Anal Fistula: Symptoms, Causes, Treatment, and Cost

The anus is the outer opening on the body through which faeces are expelled. The anus has some small glands that create mucus. Sometimes, the glands can get clogged, causing an infection. This infection leads to an abscess, which then develops into fistulas or tunnels.

An anal fistula is like a small tunnel connecting the abscess (infected cavity) to an opening located on the skin outside the anus.

Anal fistulas cause uncomfortable situations like itching and skin irritation, and usually don’t recover on their own. Mostly, surgery is needed to repair these fistulas.

Are you suspecting that you might have an anal fistula? Look out for these telltale signs of the infection.

• Irritation around the anal skin region
• A persistent and throbbing pain that worsens when you cough, defecate, sit down, or move around
• Smell discharge from near the anus
• Expelling pus or blood during defecating
• Redness and signs of swelling around the anus
• High body temperature, especially in case an abscess is present
• Bowel incontinence, or inability to control the bowel movements

In some cases, the end of the fistula can be visible. It will appear like a hole in the skin surrounding the anus. However, you may not be able to view this yourself or even with the help of a mirror.

Consult the doctor right away if you notice any or all of the above mentioned anal fistula symptoms.

The anus has glands inside that make fluids. Sometimes, the glands get blocked or clogged. This clogging action of the gland leads to the formation of a swollen pocket of infected tissue and liquid known as an abscess. Since a fistula is the tunnel that connects the anal gland to this opening on the skin if this abscess is left untreated, it starts to grow, eventually making a hole in the skin outside the anus.

Anal abscesses and clogged glands are the main reasons for anal fistulas. However, the lesser common causes are:

• Radiation
• Crohn’s Disease, which is an inflammatory disease affecting the intestines
• Sexually transmitted diseases
• Trauma
• Tuberculosis
• Cancer
• Diverticulitis - a disease wherein small pouches are formed within the large intestine and become inflamed

As per the estimates from The World Health Organisation (WHO), anal fistulas affect about 50,000 to 1,00,000 people every year. This infection is often unnoticed in underdeveloped countries due to lack of proper healthcare and medical facilities.

As anal fistulas are extremely painful, it is best to avoid getting the glands infected. The best way from avoiding anal fistulas occuring in the first place is to maintain a sustainable and healthy lifestyle. Try to eat nutritional food and follow good habits as this will maintain healthy tissues. Also, avoid smoking as it promotes and boosts fistula healing.

Dos

• Keep the anal region dry at all times
• Eat fibre rich food as this will make the stool soft, and pass through easily
• Never hold in the urge to defecate, do it right away, whenever the sensation arises.
• Exercise regularly
• Stay hydrated and increase fluid intake

• Don’t strain while defecating
• Avoid smoking as it damages tissues

If you have any of the above fistula symptoms, consult your healthcare provider. The doctor will ask you a few preliminary questions about the symptoms you have been experiencing, along with your medical history. At the time of a physical examination, the doctor will examine the region near the anus for the presence of a fistula. They might also press the area to check for any soreness and pus discharge.

Some fistulas are easily visible, while the others are harder. The fistulas can also close and open on their own.

The doctor might also use these tools for proper diagnosis:

• A fistula probe: A thin probe will be inserted via the external opening of the fistula. The doctor might inject a special dye to see where the fistula opens on the inside.
• Anoscope: This is a hollow-tube like device that is used by medical professionals to look inside the anal cavity.
• Images: The doctor might refer you to a colon specialist. The specialist in turn might requesyou to get an ultrasound, where images of the anal area are created using sound waves. Alternatively, the doctor might suggest an MRI where images are created using special magnets.

If your anal fistula condition is left untreated, then abscesses may become permanent, causing pain, bleeding, skin infections, sepsis, and faecal incontinence or inability to control bowel movements.

However, there could be some complications after surgery as well. Infection, faecal incontinence caused by removal of the anal sphincter, or development of further fistulas might occur.

If you have chronic and recurring symptoms of the anal fistula condition, contact your medical professional. They will scan the anal region and might also carry out a rectal examination to check for signs of a fistula.

It is vital to get an anal fistula checked and treated immediately. Leaving the fistula untreated will make it worse, and the infection will cause more discomfort.

Surgery is the only way to effectively cure an anal fistula, but there are some home remedies that can be applied for symptomatic relief. Follow these treatments while waiting for the surgery for temporary relief.

