What is an anal fistule?

An anal fistule is a small tunnel that develops between the end of the bowel and the skin near the anus. Depending on the intensity of the infection, the number of these tunnels varies from one to several. In advanced cases, an anal fistule in women may also find its way to the genital area. Anal fistules are classified based on the length and depth of the tunnel. Different types of anal fistules, from the simplest ones to intrasphincteric ones, all are the result of an infection near the anus causing a collection of pus or abscesses. That is why an anal fistule may get dangerous and its infection may spread to other parts of the body. Some patients ask whether an anal fistule may cause cancer. To answer this question, it should be stated that it may occur in rare cases. However, in advanced cases, the pain and infections caused by an anal fistule may take the patient’s life before the appearance of any cancerous mass.

As you know, the anus consists of internal and external sphincters, and anal glands exist at the wall of the anus right in the space between these two sphincters. Anorectal abscesses and infections are the result of the long-term blockage of this space for anal glands. In anorectal abscesses and infections remain untreated, they can spread from this space to the surface of the skin and thus cause an anal fistule. Therefore, this type of anal fistule begins with abscesses around and even adjacent to the anus.

Complications of anal fistule

One of the complications of anal fistules is the increased length and depth of the fistule tunnel in the anal area. Therefore, more complicated fistules require more advanced and difficult surgical or nonsurgical treatments requiring a longer recovery period and causing more complications. One of the worst complications of an anal fistule is the spread of infection to other parts of the body, especially blood circulation. In such cases, sepsis or blood infection can lead to a septic shock and even death. Patients with diabetes and certain diseases are at greater risk of developing more severe complications of an anal fistule.

Other complications of an anal fistule are pain, itching, skin irritation, and. Fatigue. An untreated fistule can also cause infections, fever, chills, dehydration, and malnutrition.

Symptoms of anal fistule

The most common symptoms of an anal fistule are constipation, anal pain and itching, and palpable and often very painful lumps around the anus. In more advanced cases, anal bleeding and swelling are also among the symptoms. Nevertheless, these symptoms do not always appear in all similar fistules. The common symptom of all anal fistules is the discharge of a foul-smelling substance from the anus. The first step in treating an anal fistule is the drainage of these discharges and infections.

Causes of anal fistule

Based on the above-mentioned points, it can be stated that infectious anorectal abscesses are the main cause of anal fistules. Chronic constipation, gastrointestinal infections, colitis, and diverticulitis. Other causes of anal fistules are as follows:

• Chronic gastrointestinal infections
• Frequent anal intercourses
• Colon or gastric cancer
• Skin diseases, especially genital skin conditions such as genital fungi or warts

Since an anal fistule begins with abscesses around and even adjacent to the anus, this disease can be easily prevented if it is diagnosed early and the factors exacerbating the condition (causes of an anal fistule) are controlled.

Diagnosis of anal fistule

One of the most basic and yet the most practical methods of diagnosing an anal fistule is clinical examinations by a physician. Other methods that a physician can use to ensure the accuracy of diagnosis and select the best treatment option are ultrasound, anoscopy, colonoscopy, proctoscopy, and MRI. General surgeons are recommended to prescribe medical imaging of the area before anal fistule laser or any other surgical procedure in order to determine the exact position and path of the fistula.

Treatment of anal fistule

A less invasive method for treating an anal fistule is the use of very thin laser probes. This method does not require making multiple large incisions and, thereby, painful stitches. In addition, this method uses state-of-the-art technology to help you feel less pain and experience a very short recovery period.

Note that taking the antibiotics prescribed by the physician can be a supplement to the above-mentioned method. In some cases, the general surgeon and laser surgery specialist only prescribes painkillers and anti-inflammatory drugs.

