Health is one of our most precious assets, but we often pay little attention to the warning signs our bodies send to us. Pain or unusual sensation, particularly in the anal region, causes confusion and complications, especially when it involves fistulas. According to a study, anal fistula is found in 8.6 cases out of 100,000 people. If identified early and promptly treated, anal fistulas can be cured. In this blog, let us delve into the specifics of anal fistula and uncover the answer to the most important question: how do you know if you have a fistula?
What is Fistula?
An anal fistula is an abnormal tunnel-like passage between the anal canal and the surrounding skin. It may be caused by infections, abscesses, injury, or other conditions affecting the anal region.
Anal fistulas are typically the result of an infection originating in an anal gland. This infection leads to an abscess, a collection of pus within the tissue. When this abscess develops a single internal opening within the anal canal, it is referred to as a sinus. However, if the infection progresses and creates an external opening through the skin, it becomes a fistula.
The anal fistula provides an unintended pathway for faecal matter and pus to escape, often causing leakage that is beyond the patient’s control due to the absence of sphincters in the tract. This condition can cause significant discomfort and awkwardness in daily life.
Fistulas generally occur within the anal region, but they can also occur in other urinary tract and digestive systems. Anal fistulas are painful and cause infections in some cases if left untreated. So, early recognition and treatment are crucial to avoid complications.
Symptoms of Fistula
Recognition of anal fistula symptoms will help you identify whether you have a fistula. Some common symptoms include:
- Abnormal Discharge or Pus: The primary sign of a fistula is a foul-smelling discharge from the anal region.
- Persistent Pain or Ache: Pain or discomfort around the anus often worsens by sitting, bowel movements, or certain activities.
- Swelling in the Affected Region: Inflammation may take place, causing swelling around the anus, indicating an underlying problem.
- Changes in Bowel Habits: Difficulty passing stool, frequent bowel movements, or irritation in the anal region may be linked to an anal fistula.
If you have such symptoms, the prudent step is to seek medical attention to diagnose the problem.
What are the Causes of Fistula?
Most anal fistulas arise as a result of an anal abscess. If an abscess does not heal properly after drainage of pus, then the fistula may develop. In 40% of the cases where the anal abscess is drained, fistulas are formed.
Other less common causes of an anal fistula are:
- Crohn’s Disease: A disease which causes chronic inflammation of the digestive tract.
- Diverticulitis: An infection of the small pouches that can develop in the wall of the large intestine; such pouches are called diverticula.
- Hidradenitis Suppurativa: A chronic skin disease that produces abscesses and scarring.
- Infections: Diseases like tuberculosis (TB) and HIV can cause fistulas to form.
- Surgical Complications: Fistulas may occur as a result of the surgeries performed near the anus.
Treatment Options for Fistula
Patients typically consult experts such as gynaecologists, urogynecologists, or colorectal surgeons when they need fistula treatment. Once the presence of a fistula is determined, the healthcare provider will determine the most appropriate treatment plan to undertake.
Non-invasive Treatment Approaches
Some of the non-surgical treatment options are:
- Fibrin Glue: A specific type of medicinal glue is employed to seal the fistula. This subsequently facilitates the subsequent process of healing.
- Fistula Plug: The plug is usually a collagen matrix placed to fill the fistula and promote closure.
- Catheters: Catheters are used for small fistulas to drain fluid and manage infection, thereby alleviating symptoms.
- Kshara Sutra and Kshara Karma: Older Ayurvedic treatments where medicated threads are applied to the fistula tract
Medicinal Treatment
Drugs and antibiotics may be prescribed to manage any infection temporarily, caused by the fistula. Nonetheless, there are no drugs that may be able to cure fistulas completely from a body.
Some of the advanced treatments include:
- LIFT: It is a minimally invasive procedure that sutures the fistula tract.
- Laser Fistulectomy/ fistulotomy: Surgical intervention that mainly implies excision of the fistula tract or cutting open the tract using a laser and allowing it to heal.
- Seton Application: A thread keeps the fistula open to allow it to drain and heal.
- PERFECT: A relatively newer approach intends to preserve the sphincter function.
- Total Excision and Repair: Total removal of the fistula with subsequent closure of the opening.
- VAAFT (Video-Assisted Anal Fistula Treatment): A video system is used for accurate identification and treatment.
Often, patients wonder how long it takes for a fistula to heal. The healing time depends on several variables, such as the type of fistula, the treatment method, and the patient’s health. Surgical treatments may be faster than medical management alone.
A fistula might take a few weeks to a few months to heal. Also, it can recur in 7% to 21% of patients. You must follow up with the care provider to ensure proper recovery and avoid recurrence.
What Happens if a Fistula is Not Treated?
If my fistula is untreated, the following complications can occur:
- Chronic Infection: Untreated fistulas eventually cause infection, creating further health problems.
- Spreading of the infection: When not treated, fistulas tend to spread in different directions and higher up the anal canal, which makes it complex to treat and may require a bigger surgery and a longer time to heal after surgery.
- Abscess Development: A pus-filled abscess may be formed, which will be painful and require drainage.
- Influence on Quality of Life: Discomfort and the threat of embarrassing symptoms influence daily activities and mental well-being.
- Serious Health Issues: Untreated fistula can lead to severe complications due to unnecessary connections between organs.
Continue reading here about: How to Identify a Fistula?
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