Anal Fistulas

A fistula is an abnormal connection that forms between internal organs or between internal organs and the body's surface. Fistulas usually occur as a result of inflammation or injury in an organ. Tears in the perineal area during childbirth, chronic inflammatory bowel diseases, or abscesses can lead to fistula formation. Symptoms such as bleeding and pain may be present. In addition, body fluids, urine, and feces may discharge from unnatural points. Fistulas can be diagnosed with a physical examination and ultrasonography. Fistulas are often treated by surgically closing them. Op. Dr. İbrahim Çolhan, who serves patients in Adana, explained what anal fistulas are, their symptoms, and treatment methods.

What is an Anal Fistula (Tunnel Around the Anus)?

An anal fistula is an abnormal tube-shaped connection that occurs between an organ and another structure. The most common type of fistula is an anal fistula. However, fistulas can also form between two bowel segments, between the rectum and vagina, between the bowel and skin, or between the bowel and bladder.

An anal fistula occurs between the last part of the bowel and the skin tissue around the anus. It is seen due to an abscess that develops as a result of an infection around the anus. After the abscess drains, a small channel forms. An anal fistula irritates the skin and leads to severe discomfort. Anal fistulas that do not heal on their own are usually treated by surgically closing them.

The main cause of anal fistulas is abscesses that form around the anus. A fistula can develop in one out of every two to four people who experience an anal abscess. If anal fistulas are not treated, the likelihood of spontaneous healing is very low. Therefore, they need to be treated with surgery.

Why Do Anal Fistulas (Tunnel Around the Anus) Form?

The primary cause of anal fistula formation is abscesses that do not heal for a long time. An abscess can fill with body fluids such as feces or urine, which prevents healing. Over time, the abscess progresses towards the skin, a body cavity, or an organ, forming a fistula or channel there. Fistulas, which can develop due to various factors, are usually triggered by the following reasons:

Vaginal tears occurring during childbirth and infection in an episiotomy incision, leading to a fistula between the rectum and vagina.
Fistulas can occur in the intestines after surgeries performed on digestive system organs. Radiation therapies used in cancer treatment can also trigger fistula formation.
Chronic inflammatory bowel diseases such as Crohn's disease, and some sexually transmitted diseases can also lead to fistula formation.
Cancer can destroy tissues, leading to fistula formation.
Fistulas can also occur in the body after radiotherapy applied in the treatment of cancer cases.
Sometimes, wounds can accidentally form on a blood vessel wall or an organ as a result of using medical devices such as catheters or endoscopes. If this wound becomes inflamed, a fistula may subsequently form.
Infection of structures located in the large intestine can also create a fistula in the body.
Chronic skin diseases that cause abscesses and scars can lead to fistula formation.
Anal fistulas can occur as a complication of rectal and hemorrhoid operations performed around the anus.
Hysterectomy or cesarean delivery can create a fistula between the vagina and bladder in a person.
Operations performed on the posterior wall of the vagina can create a fistula opening into the anus or rectum.

Symptoms of Anal Fistula (Tunnel Around the Anus)

Anal fistulas irritate the skin tissue around the anus.
The person experiences a throbbing pain that increases when sitting or moving, coughing, and during defecation.
Foul-smelling discharge is observed in the anal area.
Blood and pus discharge are seen during defecation.
If there is an abscess in the anal region, swelling, increased warmth, and redness may be observed around the anus.
The patient may have difficulty controlling bowel movements.
The opening of the fistula is seen as a small hole in the skin. However, patients often have difficulty noticing it.

How is a Fistula Diagnosed?

Fistulas can often be diagnosed by listening to the patient's symptoms and complaints, and through methods such as physical examination. If the doctor deems it necessary, diagnostic methods such as barium enema, colonoscopy, computed tomography, endoscopy, and fistulogram may be used.

In the fistulogram method, a contrast agent is injected into the fistula in question, and an X-ray of the area is taken. This dye allows the contents of the fistula to be seen better on the X-ray film. For fistulas opening to the skin, a small tube is placed into the opening. X-rays are taken from different angles by changing the patient's position several times.

How is Anal Fistula (Tunnel Around the Anus) Treated?

When treating fistula cases, different methods can be evaluated based on the location of the fistula, the severity of the patient's symptoms, and the seriousness of the condition. For example, it may be possible to eliminate the infection with antibiotic medication applications.

For some fistulas, treatment may involve an enteral diet application. An enteral diet is a liquid nutrition model given orally or through a feeding tube. Liquid nutrition formulas contain essential nutrients that the body requires. These replace solid foods. The patient not consuming solid food leads to less stool formation, which supports the healing process of the fistula.

Small fistulas can be treated with a catheter. With the catheter, the fistula is drained, and the infection is brought under control. Sometimes, fibrin glues that fill the fistula may also be preferred in the treatment of fistulas. In patients who do not respond to other treatments, the fistula can be surgically removed or closed.