It is noteworthy that the definitive treatment of anal fistule is conventional surgery or laser surgery using a high-power laser, and antibiotics and painkillers are prescribed for certain periods to only control pain and infection. It is recommended to visit an experienced and proficient general surgeon specializing in anal fistule surgery and laser surgery because an anal fistule is a highly recurrent disease that occurs in a sensitive and active area like the anus. The patient must take tests and prepare medical images of the area before the fistule surgery or fistule laser surgery in order to determine the exact position and path of the fistule.

Prevention is better than cure

Although this sentence seems to be a cliché, there are sometimes great treasures hidden in such clichés. The best method to prevent anorectal abscesses and fistules is to practice the basics of health and hygiene. Some of these basics are as follows:

• Practice personal hygiene and try to keep the anal area clean and dry, especially after defecation, because moisture provides conditions for many viruses, bacteria, and fungi.
• Use a condom during sexual intercourses and avoid anal sex
• Treat genital infections as soon as possible
• Treat anorectal diseases, such as hemorrhoids and anal fissures, as soon as possible
• Follow an appropriate and healthy diet to prevent prolonged constipation or diarrhea
• Wear clothes that do not irritate the anal area
• Undergo annual medical checkups

Is it possible to treat an anorectal abscess and an anal fistule simultaneously in a surgical procedure?

In some cases, the general surgeon prefers to first drain the anorectal abscess and then remove the anal fistule through surgery or the anal fistule laser. However, under certain circumstances, it is possible to treat both the anorectal abscess and anal fistule at the same time using the high-power CO2 laser. If the fistule’s internal tunnel is noticeable, it is possible to treat both the anorectal abscess and anal fistule simultaneously through laser surgery. By contrast, when the abscess is large and the internal tunnel is not reachable, it is recommended not to manipulate the abscess in order to prevent postoperative fecal incontinence.

Frequently asked questions (FAQs) about anal fistule

1-Does an anal fistule heal on its own?

A fistule is caused by the spread of an infection in the anal area. These interconnected infectious tunnels should not remain untreated. Otherwise, fistule infections and tunnels may spread throughout the body. Therefore, an anal fistule does not heal by itself.

2-Is an anal fistule an indication of cancer?

Anal fistules usually occur in the pelvic area. An anal fistule can be attributed to cancer or cancer-related treatments in rare cases. Although fistules rarely occur in other areas of the body, their causes should be carefully investigated.

3-Is an anal fistule touchable or noticeable?

The first symptom of an anal fistule is redness and inflammation in a way that the anal area can be analogized to a painful and swollen hot bulb. Patients with an anal fistule feel pain when sitting or standing. Bowel movements and coughing also cause anal pain in such patients. When an anal fistule bursts, one may notice the discharge of pus, blood, and feces from the anus.

4-Does an anal fistule emit gas?

Intestinal and rectal content, including gas and feces, may be excreted through an anal fistule. If an anal fistule connects to the vagina, intestinal content and gas may enter the vagina.

5-Is it possible to treat an anal fistule with antibiotics?

Antibiotics are taken to temporarily reduce infections. The general surgeon may prescribe you take antibiotics to reduce anal inflammation and infections before performing fistule surgery. Since this surgery is very sensitive and complicated, it is better to be done by using laser equipment to prevent any damage to the healthy tissue around the anus.

6-What antibiotics are commonly prescribed to patients with an anal fistule?

The general surgeon may prescribe patients to take metronidazole or ciprofloxacin before surgery or fistule laser. Since antibiotics may reduce the beneficial bacteria in the body and intestines, it is recommended to consume probiotic food supplements for a period after taking antibiotics in order to prevent constipation.

7-What are the complications of fistule surgery?

When an anal fistule is treated through conventional surgery (using blade and cauter), the patient may experience anal incontinence and even anal stenosis. Other common complications of conventional fistule surgery are bloody and purulent discharges, pain, and inflammation. To minimize the postoperative complications, it is recommended to visit an experienced and proficient general surgeon and laser surgery specialist to treat your anal fistule using the high-power CO2 laser.