Are you experiencing pain and swelling around the opening of your anus? There is a good chance you have an anal fistula, and you should visit your doctor as soon as possible for a diagnosis.
What is an Anal Fistula?
An anal fistula is a small tube connecting an abscess (infected cavity) in the rectum to the hole of the anus. Your anus is the opening where you expel feces from the body. Inside this hole lies multiple small glands that expels mucus. These glands can get blocked, which leads to infection, creating an abscess. These abscesses can develop into a fistula.
Causes and Symptoms
What are the Causes and Anal Fistula?
The most common cause is blocked anal glands, which lead to abscesses.
However, there are other causes which include:
- Trauma
- Tuberculosis
- Cancer
- Crohn’s Disease
- Radiation
- Sexually transmitted diseases
- Diverticulitis
The Symptoms of an Anal Fistula
If you experience any of these terrible symptoms, you may have an anal fistula:
- Fever, chills, and fatigue
- Frequent anal abscesses
- Bleeding
- Pain and swelling around the anus
- Pain when excreting feces
Bloody and nasty-smelling pus is coming from the opening of the rectum.
- Pain may subside once the fistula drains.
- The drainage causes irritable skin around the anus.
Diagnosis
During your appointment, your doctor will examine the area around your rectum. They will look for a specific skin opening called the fistula tract.
Your doctor needs to deduce how deep the tact is and its direction. It will be easy to find as there will be pus from the opening.
However, there are times when the fistulas are not visible on the surface. If this happens, your physician will need to do additional tests, which include:
- Ultrasounds or MRIs
For a better view of the anal tract, your doctor will perform an ultrasound and MRI.
During this procedure, your physician will use a tool to see inside your rectum.
- Additional Examination
Your doctor will examine you under anesthetic in an operating room to properly diagnose the fistula in certain circumstances.
Suppose you are diagnosed with an anal fistula. In that case, your doctor might need to conduct further tests to determine if it is related to Crohn’s disease, an inflammatory disease of the intestine. It is widespread for people with this disease to develop fistulas.
How do you Treat Anal Fistula?
The most common treatment for a fistula is surgery. A colon specialist performs this procedure. It is a very delicate surgery as your doctor must remove the fistula while trying to protect the anal sphincter muscles. If damaged, these muscles can cause incontinence.
If the fistula is in a spot with few sphincter muscles, your doctor will treat it with a fistulotomy. The skin and muscle growth over the tubes during this procedure are cut open and restructured into a loose groove. This increases healing from the bottom up.
If your fistula is severe, your doctor will place a special drain known as a seton. A seton is very similar to a plastic band which allows the fistula to drain and heal from the inside. Your surgeon will do this in an operation room, and you will be under anesthetic.
The seton will need to remain inside your rectum for six weeks. This will be your first operation, and there are usually more that follow, which include:
- A fistulotomy
- An advancement flap procedure
- A lift procedure
A new procedure is becoming popular where your doctor will inject stem cells into your fistula. Your physician should discuss all these options with you before your treatment.
Fistula surgery is usually an outpatient procedure, meaning you can go home on the same day. However, if your fistula is very large or deep, you might have to spend several days in the hospital. In some situations, you may require multiple surgeries to get rid of it.
Recovery
Most of these surgeries are effective. Once you are home, taking a long soak in a warm bath will help you feel better, called a sitz bath. However, do not overdo the bathing, as this can cause unnecessary discomfort.
You will also need to take stool softeners or laxatives for several days to ensure you don’t irritate the affected area. However, ensure not to wipe the area too much with toilet paper as this can irritate your anus.
Most people experience discomfort or pain after their procedure, and your doctor will likely inject you with a numbing agent that will help.
You can also use pain medication to alleviate the pain. However, if your surgery and recovery go as planned, it is scarce that the anal fistula will return.
For the ladies, you can use sanitary towels for some extra padding. I would recommend the thin or ultra-thin nighttime options. Stick them to the back of your underwear instead of the front.
Other factors to take note of:
- Avoid too much activity like walking long distances or running
- Avoid lifting objects that weigh more than 5kg for at least two weeks, such as children or heavy shopping bags.
Sexual Intercourse
The Patient should perform no sexual activity for at least two weeks. Sticking items into your anus or vagina (like tampons) can cause damage to your rectum and even dislodge the seton.
After two weeks, see how you feel. If you feel like you are ready for sexual intercourse, then go ahead, but still, ensure you don’t dislodge the seton.
Constipation
It is essential to avoid constipation as this can cause unnecessary strain when going to the bathroom. This strain can undo the seton and could potentially cause complications or damage.
If you don’t want to take medication, you can incorporate extra fiber into your diet, like fresh vegetables and fruits, and drink a lot of water to loosen your bowel movements. This will also help you be more regular.
You can also purchase something called lactulose, designed to lose bowel movements. Again, it would help if you discussed this with your surgeon, as a prescription is required.
If you can’t consume lactose, there are other laxatives and stool softeners available, and you can discuss these products with your doctor to see which one will work for you.
What are the Risks Associated with Anal Fistula?
There are some risks associated with anal fistula surgery, which include:
- Severe pain that over-the-counter pain medication might not be able to treat.
- Continuous bleeding
- The seton dislodging
- Infection
When you Should Call your Healthcare Provider
If you experience any of the following distressing signs after your procedure, you must consult a doctor, especially if you have had issues with anal abscesses in the past. If any of these symptoms arise, seek out medical help immediately:
- Fever of 100.4 degrees Fahrenheit or higher
- Symptoms of the anal fistula return, like pain or drainage
- Severe pain, inflammation, swelling, or drainage in or around the anus or rectum
- Issues with controlling your bowel movements
- Hard or painful stools
- Mucus, pus, or blood in your stool will result in a dark or bright red color.
- Stomach pain isn’t relieved with medication and lasts more than a few hours.
- Continuous nausea or vomiting
If these signs persist even after seeing your doctor, it might be time for a second opinion. Seek a physician who has completed advanced surgical and non-surgical procedures and colon, rectum, and anus problems.
Final Thoughts
An anal fistula is a small tube connecting an abscess (infected cavity) in the rectum to the hole of the anus. Causes can include blocked anal glands, which lead to abscesses, trauma, cancer, Crohn’s disease, radiation, or sexually transmitted diseases.
To diagnose an anal fistula, your doctor must examine the area around your anus. If they can’t see anything outside, other diagnoses can include ultrasounds or MRIs, Anoscopy, or a surgical inspection.
Treatment for an anal fistula is usually surgery, but other procedures include placing a seton, a fistulotomy, an advancement flap procedure, and a lift procedure.
To ensure you are recovering correctly, take sitz baths 3-4 times a day (keep them short) and add extra fiber to your diet. In addition, take lactulose or laxatives, avoid wiping your anus too much, wear sanitary pads for extra comfort, avoid physical activity for the first two weeks, and have no sexual intercourse for 14 days.
Risks associated with this procedure include severe pain, continuous bleeding, the seton coming undone, and infection.
After your surgery, you should seek medical attention if you experience a fever of 100.4 degrees Fahrenheit or higher, pain or drainage, inflammation or swelling in or around the anus, problems with your bowel movements, mucus, blood secretion, and continuous vomiting.
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