Anal fistula Treatment in Indore

Anal Fistula – Description

An anal fistula is an abnormal tunnel or tract that occurs between the anal canal, inside the anus, and the skin surrounding the anus. It generally develops as a consequence of an anal abscess infection of the anal glands. An anal fistula can lead to chronic drainage, pain, and irritation, and if left inadequately treated, recurrence is also possible.

Common symptoms include:

Recurring painful lumps or abscesses around the anus

Persistent discharge of pus or blood from an opening around the anus

Pain with bowel movements

Irritation or itching around the anus

Fever in case of infection

Fistulas never heal by themselves and generally require medical or surgical intervention.

Types of Anal Fistula

Anal fistulas are categorised by their relation to the anal sphincter muscles:

1. Intersphincteric Fistula

Passes between the internal and external sphincter muscles

Most common type

2. Transsphincteric Fistula

Passes through both the internal and external sphincter muscles

May reach the skin around the anus

3. Suprasphincteric Fistula

Starts at the internal sphincter, arches above the external sphincter and opens on the skin.

Less common

4. Extrasphincteric Fistula

Originates outside the sphincter complex and extends to the skin

Rare; usually due to trauma, Crohn's disease, or infection

Anal Fistula Treatment

1. Medical Management

Antibiotics: Only for acute infection or associated abscess

Pain relief using analgesics

Note: Medical treatment cannot heal a fistula but can only control the infection and inflammation.

2. Surgical Treatment

Most fistulas need surgical treatment to remove the tract and prevent recurrence:

Common Procedures:

Fistulotomy: The tract is opened and cleaned, then allowed to heal from the inside out.

Seton placement consists of placing a thread to drain the infection and gradually cutting through the sphincter in complex fistulas.

Advancement flap procedure: Utilised for high or complex fistulas to close the internal opening

LIFT procedure: Ligation of the intersphincteric fistula tract, a minimally invasive approach to preserve sphincter function

Fibrin glue or plugs: In selected cases, to seal the fistula tract

3. Postoperative Care

Maintain perianal hygiene

Sitz bath for pain relief and healing

Follow-up to detect recurrence

Prevention of Anal Fistula

1. Prompt Treatment of Anal Abscess

Early drainage of an abscess prevents fistula formation.

2. Practice Anal Hygiene

Cleaning gently after bowel movements

Avoid irritation

3. Manage Constipation

High-fiber diet

Adequate hydration

Stool softeners, if needed

4. Address Underlying Conditions

Control Crohn's disease, infections, or other gastrointestinal conditions 5. Avoid Trauma: Careful management of anal procedures or injuries