• Sitz bath: A sitz bath is basically soaking the anal region in warm water, as it brings temporary relief from pain, swelling, and irritation. This bath can be taken several times each day, but make sure the tub is clean before every use.If suggested by the doctor, you can also add betadine or some other disinfectant.
• Stool softener: if you struggle from constipation, straining while defecating can worsen the fistula. Use some stool softener or a laxative as they ease the passing of faeces. However, consult the doctor before using these.
• Soft seating: Try and sit on soft surfaces- either a small pillow or a rolled up cloth/towel. Use this technique while at work, as this will ease the pain of the fistula.
• Ointments: There are certain ointments or creams that are available. These creams are generally antibiotic and anaesthetic, and require a doctor’s prescription. The ointment is used to numb the pain, and can reduces the swelling in the area. Only use these ointments after seeking the doctor’s permission.
• Hydration: Staying hydrated is the best and easiest home remedy to provide relief from anal fistulas. Drinking enough fluids ensures that the stool is not hard, lowering the pressure on the fistula.
• Fibre intake: Pay special attention to the amount of fibre consumed if you have anal fistulas. The doctor might recommend you to consume more/less fibre depending on the state of the fistula. Consuming more vegetables, fruits, whole grains, and nuts are the easiest way to increase fibre intake.
• Personal hygiene: Maintain good personal hygiene, especially if you have an anal fistula. Clean the anal gland very cautiously and wash your hands with soap and water each time before and after cleaning up.

What you eat has a great impact, especially if you have an anal fistula. Patients must try to eat healthy, follow a proper diet, and maintain personal hygiene. Some of the best food to eat during anal fistulas are:

• Carrots, tomatoes, and green leafy vegetables are a rich source of beta carotene. This beta carotene converts into retinol, an active form of Vitamin A. Vitamin A is essential in repairing the tissues.
• Citrus fruits like mandarins, oranges, strawberries, and tomatoes must be consumed as they contain Vitamin C. This prevents water retention and reduces the risk of further infections.
• Dry fruits like cashews, peanuts, walnuts, and almonds contain zinc, which stimulates the formation of new cells, while repairing the damaged cells.
• Raw fruits and vegetables should be eaten as they contain Vitamin B and Vitamin C. This helps to reduce infection and also reduce the extremity of the condition.
• Raw cabbage juice is an excellent stool softener, helping reduce constipation.
• Fresh orange juice boosts the recovery process.
• Consume a lot of salads, and add cucumbers, tomatoes, sprouts, microgreens, and lettuce.
• Replace white rice with brown rice.

Avoid some food items as they can aggravate the anal fistulas.

• Avoid spicy and oily food as they have a tendency to cause bleeding from the anus.
• Eat smaller portions, and eat frequently. Make sure to consume more salads, sprouts, and microgreens.
• Avoid spicy salad dressings. Opt for seasoning with less oil and spices.
• Avoid coffee or tea. Replace these beverages with a glass of warm water. Add lemon juice as it stimulates bowel movements.
• Avoid consuming fried items like chips and fries. Also, don’t eat junk food like burgers and pizzas. Junk food contains refined flour or maida, which increases anal fistula problems, slows down metabolism and even causes constipation.
• Consume milk products in moderate quantities only. Don’t have a lot of paneer, yoghurt, or milk.

The safest way to get rid of the anal fistula is to undergo a surgical procedure. However, certain fistulas can be tackled with antibiotics and other medication. If the infection does not respond positively to the medication an emergency surgery might be suggested to the patient.

If you opt for fistula removal, you should know about some of the options:

• A medical plug is used to close the fistula, helping it to heal and close
• A thin cord called a seton is placed inside the fistula that drains any infection and allows it to heal
• Make an incision along the stretch of the affected region of the fistula to open it and give it enough time to heal
• Medical glue can be used to close the fistula

Depending on the extent of the fistula any of these removal methods can be used.

If you have an anal fistula, it is important to know all details about the treatment, surgery, and medicines. Read ahead to know more.

When you visit your general physician with an anal fistula, they will recommend you to an expert. A proctologist is a specialist doctor who deals with anorectal diseases. A proctologist manages piles, fistulas, and fissures. A general physician can also treat an anal fistula, but a procotologist is a specialist in this field. You will find the most experienced proctologists or general surgeons at Pristyn Care.

If you want to treat anal fistulas without adopting the path of surgery then using a fibrin glue is the only way. The surgeon will administer general anesthesia to the patient and will insert the fibrin glue into the fistula. This glue is used by medical professionals because it encourages the fistula to heal slowly and seal the affected region.

This method is useful to treat simple fistulas, but the results might not be long lasting. For fistulas that pass through the anal sphincter, a fibrin glue can be easily used because it does not get cut.

Calcium channel blockers, topical nitrates, and onabotulinumtoxinA injections are considered to be the best and most effective medication to treat anal fistulas. The medicines are useful in reducing the tone of the anal sphincter, increasing the anodermal blood flow.

Patients may also be prescribed antibiotics, especially if they show clinical symptoms. Also, antibiotics like ciprofloxacin and metronidazole are prescribed for 7-10 days post surgery. These drugs are useful in preventing recurring of anal fistulas after the incision.

