What Is An Anal Fistula

A fistula in ano is a tunnel like pipe like track, developed in the perianal region, usually having one or more external openings around the anus leading to an internal opening in the mucosa of the anal canal or the rectum.

Anal fistula, a rare condition, is a chronically inflammed, abnormal tunnel between the anal canal and the outer skin of the anus. It often drains watery pus, which can irritate the outer tissues and cause itching and discomfort.

Causes:

  • Previous history of ano rectal abscess.
  • Some times a fissure in ano/ anal fissure gets infected & the infection travels down to form a track or a fistula.

What Are The Symptoms?

  • Itching
  • Discharge of watery pus
  • Irritation of tissue around the anus
  • Discomfort
  • Pain

Possible Contributing Factors:

  • Tearing of the lining of the anal canal.
  • Infection from an anal gland.
  • Chron’s, ulcerative colitis, tuberculosis.
guidelines to approach an expert for investigating a possibility of anal fistual:

Recurrent Boils Developing At The Same Site( Around The Anus).

  • Burning sensation or pain in perianal region.
  • Pus discharge/blood discharge in perianal or from the anus.

Surgical Treatment Of Fistula In ANO:

  • Fistulotomy:laying open of the fistula track.
  • Fistulectomy: excision of the fistula track.
Fistulotomy / Fistulectomy:

The laying-open technique (fistulotomy) is useful for 85-95% of primary fistulae. Complete fistulectomy creates larger wounds that take longer to heal and offers no recurrence advantage over fistulotomy.

Seton Placement:

A seton ( thread tie ) can be placed alone, combined with fistulotomy, or in a staged fashion. This technique is useful in patients with the following conditions: Complex fistulae (ie, high transsphincteric, suprasphincteric, extrasphincteric) or multiple fistulae Recurrent fistulae after previous fistulotomy With time, healing occurs above the seton as it gradually cuts through the muscles. The seton is tightened on subsequent weekly visits until it falls out. This could take 2-5 visits to cure.