Anal Fistula

Learn more about Anal Fistula

Anal Fistula

An anal fistula is an abnormal connection from just inside the anal canal usually extending to the skin overlying the buttock. It is a common consequence of a perianal abscess.

A fistula is NOT a reflection of poor hygiene. The application of soaps and excessive cleaning will not aid the problem, and may do further harm to the skin.

A fistula will is not likely to heal with antibiotics alone, and antibiotics almost never have a role in a typical fistula.

Anal fistula diagram

Treatment hinges on its anatomy

Definitive repair of a fistula can be difficult, as one must balance healing with the preservation of normal sphincter muscle function (those muscles which allow you to control your bowel motions or wind until a convenient time).

Treatment of the fistula hinges on its anatomy, the degree of muscle involvement, and any risks the patient has of incontinence (a lack of bowel control).

A ‘simple’ fistula is one that involves minimal muscle, in a patient without any risks for incontinence. These can be healed quite simply by a ‘fistulotomy’ which is simply cutting down onto the track and then allowing the wound to heal.

A ‘complex’ fistula involves a significant amount of muscle, occurs in a patient with a risk of incontinence, or actual incontinence, or those with conditions that effect healing (Eg Crohn’s disease, a history of irradiation).

A complex fistula requires a more extensive work-up, which may involve an ultrasound or MRI scan to assess the muscles and the type of fistula, muscle pressure testing, and ultimately a procedure that does not threaten the muscles, or continence.

The initial step in fistula management

An initial step in fistula management is often the insertion of a ‘draining seton’, a thin plastic cord which allows any infection to resolve. This is usually a temporary measure, but certain patients will opt to use these permanently.

Operations that preserve muscle function need to be tailored to an individual patients specific circumstances, but possible operations include: anal fistula plug (see video below) fistula clip, ligation of intersphincteric fistula tract (LIFT), a rectal advancement flap (MAF/ERAF) and more.

In our consultation about your fistula, you will expect a simple explanation of the problem, and the commencement of an individual strategy to achieve healing with minimal risks. An anal fissure may be associated with other diseases (such as Crohn’s disease, an inflammatory condition), or the symptoms may reflect an alternative diagnosis. If the symptoms fail to respond to a single short-course of treatment (e.g. topical creams), then investigation is usually warranted. Particular warning symptoms include pain NOT associated with defecation, bleeding mixed in with the stool, new incontinence, a recent change in bowel habits, or a personal or family history of colonic polyps, bowel cancer or inflammatory bowel disease.

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