Anal Fistula

Service Description

An anal fistula is an abnormal tunnel that develops between the bowel and the skin near the outside of the anus, where stool (feces) comes out. The anus has many tiny glands that make lubricating fluid. Sometimes, these glands become plugged and infected, and that can cause a fluid-filled pocket (abscess) to form. An anal fistula often develops after this infection or abscess. CAUSES In most cases, an anal fistula is caused by a past or current anal abscess. Other causes include: • Trauma to the rectalarea. • Radiation to thearea. • Medical conditions or diseases, suchas: ◦ Chronic inflammatory bowel disease, such as Crohn disease or ulcerativecolitis. ◦ Colon cancer or rectal cancer. ◦ Diverticular disease, such asdiverticulitis. ◦ An STD (sexually transmitted disease), such as gonorrhea, chlamydia, orsyphilis. ◦ An infection that is caused by HIV (human immunodeficiencyvirus). ◦ Foreign body in therectum. SYMPTOMS Symptoms of this condition include: • Throbbing or constant pain that may be worse while you aresitting. • Swelling or irritation around theanus. • Drainage of pus or blood from an opening near theanus. • Pain with bowelmovements. • Fever orchills. DIAGNOSIS Your health care provider will examine the area to find the openings of the anal fistula and the fistula tract. The external opening of the anal fistula may be seen during a physical exam. You may also have tests,including: • An exam of the rectal area with a gloved hand (digital rectalexam). • An exam with a probe or scope to help locate the internal opening of thefistula. • Imagingteststofindtheexactlocationandpathofthefistula.ThesetestsmayincludeX-rays,an ultrasound, a CT scan, or MRI. The path is made visible by a dye that is injected into the fistula opening. You may have other tests to find the cause of the anal fistula. TREATMENT The most common treatment for an anal fistula is surgery. The type of surgery that is used will depend on where the fistula is located and how complex the fistula is. Surgical options include: • A fistulotomy. The whole fistula is opened up, and the contents are drained to promotehealing. • Setonplacement.Asilkstring(seton)isplacedintothefistuladuringafistulotomy.Thishelpsto drain any infection to promotehealing. • Advancement flap procedure. Tissue is removed from your rectum or the skin around the anus and is attached to the opening of thefistula. • Bioprostheticplug.Acone-shapedplugismadefromyourtissueandisusedtoblocktheopening of thefistula.

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