There are a few surgical methods to get relief from anal fistulas.

• Fistulotomy: A fistulotomy is a surgical operation that requires cutting open the entire fistula across the length, so that it can heal into a flat scar. This procedure is most effective for fistulas that are unable to pass through the anal sphincter, as the tendency of incontinence is the least here. If the surgeon has to make a cut through a small portion of the anal sphincter, they will try and reduce the risk of incontinence, or even suggest an alternative form of surgery.
• Seton: This is basically a surgical thread kept within the fistula for several weeks, as it keeps it open, allowing it to drain and heal. This method is mostly applicable for cases in which the fistula passes through a large portion of the anal sphincter. A loose seton will aid the the fistula to drain without curing it. A tighter seton has to be made use of to cut through the fistula, managing it completely.
• Advancement flap procedure: The advancement flap procedure is recommended if the fistula goes through the anal sphincter. This method cuts out the fistula and then covers the depression with a piece of tissue taken from the rectum. Although this method has a lower success rate as compared to a fistulotomy, it eliminates the requirement of cutting the anal sphincter muscle.
• LIFT: This is short for ligation of the intersphincteric fistula tract, and is another option when the fistula passes via the anal sphincter muscle. This treatment entails making a cut in the skin above the fistula, moving the sphincter muscle apart. The fistula is sealed and eventually cut open. A new age technique, more research is required on this form of surgery to confirm the effectiveness in curing the anal fistulas.
• Endoscopic ablation: This procedure entails inserting an endoscope with a camera attachment at the end, into the anal fistula. An electrode passes via the endoscope, and is used to the fistula.This method is effective as there are no serious safety concerns.
• Bioprosthetic plug: A bioprosthetic plug is inserted with the intention to obstruct the opening of the fistula. This cone shaped plug is made from animal tissue, and it works well in obstructing an anal fistula without causing any complications.

Fistula surgery in itself is not painful as you are under general anaesthesia. However, you will experience some discomfort for about a week post surgery. Take some OTC like a paracetamol or ibuprofen to relieve the pain.

While it depends on the kind of surgery and the size of the fistula, it normally takes from 1-2 weeks to recover from anal fistula surgery. After the surgery, you are likely to experience some discomfort for a week.n nThe wound will fully heal in about 6 weeks. Depending on the size of the fistula, you might be required to go to the hospital to change the dressing, or for cleaning the wound daily. Your doctor might suggest a gauze pad to protect any discharge from the wound.nnYour doctor may ask you to shower or bath more frequently, to ease the discomfort and keep the wound clean. Avoid adding any fragrance or soap to the bath water, as this could irritate the wound. n

While the cost of the fistula treatment is impacted by many factors like the type of surgery and the hospital, the starting price is from Rs. 45,000. The average cost starting from doctor’s consultation, surgery, and then recovery is somewhere around Rs. 52,500.

Anal fistula surgery is a permanent cure. In case of recurrence of the anal fistula, the doctor will recommend another procedure.

Most anal fistulas heal within 6 weeks, and there are some general post treatment guidelines that must be followed:

• Take paracetamol or ibuprofen to alleviate the pain.
• Clean the wound by washing it properly. Dry the wound by patting it, not by rubbing it.
• Change the wound dressing.
• Use a gauze pad to prevent discharge from soiling the clothes.
• Avoid sexual intercourse for some time after the operation.
• Exercise gently to avoid infections.

There are some side effects that a patiient can experience either at the time of the fisula operation or after it. These side effects include bleeding, infection, or a reaction to anaesthesia. Some of the other complications are:n

• Bowel incontinence: The urge to defecate and inability to control it is a side effect to anal fistula surery. The probability of suffering from bowel incontinence depends on the kind of fistula surgery. If the surgery has been done by a good surgeon, chances of bowel incontinence are extremely low.
• The wound could take a longer time to heal.
• The fistula can recur in some cases. If it comes back, you may need a different kind of fistula repair surgery.
• In some cases stenosis may happen. Stenosis is the narrowing of the bottom of the anal canal. This usually happens when the fistula starts to heal, making it difficult to defecate.

  Despite these side effects, it is recommended that the person undergoes fistula surgery. The benefits of this surgery outweigh the side effects that may occur, as living with a fistula can be extremely painful. The doctor will provide the correct guidance and mitigate these side effects. Visit an expert doctor at Pristyn Care for a second opinion.

Anal fistula surgery is not a serious surgery, and should definitely be opted for. Fistulas do not heal themselves, and the home remedies might provide some relief, but surgery is the best option for a permanent cure. Living with anal fistulas ca get quite discomforting and can affect the quality of a person’s life negatively. Book an appointment with an expert medical professional at Pristyn Care, and get the best treatment.