Anal Fistula – Diagnosis and Treatment
Diagnosis
Diagnosing an anal fistula starts with a discussion about the person’s symptoms, such as pain near the anus, drainage of pus, fever, or swelling.
The health care provider performs a physical exam to check the skin around the anus for any openings or signs of infection.
The provider carefully inspects the rectum and anal canal to find both the external and internal openings of the fistula.
Sometimes, the doctor uses special tools during the exam:
- Fistula Probe: The provider gently inserts a narrow, flexible tool to map the tunnel’s path.
- Anoscope: A small lens allows the provider to view the inside of the anal canal and check for hidden openings.
If the path of the fistula is not clear or if it runs deep through important muscles like the sphincter, the provider may order imaging tests:
| Test/Procedure | Purpose |
|---|---|
| MRI | Provides detailed pictures of the anal canal, sphincter, and helps map the fistula’s tunnel. |
| Endoscopic ultrasound | Uses sound waves to visualize the tunnel and surrounding tissues in the pelvic floor. |
| Fistulography | Involves injecting contrast dye and taking X-rays to show the tunnel on imaging. |
| Flexible sigmoidoscopy | Examines the lower colon to find related digestive tract issues. |
| Colonoscopy | Looks at the full colon, helpful if Crohn’s disease or cancer is suspected. |
If the exam is too painful or complicated, the provider can perform it under anesthesia to ensure accuracy and comfort. Sometimes a dye is injected to help locate hidden passages.
The provider also rules out other problems, such as rectal cancer, colon cancer, or conditions like Crohn’s disease that can affect the anal glands and digestive tract.
Treatment
The approach to managing an anal fistula depends on its location, complexity, and cause. The main goals are to fully repair the fistula, prevent recurrence, and protect the sphincter muscles.
If these muscles are injured, the patient risks losing control over bowel movements.
Surgical treatment is the most common approach. Here are some main procedures:
- Fistulotomy: The surgeon opens the fistula tunnel, cleans out infection, and stitches the tunnel flat. For tricky cases, the surgeon may remove part of the tunnel or perform the process in two steps.
- Endorectal Advancement Flap: The surgeon uses a piece of tissue to cover the repair after removing the fistula’s inner opening. This method can save more of the sphincter muscle.
- LIFT Procedure (Ligation of the Intersphincteric Fistula Tract): For more complex or deep fistulas, the surgeon places a string called a seton to widen the tunnel. After some weeks, the surgeon removes the infected tissue and closes the internal opening.
- Fistulectomy: The surgeon removes the whole fistula tract. This method is used for certain types or more persistent tunnels.
- Seton Placement: The surgeon may leave a seton, such as a silk or latex string, in place to help drain infection and promote healing. Sometimes, this is used before other surgical steps.
Other surgical methods for complex cases:
| Method | What It Involves |
|---|---|
| Ostomy/Stoma | The surgeon creates a temporary opening in the abdomen to divert stool. |
| Muscle Flap | The surgeon uses healthy tissue from another area to fill the tunnel. |
Non-surgical options may help in select cases, especially for patients for whom surgery is a risk:
- Fibrin Glue or Collagen Plug: The provider clears the tunnel and shuts it internally. Fibrin glue or a collagen plug is placed into the tunnel to seal it.
- Antibiotics and Medication: These do not usually cure a fistula alone but may help if there is an infection or a condition like Crohn’s disease.
- Seton Alone: For simple infections or those not ready for surgery, a seton string may help drain the abscess and allow healing.
Common Steps in Surgical Treatment
- The provider uses a probe to find the precise path of the fistula.
- The provider clears out infected tissue and debris to lower the risk of the infection coming back.
- During any procedure, the provider carefully protects muscles near the fistula to avoid incontinence.
Proper care is important for healing after any form of anal fistula treatment. It is essential to follow up with the care team for wound checks and to manage any complications, such as infection, abscess, or fistula recurrence.
Healthy Habits and Home Tips
To ease pain, swelling, and itching around the anus, people can try several home steps:
- Take warm sitz baths to help soothe discomfort and redness.
- Use over-the-counter pain medicine, if needed.
- Add more fiber and drink water to keep stool soft and avoid straining.
- Clean the area gently after each bowel movement.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Patients should contact the clinic to check if any special preparations are needed, such as avoiding food or drinks before certain tests. Writing down all symptoms—even minor ones—will help keep track of concerns.
It is also smart to note major life events, sources of stress, recent changes, and personal or family health history.
A table can help organize medications and supplements:
| Name | Dosage | How Often Taken |
|---|---|---|
| Example: Lisinopril | 10 mg | Once daily |
| Vitamin D | 1000 IU | Once daily |
Prior to the meeting with the healthcare provider, prepare a list of questions, such as:
- What might be causing these symptoms?
- Are there different possible explanations?
- Will tests be needed?
- Is the issue short-term or long-lasting?
- Are there foods to avoid or include?
- Are there activities to avoid?
- What treatments are available?
- Are there other options besides the first suggested treatment?
- How can other health conditions be managed together?
The patient should bring their questions to the appointment and feel free to ask anything new that comes up.
Questions Your Healthcare Provider May Ask
A healthcare provider may ask a series of questions to better understand the situation. Examples include:
- When did these symptoms start?
- Are the symptoms constant or do they come and go?
- How intense are the symptoms?
- Where is the discomfort located?
- Is there anything that makes the symptoms better?
- Is there anything that makes them worse?
- Does the patient have other health problems, like Crohn’s disease or digestive issues?
- Is constipation an issue?
If you prepare to answer these questions, you can make the appointment more productive and give the provider important information.
