: If the fistula passes through the anal sphincter muscles, this procedure is used to cover the hole and allow the fistula to heal.
Fibrin Glue of Collagen Plug: This is a non-surgical method in which the surgeon injects a special glue while under general anaesthesia. This closes the fistula and initiates healing.
Anal Fistula Surgery: Depending on the complexity, surgery may be necessary to completely heal the fistula and restore normal function.

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How Can an Anal Fistula Be Prevented?

While not all cases can be prevented, certain lifestyle changes can reduce the risk of developing an anal fistula. Prevention mainly focuses on avoiding infections.

Early treatment of underlying conditions plays a key role in reducing complications.

Maintain good hygiene around the anal area
Avoid straining during bowel movements by consuming a high-fiber diet
Treat infections or abscesses early to prevent fistulas from forming
Practice safe sex to reduce the risk of sexually transmitted infections

Frequently Asked Questions

1. What is an anal fistula?

An anal fistula is an abnormal tunnel-like passage that forms between the inside of the skin around the anus, often known as the rectum. It typically develops as a result of an infection or abscess near the anus.

2. What causes an anal fistula?

Most anal fistulas come on by infections that start inside the anal gland, which then leads to an abscess. The abscess can cause tissue to break down, creating a pathway for the fistula to develop.

3. What are the common symptoms of an anal fistula?

Anal fistula symptoms may include discomfort, swelling, redness, discharge of pus or blood, itching, and discomfort while sitting or during bowel movements.

4. How is an anal fistula diagnosed?

Normally, a doctor will do a physical examination of the affected area to diagnose an anal fistula. Sometimes, additional tests like an MRI or a fistulogram may be recommended to assess the extent and location of the fistula.

5. Is surgery the only treatment option for anal fistulas?

Surgery is often the main treatment for anal fistulas, especially when they are causing symptoms. Surgery aims to remove the fistula and any associated abscess or infection. In some cases, a seton (a small piece of surgical thread) may be placed to help drain the fistula and prevent recurrence.