Anal fistulas can be both painful and complex to treat. You may notice recurring abscesses that build up, burst, and then heal just enough before the cycle starts all over again. This pattern typically occurs as the body attempts to seal off the fistula tract but leaves no exit for the infection.
If you suspect you may have an anal fistula, recognising the signs and understanding treatment options can make all the difference. To help, here we’ll discuss what an anal fistula is, symptoms to watch out for, and your treatment options.
What is an anal fistula?
An anal fistula is an abnormal channel that forms between the inner lining of the anal canal and the skin near the anus. It typically develops after an anal abscess has partially healed, leaving a tunnel through which infection can repeatedly spread.
Instead of resolving cleanly, the tract can trap fluid and bacteria. Over time, this can lead to the growth of a cyclical abscess, pain, and persistent discharge.
It’s worth noting that anal fistulas are not always straightforward. Some are simple, with a single tract, while others branch off in more complex patterns that can affect deeper areas of tissue.
Common risk factors include Crohn’s disease, previous anal abscesses, or any condition that compromises the body’s ability to heal.
Spotting the signs
Symptoms vary from patient to patient, but there are a few common signs you can watch out for. If you notice persistent pain in the anal area, recurring abscesses, or discharge of blood or pus near the anus, it’s time to consider an anal fistula as a possible cause.
The pain often intensifies during bowel movements or when sitting for extended periods. Sometimes, patients mention feeling a small lump or having ongoing irritation around the anus.
Anal fistulas may also produce a low-grade fever if an infection flares up. Over-the-counter treatments can offer temporary relief, but they rarely address the underlying issue. Because infection often recurs, it’s best to seek a professional diagnosis sooner rather than later.
A physical exam is often sufficient for diagnosis. However, more complex cases may require further tests like an MRI to map out the tract accurately.
Treatment options for anal fistula
Treating an anal fistula usually starts with controlling infection. An abscess, if present, is drained to relieve pain and prevent further complications. This initial procedure ensures that trapped fluid is cleared out, easing discomfort in the short term.
The next step then usually involves placing a small drainage device called a seton through the fistula tract under general anaesthetic. This keeps the channel open so that any infection can continue to drain, instead of repeatedly building up inside.
Keeping the fistula open, although seemingly counterintuitive, stops abscess formation and promotes healing. Patients generally tolerate a seton well, and it helps to break the cycle of infection while preparing for a long-term fix. One recent study found that the loose seton method was a safe, effective and painless treatment for abscesses, with good results.
After about three months, once the infection is under control, a second operation is performed to close or remove the fistula. This can involve various surgical techniques depending on the complexity of the tract. The aim is to eliminate the fistula without compromising nearby muscle function or causing undue discomfort.
If you’re worried you may have an anal fistula, schedule a consultation with Mr Michael Stellakis today. He offers a comprehensive approach to diagnosing and treating anal fistulas.
