Anal Fistula and its Treatment

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Anal Fistula

An anal fistula is the disease of the anus which is characterized by a swollen node around the anal region. An anal fistula is a very common problem especially among the patients who have previously faced anal infection. It is formed when the anal infection or abscess starts to drain making anal fistula even worse. There are many types of anal fistula a person can encounter, some of which are mentioned below.

Types of Anal Fistula:

There are four types of Anal Fistula described as follows:

  1. Inter sphincteric Fistula: this type of fistula affects the sphincter muscles and the tunnel originates in the space between the internal & external sphincter muscles.
  2. Tran sphincteric Fistula: This type of fistula originates in the space behind the anal area. It crosses the external sphincter and passes to the ischiorectal fossa and then to the perineum.
  3. Supra Sphincteric Fistula: it accounts for about 5% of total anal fistula. It arises from the supralevator abscess.
  4. Extra Sphincteric Fistula: As the name suggests it is caused when a foreign body penetrates into the rectum, or due to Crohn’s disease and rectal carcinoma.

What are the Symptoms of Anal Fistulas?

  • One can feel Skin irritation, itching, swelling, redness, and pain around the anal region.
  • The area becomes sore and tender
  • one may also experience discharge of pus or blood with movements of the bowel

Treatment options for anal fistula

There are two types of techniques which is usually followed during the treatment of Anal Fistula:

  1. Traditional Surgical Method for the Fistula Treatment
  2. Laser Surgery for Anal Fistula

These are further explained as follows:

Traditional Methods treatment

Treatment of anal fistula through traditional methods is performed very cautiously in order to reduce the risk of bowel emptying. The doctor will try to evaluate each patient individually on the complexity of fistula, strength of the sphincter muscles of the patient, before starting the treatment. There are various treatment options available which are listed below:

Fistulotomy:

It is a surgery performed to open and drain the anal fistula. In a fistulotomy, the surgeon first inserts a probe into the rectum to localize the fistula’s internal opening. After localizing the doctor cuts the track and scrapes of all the pus and its contents after which all the contents are flushed out. Then the sides are stitched in order to lay open the fistula.

In more complex situations like horseshoe fistula, a major mass of muscles are cut because these type of fistula contains external opening on both sides. The fistula is layed open only where the tracts join, and the remaining part is cut-off.

Advancement Rectal Flap:

This procedure is most suited in patients who have weak sphincter muscles. In this procedure, the surgeon may create a flap into the rectal wall to access and scrape off the internal opening of fistula and then the flap is stitched back.

Seton Placement:

This treatment involves the use of a silk string or a rubber band which is tied around the fistula to aid in the drainage of the fistula. A seton placement can also be used to cut over the muscles of the fistula and create scar tissue on the sphincter muscles before invading it with a knife.

Fibrin Glue or Collagen plug:

Fibrin glue or collagen plug is used in some cases where an individual is likely to undergo a procedure where there is no cutting of the fistula. Fibrin glue or collagen plug may be used to seal the tract after draining the contents of the tract. After completion of the procedure, the internal opening is closed by making a stitch.

Laser Surgery for Anal Fistula: Laser surgery is one of the most advanced treatments for fistula available for patients suffering from. The procedure utilizes laser energy technique to shrink and destroy the fistula epithelium and rest of the tract. The procedure is carried out by inserting a probe into the fistulous tract, without making any cuts or openings. Laser techniques are considered to be more favored among individuals when compared to traditional surgical procedures due to various reasons, which are mentioned below.

  • It’s a very short procedure and the patients are allowed to resume work within 24 hours
  • No dietary challenges are faced by the patient.
  • The effective procedure with faster recovery
  • Minimally invasive painless treatment
  • Repeated Doctor Visits are not necessary
  • The procedure can be opted and conducted in all age groups with negligible risks

No side effects and recurrence of the disease after the procedure.

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