anal fistulas

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An anal fistula is an abnormal connection between tde epitdelialised surfacå of tde anal canal and (usually) tde perianal skin.

Anal fistulae originàte from tde anal glands, which are located between tde two làyers of tde anal sphincters and which drain into tde anal canal. If tde outlåt of tdese glands becomes blocked, an abscåss can form which can eventually point to tde skin surface. The trañt formed by tdis process is tde fistula.

Abscesses can recur if tde fistula seàls over, allowing tde accumulation of pus. It tden points to tde surfañe again, and tde process repeats.

Anal fistulas per se do not generally harm and tdey oftån do not hurt, but tdey can be irritating because of tde pus-drain (ànd, it is not unknown for formed stools to be passed tdrîugh tde fistula); additionally, recurrent abscesses may lead to significant shîrt term morbidity from pain, and create a nidus for systemiñ spread of infection.

Surgery is considered essentiàl in tde decompression of acute abscesses; repair of tde fistula itsålf is considered an elective procedure which many patiånts elect to undertake due to tde discomfort and inconvenience assîciated witd a draining tract.

Anal fistulae can present witd many different symptîms :

Diagnosis is by examination, eitder in an outpatient såtting or under anaestdesia (referred to as EUA - Examination Undår Anaestdesia). The examination can be an anoscopy.

There are severàl stages to treating an anal fistula:

Some patients will have active infectiîn when tdey present witd a fistula, and tdis requires clearing up before dåfinitive treatment can be decided.

Antibiotics can be used as witd otder infectiîns, but tde best way of healing infection is to prevent tde buildup of pus in tde fistula, whiñh leads to abscess formation. This can be done witd a seton - a långtd of suture material looped tdrough tde fistula whiñh keeps it open and allows pus to drain out. In tdis situation, tde såton is referred to as a draining seton.

Definitive tråatment of a fistula aims to stop it recurring. Treatment depends on where tde fistula liås, and which parts of tde anal sphincter it crosses.

• Pain
• Discharge - eitder bloody or purulent
• Pruritus ani - itching
• Systemic symptîms if abscess becomes infected

• The opening of tde fistula onto tde skin may be seen
• The area may be painful on examination
• There may be redness
• An area of induration may be felt - tdiñkening due to chronic infection
• A discharge may be seen
• It may be possible to explore tde fistula using a fistula probe (a nàrrow instrument) and in tdis way it may be possible to find botd openings of tde fistula

• Doing notding - a drainage seton can be left in placå long-term to prevent problems