WHAT IS A ANAL FISTULA ?

An anal fistula is an abnormal tunnel or passageway that forms between the inside of the anus or rectum and the outside skin near the anus. It often develops as a result of an infection or inflammation in the anal glands or adjacent tissues. Anal fistulas can cause pain, discomfort, and recurrent infections, and they typically require medical treatment or surgical intervention to heal properly.

WHY DO ANAL FISTULA OCCURS

Anal fistulas typically occur as a result of an infection or inflammation in the anal glands. Here’s a more detailed explanation of the process:

1. Infection or abscess : It often starts with an infection or abscess (a pocket of pus) in the anal glands. These glands are located just inside the anus and are responsible for producing mucus to help with bowel movements.

2. Blocked anal gland : When an anal gland becomes blocked, it can become infected. The infection may cause an abscess to form, and the pressure from the abscess can lead to the formation of a tunnel or tract through the surrounding tissues.

3. Fistula formation : As the infection tries to find a way to drain, it can create a small tunnel that connects the inside of the anus or rectum to the outer skin near the anus. This tunnel is what’s known as an anal fistula.

TYPES OF ANAL FISTULA

There are several types of anal fistulas, classified based on their location and characteristics. The most common types include:

1. Intersphincteric Fistula : This type of fistula runs between the two sphincter muscles (muscles that control the anus). It’s relatively shallow and may be less complex.

2. Transsphincteric Fistula : This fistula traverses both sphincter muscles and is typically more complex than the intersphincteric type.

3. Suprasphincteric Fistula : This type starts above the sphincter muscles, goes around them, and then connects to the rectal cavity. It’s often considered more complex and may require specialized treatment.

4. Extrasphincteric Fistula : An extrasphincteric fistula bypasses the sphincter muscles and follows an external route to the skin around the anus. It is considered more complex and may require special attention during treatment.

5. Horseshoe Fistula : This type forms a curved or horseshoe-shaped tract around the anus, often connecting with both sides of the sphincter muscles. It can be challenging to treat due to its shape.

6. Blind Fistula : A blind fistula is a type of fistula that doesn’t have an external opening, and it may not produce noticeable symptoms until it becomes infected.

SYMPTOMS OF ANAL FISTULA

The symptoms of an anal fistula can vary depending on its location, complexity, and whether it’s currently infected or not. Common symptoms of an anal fistula may include:

1. Pain : Persistent or recurrent pain around the anus is a common symptom.

2. Swelling : You may notice swelling or a lump near the anus.

3. Discharge : An anal fistula often produces foul-smelling discharge or pus, which may stain underwear.

4. Itching or irritation : The skin around the anus may become itchy or irritated due to the discharge.

5. Bleeding : In some cases, you may notice blood in the stool or on toilet paper.

6. Fever : If the fistula becomes infected, you may experience a fever, along with increased pain and swelling.

7. Difficulty sitting : Pain and discomfort may make it difficult to sit comfortably.

8. Recurrent infections : Anal fistulas can lead to recurrent abscesses or infections in the anal area.

Treatment of Anal Fistula

 The treatment of an anal fistula typically involves medical or surgical approaches, and the choice of treatment depends on the type, location, and complexity of the fistula. Here are some common treatment options:

1. Incision and Drainage (I&D) : If the fistula is associated with an abscess, the initial step may involve draining the abscess. This relieves pain and pressure, but it doesn’t usually cure the underlying fistula.

2. Medication : Antibiotics may be prescribed to treat or prevent infection, especially if an abscess is present.

3. Seton Placement : A seton is a piece of thread-like material that is inserted through the fistula tract and left in place for weeks or months. This helps to promote drainage and prevent recurrent infection.

4. Fistulotomy : In this surgical procedure, the entire fistula tract is cut open and allowed to heal from the inside out. It’s suitable for simple, superficial fistulas.

5. Advancement Flap Repair : This procedure involves creating a flap of tissue to cover the internal opening of the fistula, promoting healing.

6. LIFT Procedure (Ligation of the Intersphincteric Fistula Tract) : This surgical technique involves closing off the fistula tract at both ends to promote healing.

7. Fibrin Glue Injection : Fibrin glue is injected into the fistula tract to seal it off. This is generally used for certain types of low or superficial fistulas.

8. Video-Assisted Anal Fistula Treatment (VAAFT) : A minimally invasive procedure that uses a camera to locate and treat the fistula, often with the application of glue or other sealing agents.

9. Sphincter-Sparing Procedures : Complex fistulas that involve the sphincter muscles may require more advanced surgical techniques like the LIFT procedure, mucosal advancement flap, or other methods to preserve sphincter function.

10. Laser Ablation Of Fistula Tact :- It is less invasive technique with faster recovery .