What is Anal Fistula?

An anal fistula is the formation of an abnormal channel between the skin surrounding the anus and the cavities within the rectum. This condition usually develops as a result of inflammation around the anus, which begins with an infection caused by a blocked gland in the anal area. A fistula can develop into a structure where a channel is surgically created and discharges to the outside.

Formation of an Anal Fistula

An anal fistula often occurs when an abscess (an area of ​​inflamed tissue) around the anus ruptures. The inflammation from the abscess can develop into a fistula channel over time. A fistula usually consists of a channel running from one end to the other, and this channel can sometimes extend to the skin surface.

Fistulas can have a simple channel structure or form more complex structures. Some fistulas may contain multiple channels and a tortuous structure. Such structures may require further surgical intervention.

Symptoms

The most common symptoms of an anal fistula are persistent inflammation, pain, and discharge around the anus. The external end of the fistula can often leak inflamed, pus-like fluid. Other common symptoms include:

Pain and discomfort: The fistula can cause pain after using the toilet or while sitting. The pain can sometimes be excruciatingly severe.
Discharge: Inflamed fluid can continuously leak from the external end of the fistula.
Redness and swelling: The skin around the anus may become red and swollen.
Bleeding: In some cases, bleeding may occur, especially during defecation.
Fever and weakness: A fistula can cause general weakness and fever due to infection.
Causes

The primary cause of an anal fistula is infection, which occurs as a result of blockage of the glands around the anus. The blocked glands can become inflamed and cause an abscess, which can develop into a fistula tract over time. Other factors that can lead to the development of an anal fistula include:

Crohn’s disease: Crohn’s disease, a chronic inflammation of the intestines, can lead to the formation of an anal fistula.
Inflammatory bowel diseases: Intestinal diseases such as colitis can also cause fistulas.
Diabetes: High blood sugar levels can weaken the body’s ability to fight infections, increasing the risk of fistula formation.
Trauma: Trauma or surgery in the anal area can lead to fistula development.
Genetic factors: A genetic predisposition can increase the risk of anal fistula formation in some individuals.

Diagnosis and Examination

An anal fistula is usually diagnosed through a physical examination. A doctor can detect the presence of a fistula by examining the swelling and discharge around the anus. However, certain tests may be necessary to understand the complexity of the fistula and perform a more detailed evaluation. These include:

Digital rectal examination: This is performed to check for hardness and swelling around the anus. Anorectal ultrasonography: Used to determine the depth and structure of the fistula.
Magnetic resonance imaging (MRI): Useful for evaluating more complex fistulas.

Treatment Methods

Treatment of an anal fistula usually requires surgical intervention. The goal of treatment is to clear the fistula tract and prevent re-infection. Treatment options include:

Surgical intervention: Surgical opening and cleaning of the fistula is the most common treatment method. This procedure is usually performed under local anesthesia. However, complex fistulas may require more extensive surgery.

Fistula seton (Seton treatment): A seton is a surgically placed thread that is passed through the fistula tract. This thread helps clear the fistula tract and reduces the risk of infection.

Laser treatment: In some cases, laser treatment of the fistula is possible. The laser burns the fistula tract, allowing it to heal.

Fistula plastic surgery (Fistulectomy): This is another surgical technique used to completely remove and repair the fistula.

Antibiotic treatment: Antibiotic treatment may be administered to prevent the spread of infection and reduce inflammation. However, this treatment alone is often insufficient.

Outcome and Prevention

If left untreated, anal fistulas can seriously impact quality of life and lead to permanent problems. However, with appropriate treatment, fistulas can be healed and the likelihood of recurrence can be reduced.

To prevent fistula formation, it is important to maintain hygiene, regularly clean the anal area, and avoid excessively wet areas. Furthermore, early treatment of intestinal diseases and infections can reduce the risk of fistulas.

In conclusion, although anal fistulas are generally treatable, they are a health problem that should be considered and addressed early. Consulting a specialist and deciding on the right treatment method ensures better long-term outcomes.