Anal Fistula Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Anal fistula disease is the medical term for the condition of the formation of a tunnel under the skin that connects the skin to the anus.
In effect, a hole will form in the skin, where fluid or feces can come out through the hole.
Most cases of an anal fistula are caused by an infection in the glands in the anal area.
An anal fistula is the term for the condition of the formation of a tunnel under the skin that connects the skin to the anus. What caused it? Check here.
Anal fistula
| Medical specialist | Surgical specialist |
| Symptom | Anal pain, spontaneous discharge or stool |
| risk factor | smoking, obesity, diabetes |
| How to diagnose | Physical examination |
| Treatment | Surgery |
| Drug | Antibiotics, if there is an infection |
| Complications | Difficulty holding bowel movements (fecal incontinence), recurrence of anal fistulas |
| When to see a doctor? | Presence of severe pain in the anus that does not go away, especially with spontaneous discharge or stool. |
Symptom
Symptoms that arise from anal fistulas can include:
- Pain and swelling around the anus
- There is bleeding from the anus
- There is a sharp or unpleasant odor around the anal skin
- The formation of a hole in the skin and fluid or feces appears from the hole
- The skin is red and sore due to irritation
Reason
The anus has several small glands to keep it dry.
If one of these glands is blocked, gradually an infection will occur and a collection of pus will form in the anal gland. Medically, this condition is known as an anal abscess.
Under these circumstances, immediate medical treatment is needed in the form of incision and drainage of the abscess, namely the act of making an incision in the abscess so that the pus in it can drain completely and complete healing can occur.
If treatment measures are not taken immediately, the body will react by trying to find a way out for pus to come out of the glands in the anus. You do this by forming a tunnel between the anal glands and the skin.
Apart from abscesses in the anal glands, other causes of anal fistulas are injury to the anal area, cancer in the rectum or anal area, tuberculosis infection, Crohn’s disease, chronic diarrhea, and diverticulitis.
Risk Factors
Here are some risk factors for the formation of an anal fistula:
- Male sex (the incidence of fistula ani in male: female is 12.3: 5.6 100,000 population)
- Obesity
- Diabetes
- Smoke
- High cholesterol
- Sedentary lifestyle
Diagnosis
To ensure the presence of an anal fistula, initially the doctor will conduct an interview regarding the complaints that are experienced.
In addition, the doctor will do a physical examination, especially in the area around the anus. The doctor will see if there is inflammation in the anus and holes in the skin around it.
If there is a hole that is suspected to be a fistula, the doctor will check the depth of the hole and see if there is a tunnel forming that connects the hole in the skin to the gland in the anus.
Examinations that are painful for the patient can be carried out while the patient is anesthetized.
In some cases, anal fistulas are not easily visible from the outside. For this condition, the doctor needs to perform an endoscopic examination, which is an examination using a kind of camera to see conditions inside the anus and rectum.
If a fistula tunnel is found, sometimes an ultrasound or magnetic resonance imaging (MRI) examination of the anal area is also needed to see the direction and depth of the tunnel.
If an anal fistula is really found, further examination is needed to find out why it happened.
If Crohn’s disease, rectal and anal cancer, or diverticulitis is suspected, a colonoscopy will be performed.
Similar to anuscopy, colonoscopy is also an examination that uses a kind of camera to see the condition of the large intestine. This tool is inserted through the anus.
Treatment
The main treatment for anal fistulas is fistulotomy surgery. In this operation, the doctor will make an incision in the skin and muscles up to the fistula tunnel.
Upon reaching the area, the tunnel will be completely cleaned of tissue and cells that shouldn’t be there.
The goal is to stimulate complete healing while closing the tunnel tightly so that the fistula disappears.
After fistulotomy surgery, the doctor will generally give medicine to soften the stool for several days to a week to reduce pain and discomfort after surgery.
Another treatment that can be done is to fill the anal fistula tunnel with some kind of glue.
The goal is to glue the anal fistula tunnel walls so that the tunnel is tightly closed. However, this treatment is often less effective.
In most cases, anal fistula patients do not require medication. However, in certain cases such as an infection found, antibiotic treatment will be given.
Prevention
Consuming adequate amounts of fiber and 1.5–2 liters of water per day is good for preventing constipation and keeping stools soft.
This step will also prevent injury to the anus. This will indirectly prevent the formation of anal fistulas.
Complications
One of the risks of having anal fistula surgery is damage to the anal valve, which causes difficulty holding bowel movements (fecal incontinence).
Therefore, diagnosis and planning of surgery should be carried out thoroughly.
In the first year after treatment, the chance of an anal fistula reappearing is higher.
This is especially the case in patients with diabetes, smoking, obesity, and having a history of anal fistula surgery.
When to See a Doctor?
If there is severe pain in the anus that does not go away, especially with spontaneous discharge or stool.