Anal Fistula

🔍 What is an Anal Fistula?

An Anal Fistula (medically called fistula-in-ano) is an abnormal tunnel-like connection between the anal canal and the skin near the anus. It usually develops after an anal abscess — when the infected gland near the anus does not heal properly and forms a passage to drain pus or stool to the skin surface.

It is a chronic and often recurring condition that usually requires medical or surgical treatment.

⚠️ Causes of Anal Fistula

The most common cause is a previous or untreated anal abscess. Other causes include:

• Chronic infection or inflammation in the anal glands

• Crohn’s disease (inflammatory bowel disease)

• Tuberculosis (rare)

• Radiation or trauma to the rectal area

• Post-surgical complications

• Sexually transmitted infections (rare)

🩺 Symptoms of Anal Fistula

• Persistent or recurring pus or fluid discharge near the anus

• Pain, swelling, or redness around the anal region

• Fever (if infection is present)

• Painful bowel movements

• A visible opening or hole on the skin near the anus

• Skin irritation or itching due to discharge

If left untreated, an anal fistula may become infected repeatedly and lead to formation of recurrent abscesses.

🔍 Diagnosis

Your doctor may use the following to confirm diagnosis:

• Physical examination – identifying external openings or discharge

• Digital rectal exam (DRE)

• Proctoscopy or anoscopy

• Imaging tests like MRI fistulogram or endoscopic ultrasound for complex fistulas

🛠️ Treatment Options

Unlike anal fissures or piles, anal fistulas do not heal on their own and usually need surgical management.

1. Fistulotomy

• The most common and effective treatment

• The fistula tract is opened and cleaned to heal from inside out

2. Seton Placement

• A special surgical thread (seton) is placed to drain infection and slowly cut through the tract

• Used in complex or high-risk fistulas

3. LIFT Procedure (Ligation of Intersphincteric Fistula Tract)

• A sphincter-sparing technique used for internal fistulas

4. Laser Surgery

• Minimally invasive with faster healing and minimal pain

5. Fistulectomy / Fistula Plug / Advancement Flap

• Advanced procedures for complex or recurring fistulas

🧑‍⚕️ When to See a Doctor

• Persistent pain or pus discharge from near the anus

• History of anal abscess with recurring symptoms

• Redness, swelling, or fever around the anal region

• Any suspected lump or opening near the anal skin

🔁 Prevention & Aftercare

• Maintain good anal hygiene

• Treat anal abscesses early to prevent fistula formation

• Manage underlying conditions like Crohn’s disease

• Post-surgical care: sitz baths, wound care, high-fiber diet, and hydration for soft stools