Transsphincteric Fistula

A transsphincteric anal fistula refers to the formation of an abnormal channel that passes through the sphincter muscles located both inside and outside the anus. These fistulas extend outward from the anal canal. As a result of this progression, one or more openings occur on the outer surface of the anus. Transsphincteric fistulas constitute an important category among anal fistulas. They are often considered more complex cases. Transsphincteric fistulas affect both the internal and external sphincter muscles. Therefore, their treatment can be more challenging. The goal in treating these fistulas is to preserve the function of the sphincter muscles.

Treatment for transsphincteric anal fistula is carried out through surgical intervention. During the surgical operation, the fistula tract is closed, and certain measures are taken to prevent recurrence. Managing such fistulas requires meticulous care to preserve the sphincter muscles in the anus and maintain anal continence. The patient's recovery process is shaped by the scope of the surgical operation and the patient's general health condition.

What are the Symptoms of Transsphincteric Anal Fistula?

The symptoms caused by transsphincteric anal fistula vary depending on the location of the fistula and the severity of the condition. The most common symptoms of transsphincteric anal fistula include itching, discomfort felt in the anal region, and blood in the stool. Additionally, bloody or purulent discharge may come from the fistula tract, which is considered a typical symptom of transsphincteric anal fistula.

All these symptoms significantly impair the patient's quality of life and increase the risk of infection. Therefore, patients exhibiting these symptoms should promptly consult a healthcare institution to benefit from early diagnosis and treatment options.

What Causes Transsphincteric Anal Fistula?

Transsphincteric anal fistulas occur as a result of infections in the anorectal region. These infections originate from the blockage of anal glands and the subsequent formation of abscesses. As these abscesses drain, the infected tissue may find a path outwards, resulting in the formation of a fistula tract. This process develops due to bacterial infections and is more commonly seen in individuals with weakened immune systems.

In addition to chronic inflammatory bowel diseases, various other factors can trigger the development of transsphincteric anal fistulas. Conditions like Crohn's disease or ulcerative colitis can lead to the development of chronic inflammation in the patient's intestinal wall, which increases the risk of fistula formation. Furthermore, transsphincteric fistulas can also result from past surgical operations, traumas, and sexually transmitted infections. In almost every case, accurately identifying the underlying cause of the fistula is essential for proper treatment planning and implementation.

How is Transsphincteric Anal Fistula Treated?

Treatment for transsphincteric anal fistula is often performed through surgical operations. This is because transsphincteric anal fistulas are more complex in structure compared to other fistulas, and there is a risk of damage to the anal sphincter muscles. Surgical operation aims to close the fistula tract and eliminate infection, while also focusing on preserving sphincter function. The most commonly used surgical treatment options are fistulectomy, seton placement, and fistulotomy.

In a fistulotomy operation, the fistula tract is opened with the aim of healing. However, there is a risk of damage to the sphincter muscles in this operation. Seton placement is preferred for complex and high fistula cases. In the seton placement method, a thread called a seton is inserted into the fistula tract, allowing the canal to heal gradually. During this stage, drainage of the infection is performed. In the fistulectomy method, the entire fistula tract is removed from the body. It is preferred for complex cases. When deciding which surgical method to use for treatment, the characteristics of the fistula and the patient's general health condition are considered.

How is Non-Surgical Treatment for Transsphincteric Anal Fistula Done?

Non-surgical treatment options are alternative choices preferred for patients who are not suitable for surgery or for mild fistulas. Non-surgical treatments for transsphincteric anal fistula include fibrin glues, biological fistula plugs, and medication therapies. Fibrin glues and biological plugs are placed inside the fistula tract. This closes the tract and encourages the natural healing process. All these methods are minimally invasive procedures and are generally less painful. The recovery process after these treatments can also be quite fast.

However, the success of non-surgical treatment methods may vary depending on the underlying causes of the fistula and its characteristics. They may not always be suitable for complex transsphincteric anal fistulas. Therefore, the patient's condition should be thoroughly evaluated, and the most appropriate treatment method should be decided. This requires an evaluation by an experienced, specialist doctor in the field of colorectal surgery.

Both surgical and non-surgical treatment approaches offer valuable options for the treatment of these fistulas.