Learn more about 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.
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.
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.