6 Most Common Questions About Fistulas – Answered

If you have been diagnosed with fistula, you may have some questions about what it is, why you have it, and what can be done to cure it. Below are the answers of the most common questions we receive about fistulas. Read to know more about. 

  1. What Is Fistula?

Fistula is an inflammation of the blood vessels of the anal canal, which results in an abnormal channel between the anal canal and the skin near the anus. Usually, this disease is seen in the people who had an anal abscess earlier. An anal abscess is a cavity that is filled with purulent discharge. Fistula occurs when the drained abscess does not heal completely. Fistula results in bleeding along with discharge from it. Once fistula develops, it should be treated properly on time. Untreated fistulas can get severe with time and can cause persistent drainage for a long period of time. 

Fistula may potentially cause bowel incontinence if left untreated or not treated professionally. An obstetric fistula may develop between the rectum and the vaginal cavity in case of complicated vaginal deliveries. Also, people younger than 40 years of age are prone to developing fistula.

Different types of fistulas are classified by their location. Below are the various types of fistulas. 

Intersphincteric Fistula — In case of this type of fistula, the tract begins in the space between the internal and external sphincter muscles and opens very close to the anal opening. 

Transsphincteric Fistula — The tract begins between the internal and external sphincter muscles or in the space behind the anus. It crosses the external sphincter and opens an inch or two outside anal opening. Transsphincteric fistula can wrap around the body in a U shape, with an external opening on both sides of the anus.

Suprasphincteric Fistula — In this case, the tract begins in between the internal and external sphincter muscles. It goes upward to a point above the puborectalis muscles. Then it crosses puborectalis muscles and extends downward between puborectalis and levator ani muscle. Then, it opens an inch or two outside the anus. 

Extrasphincteric Fistula — In case of extrasphincteric fistula, the tract begins at the rectum or sigmoid colon. Then it goes downward, passing through the levator ani muscle and opens around the anus. Usually, these types of fistula are caused by a diverticular abscess, appendiceal abscess or Crohn’s disease.  

  1. What Are The Causes Of Fistula?

There are several glands inside your anus that make fluids. But sometimes either they get blocked or clogged. When this happens, a bacteria buildup can create a swollen pocket or infected tissue and liquid, which is medically called an abscess. If you do not get the abscess treated, it will grow and eventually make its way to the outside and punch a hole in the skin near the anus so the gunk inside it can drain. Experts believe that most of the time abscess causes fistula. However, some other conditions can also contribute to fistula development. This includes the following:-

  • Tuberculosis
  • Chronic diarrhea
  • Chronic constipation
  • Lifting heavy weights
  • Prolonged anal fissure
  • Sexually transmitted diseases
  • Excess straining during bowel movements
  1. What Are The Symptoms Of Fistula?

There are several symptoms of fistula that can help you in understanding your disease and its severity. Consult a doctor immediately if you notice any of these symptoms. Early medical intervention can help in curing the disease very easily, quickly and permanently. Below are the most common symptoms of fistula.

  • Redness
  • Bleeding
  • Skin irritation
  • Frequent fever
  • Discharge of pus
  • Swelling around anus
  • Pain in the anal region
  • Recurring anal abscess
  • Painful bowel movements
  • Straining while bowel movements
  • Itching and discomfort in the anal region
  1. How Is Fistula Diagnosed?

Usually, it is simple and easy to locate the external opening of the fistula. However, locating the internal opening of the fistula can be more challenging and tedious. It is important for a doctor to find the entire fistula for effective treatment. Generally, the external opening of the fistula is inflamed, red, oozes pus and is sometimes mixed with blood. The location of the external opening gives a clue to a fistula’s likely path and sometimes the fistula can be felt. However, locating its visual path requires various tools and oftentimes it may not be even seen until surgery. 

Tools that are often used to diagnose fistula include:-

  • Fistula probe — This is an instrument specially designed to be inserted through a fistula. 
  • Anoscope — It is a small instrument that is used for visualization of the anus and lowest portion of the rectum. An anoscope is a tube that can be inserted into the anal canal. When the tube is inserted, a light attached to it helps the doctor to visualize the wall of the anus and the lower rectum. 

If your fistula is potentially complicated or in an unusual place, following tools are used to diagnose the fistula.

  • Diluted methylene blue dye. Injected into a fistula.
  • Fistulography — Injection of a contrast solution is injected into a fistula and then X-ray is done. 
  • Magnetic resonance imaging.

Below are the tools that are used to rule out other diseases such as ulcerative colitis or Crohn’s disease. 

  • Flexible sigmoidoscopy — This is a thin and flexible tube with a lighted camera inside the tip that helps the doctor to see the lining of the rectum and sigmoid colon as an image on a television screen. 
  • Colonoscopy — It is similar to sigmoidoscopy but with the ability to examine the entire colon or large intestine. 
  1. What Is The Best Treatment Of Fistula?

There are several treatment options for treating fistula. However, laser surgery is considered the best and permanent treatment. Usually, treatment of fistula without surgery is not possible. Laser surgery is gaining popularity due to its benefits and effectiveness. 

During the surgical procedure, the doctor introduced a precise amount of laser energy in your fistula tract through a thin laser probe. After that the doctor destroys fistula tissues and the laser probe is pulled back closing the tract. The surrounding tissues are left intact during the whole procedure. Laser surgery for fistula takes around 30-40 minutes and the recovery is very short and comfortable. 

There are several other advantages of fistula laser surgery. This includes the following:-

  • Quick recovery
  • Short procedure
  • Minimally invasive 
  • Daycare procedure
  • There are fewer stitches
  • No restrictions on diet
  • Painless and bloodless 
  • Fewer chances of infection
  • Results no wounds or scars
  • Almost no chance of recurrence
  • Same day treatment & same day discharge
  • Can resume daily life activities within 48 hours

Consult a doctor as soon as you notice symptoms of fistula such as itching, soreness, pain or bleeding in the anal region. Fistula needs immediate medical intervention. If fistula is left untreated, it may cause other health issues. Therefore, visit the nearest clinic for the diagnosis of fistula and get the best treatment. You can also consult experts online for any queries related to anal fistula or other anorectal diseases.  


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