Fistula is generally recognized as inter-connection of two of the body parts usually organ or blood vessel to another part of the body. Fistulas are normally the result of minor injury or surgery. Infection or inflammation are also other cause of a fistula formation. In some cases we have to make or prepare fistula especially for dialysis patients. But other fistulas are unwanted and make life uneasy.
An Anal Fistula (Fistula-in-Ano) is a small path or tunnel that origins from the inside of anus to the outer body part (skin) near anus from where the wastes are discharged. Normally the abscess are created in skin near anus and very small amount of waste (pus) are stored and discharged later. The abscess may be created weekly, monthly, quarterly, semi-anually or even annually. The abscess and its discreation can be painful or non painful.
There are number of small glands inside the wall of anus that make mucus. Sometime glands get blocked by the waste and it can become infected. The infected part tries to get released and it makes their own path or tunnel from internal anus throughout the soft tissue towards the outer skin. And in outer skin abscess are formed. The size of fistula may vary depending on the soft tissues. The abscess is not healed automatically. It keeps coming and going. We will need doctor to repair the fistula, but surgery is only one option.
Symptons :
- Abscess near anus
- Pain in abscess
- Redness and swelling around your anus
- Bleeding
- Painful and uneasy bowel movements
- Fever in some cases
- A foul-smelling liquid discharging from abscess
Diagnosis:
Normally fistulas are easy to find as there are abscess in the outer skin. But some are difficult to find out. Sometime they close on their own and opens later again. Normally doctor will examine physically. He/she may have to stick the finger inside anus and search for the inner opening and find the path. We may also need to do a x-ray like procedure called fistulogram to find out the exact path of the fistula and check for clots or other blockages in your fistula.
Treatment:
Some people claims to cure the fistula with medicine. But we must be very clear that there is no medication to cure it. Surgery is the one and only weapon to fix it. The surgery is performed by a Gastroenterologist (GI) surgeon or rectal surgeon. We may need to get admitted for couple of days depending on the size and severness of the fistula. In surgery the tract are removed and more important part is to protect the anal muscles which can cause incontinence(muscles and nerves that help the bladder hold or release urine, stool) if they are damaged.
The surgery or the procedure to cure fistula is called Fistulectomy. In this procedure, the skin and muscle over the path or tract are cut open.
THE TRACTS ARE REMOVED AND WOUND IS LEFT OPEN. THE WOUNDS ARE ALLOWED TO HEAL FROM THE BOTTOM.
No stich is applied so the healing process may take longer time.
In some complex cases, the surgeon may place a special thin silicone string (very similar to an elastic band) called Seton which is tied exteriorly which helps in drain and heal from inside. The seton are placed for several weeks depending on the complexity of fistula. The seton needs to be changed weekly or monthly. It is normal process, we do not need to worry. After a seton is placed, a second operation is almost always needed.
Post surgery :
We will have difficult time after surgery. A complete recovery may takes more than a months. As the wound are left open and have to heal from inside itself the recovery period is longer that other surgeries. After surgery, we must soak the affected area in luke warm water. The process is known as a Sitz Bath. We will have to put some antiseptic in the water and sit in for some time so that the wound will be infection free. We must repeat the process everytime we discharge the stool. We must also be very careful to avoid constipation as we have to use more power to discharge stool which can be really painful. To avoid we must eat lots of fluids and take stool softner medicines (laxative) as per requirement for several weeks until we are comfortable at time of stool discharge. We have to depend on painkiller to avoid the pain for many days.
Other precautions that we need to take are very common things that we have to follow in every surgery for around a month
- Avoid strenuous activities like running, jogging, swimming
- Avoid lifting objects
FINALLY, IF TREATED PROPERLY, FISTULA ARE HEALED BUT THERE IS ALWAYS A CHANCE THAT IT WILL REOCCUR AGAIN.
