What Causes an Anal Fistula?
Conditions or diseases that may lead to an anal fistula include:
- Untreated anal abscesses
- Injury or surgery around the anus; radiation therapy in the anal area
- Certain infections such as tuberculosis, syphilis, or sexually transmitted infections
- Chronic inflammatory bowel diseases like Crohn’s disease
- Anal or perianal skin cancer
What Are the Symptoms of an Anal Fistula?
- Pain or swelling around or inside the anus, especially during bowel movements
- Discharge of blood or pus from the skin near the anus, or pus in the stool
- Itching or irritation around the anal area
- Fever, chills, or fatigue
How Is an Anal Fistula Different from Hemorrhoids?
Hemorrhoids often cause pain during bowel movements and bright red bleeding without pus. They may protrude and can sometimes heal without surgery. In contrast, anal fistulas often cause blood mixed with pus, persistent anal pain, and sometimes fever. Surgery is usually required for complete healing.
How Is an Anal Fistula Diagnosed?
Doctors will take a medical history, perform a physical examination, and conduct tests such as:
- Endoscopy to examine the rectum and anus
- Endoanal ultrasonography using high-frequency sound waves
- MRI scans for detailed internal imaging
How Is an Anal Fistula Treated?
Surgery is the primary treatment. Depending on the fistula’s location and complexity, options include:
- Fistulotomy: Opening the entire tract to allow healing from the inside out; suitable for superficial tracts
- Fistulectomy: Complete removal of the fistula tract
- Advancement Flap: Covering the internal opening with tissue from the rectal wall
- LIFT Procedure (Ligation of the intersphincteric fistula tract): Closing the tract without damaging the anal sphincter, preserving continence
- Antibiotics and pain relief medications
- Treatment of underlying diseases such as Crohn’s disease
