Anal Fistula

What Is an Anal Fistula?

An anal fistula is a chronic infection in which a connection forms between the inside of the anal canal and the skin around the buttocks. The disease usually originates in the so-called proctodeal glands, which are located near the sphincter of the anus. These glands become inflamed when germs enter them. The invading pathogens can cause pus to form there. The inflamed tissue, together with the pus, is called an abscess. This then spreads in the direction of the slightest resistance and "digs its way" to the skin's surface. This channel, i.e., the newly formed connection between the anal canal and the skin surface, is the anal fistula. Anal fistulas predominantly affect men between the ages of 30 and 50.

How Does an Anal Fistula Develop?

An anal fistula develops in more than 90% of cases due to the inflammation of the proctodeal glands. In addition, there are even rarer causes in which the fistula develops independently of the proctodeal glands. These include chronic inflammatory bowel diseases such as ulcerative colitis and Crohn's disease, acute gastrointestinal tract infections such as appendicitis or inflammation of the rectum, radiation therapy, and diseases that weaken the immune system, such as HIV or leukemia. In sporadic cases, surgical procedures in the perianal or pelvic floor area can also lead to anal fistulas during the healing phase.

Anal Fistula Symptoms

Patients often suffer from pain in the inflamed area. This occurs especially during sitting and defecation, as pressure is exerted on the corresponding location in such situations. Itching or bleeding may also occur.

Furthermore, purulent secretion may escape from the fistula, which causes a high degree of suffering since the permanent oozing of the fistula and the associated odor can make the patients feel uncomfortable.

In addition, the classic signs of inflammation can be evoked. Then redness, swelling, and overheating around the fistula can be noticed.

How Is a Fistula Diagnosed?

The diagnosis of a fistula is generally made by clinical examination. Digital rectal examination and probing of the fistula tract are the most critical diagnostic measures. During probing, the course of the fistula tract is assessed with a thin blunt metal rod. Its position on the anal sphincter is significant for the prognosis and subsequent therapy.

In rare cases, diagnostic imaging techniques are used to obtain additional information on complicated fistulas. MRI and a proctoscopy, i.e., an endoscopy of the rectum, are used for this purpose, among others.

How Is an Anal Fistula Treated?

An anal fistula is usually always treated surgically. This reduces the risk of developing a closed, purulent inflammation called an abscess.

Since the diagnosis is made purely clinically and the extent of the entire fistula is often difficult to see from the outside, the surgical procedure and the steps required are only decided during the surgery. Two therapeutic approaches can be distinguished from each other.

First, fistula splitting is used for superficially localized anal fistulas. Here, the fistula tract is split with a scalpel and thus relieved. This procedure has a healing rate of almost 100% for superficial fistulas.

On the other hand, in the case of more complex or deep-seated fistulas, a fistulectomy is carried out. In this procedure, the entire fistula tract is surgically removed, which involves more damage to the surrounding tissue and is a more radical approach than that fistula splitting.

In addition, thread drainage may be used. This is used when the prevailing infection and inflammation are still active and acute. The insertion of the suture stabilizes the fistula and keeps it open, allowing pus still developing inside the fistula due to the inflammation to drain outward. Once the active phase of the inflammation is over, a fistula split can be carried out.

How Long Is the Healing Phase After Fistula Surgery?

The healing time varies depending on the severity of the fistula and thus on the tissue defect created by the surgery.

On average, scarring of the surgical wound takes 4-8 weeks. This entails an inability to work for about 2-4 weeks if everything heals without complications.

However, complications can also occur during the surgical therapy or the subsequent healing phase so that the final healing period can be longer. For example, there may be renewed inflammation and formation of anal abscesses. Also, both the anal fistula and its treatment in the form of surgery can damage the rectal sphincter, resulting in fecal continence problems.

Which Doctors and Clinics Treat Anal Fistulas?

Anal fistulas are usually first presented to the general practitioner, who then refers the patient to a proctologist or a specialized rectal center. A proctologist is a specialist for the rectum and thus also for complaints in the anal region. In addition, general and visceral surgery is often involved in the surgical treatment of fistulas.

Every patient who needs a doctor wants the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively, and a reliable doctor would never claim to be the best one, we can only rely on the doctor’s experience.

We will help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in anal fistula and are awaiting your inquiry or treatment request.

Sources

• www.awmf.org/uploads/tx_szleitlinien/088-003l_S3_Kryptoglandul%C3%A4re_Analfisteln_2017-03-abgelaufen.pdf
• next.amboss.com/de/article/b30HSf
• www.usz.ch/krankheit/analfisteln/
• enddarmpraxis.berlin/analfisteln/