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Anal Fistula

What is Anal Fistula?

An anal fistula is a tunnel that runs from the anal opening and connects the skin around it. An anal fistula mostly forms after an infection that did not heal properly. In human anatomy, the external opening through which  feces are expelled is known as the anus. Multiple small glands that make mucus are located inside the anus. When these glands get clogged and infected due to dirt and debris, it can lead to the formation of an abscess. Most of these abscesses turn into an anal fistula.

Anal Fistula formation

How does Anal fistula form?

When the abscesses that form near and around the anal mucosal tissues are not treated, it tends to keep growing and worsening over time. Eventually, the abscess punches out like a hole making its way outside the skin. 

Types of disease

Causes

  • Trauma to the anal tissues
  • Infection in the anal gland
  • Radiation from cancer treatment
  • Crohn's disease
  • Sexually transmitted disease
  • Tuberculosis
  • Diverticulitis
  • Cancer

Symptoms

  • Pain and swelling around the anus
  • Frequent anal abscesses
  • Foul-smelling bloody drainage from anal opening
  • Bleeding along with stool
  • Pain during bowel movements
  • Fever, chills and fatigue

Diagnosis

In most cases of anal fistuila, the anorectal specialist is able to diagnose it just through a physical examination. In case the condition of the anal fistula is sever, the doctor might require to do an examination of your rectum and anal canal. The commonly performed tests to diagnose anal fistula are:

Digital examination – In this test, the fistula specialist inserts a gloved, lubricated finger into the rectum to check if there are any kind of abnormal growths. 

Visual inspection – The proctologist or the anorectal surgeon might examine the lower rectum using a proctoscope, an anoscope or a sigmoidoscope. Using any of these devices, the doctor will carefully examine the lining of your anal tissues to check the severity and depth of your anal fistula.

Anoscopy – Anoscopy allows the anorectal doctor to examine the inner lining of your anus and rectum. The test checks for abnormal growths, bleeding, inflammation, and conditions such as diverticulosis.

Sigmoidoscopy – Flexible sigmoidoscopy is a useful test to look for an underlying aetiology in fistula-in-ano. 

Imaging tests – Your physician may also order an ultrasound or MRI of the anal area to get a better view of the fistula tract.

Test of Anal Fistula

Risks & Complications

Like any other surgical treatments, there are potential risks and complications associated with surgery if anal fistula too. Common complications may include:

Infection – When incisions are made in the skin, every surgery carries some risk of infection. The same is with the procedure of fistulectomy. In certain cases, where the fistula tract is too deep, the doctor might need to perform the surgery in several stages. In that case, there is a high possibility that the fistula might spread throughout the body and cause systemic infection. In case of infection from anal fistula, the doctor might prescribe antibiotics. If the infection is too severe, the patient might even require to get admitted to a hospital and undergo intravenous administration of antibiotics.

Bowel incontinence – If the fistula surgery is not performed by an expert anorectal surgeon, there are chances that the anal sphincter muscles may get damaged. The anal sphincter muscles are responsible of keeping the anus and controlling the bowel movements. In any case, if the sphincter muscles are damaged, the strength of the anal muscles are compromised which may cause leakage of feces. This condition is known as bowel incontinence. Bowel incontinence  is estimated to affect 3-7 percent of the total patients who undergo anal fistula surgery.

Anal fistula recurrence – An estimated 7-21 percent of patients who have undergoes surgery for anal fistula suffer from recurrence of anal fistula after surgery. The chances of recurrence is ten highest in case of treatment of anal fistula through fibrin glue.

  • Prevention of Anal Fistula

    Prevention of anal fistula:

    Prevention of Anal Fistula

    Here are some of the tips that can help you prevent anal fistula:

    • Consuming high-fibre diet – One  of the easiest ways to prevent anal fistula is to prevent passing of hard stools. To prevent hard bowel movements, the best thing to do is stock up your diet with fiber-rich food. If you want to avoid getting anal fistula, it is crucial to eat at least 25-30 grams of fiber per day. Some foods rich in fiber are:
      • Whole grains, oatmeal, and brown rice
      • Beans and lentils
      • Vegetable and Brussel sprouts
      • Fruits such as bananas, apples, pears, and berries
    • Drink sufficient water – Water along with a fiber-rich diet is very important for the prevention of any anorectal disease. Drinking enough water prevents constipation and hard stools which in turn decreases the need to strain while passing a bowel movement. To prevent anal fistula, drinking enough water throughout the day is extremely important. It will help your digestive system function properly.
    • Maintain cleanliness and dryness in your anal region – Anal fistula often forms as a result of clog and blockages in the anal canal. Long term accumulation of dirt and debris leads to the formation of anal fistula. To prevent this, it in crucial to clean the anal area every time you pass a bowel movement. Don’t leave the area wet after cleaning, pat it well and dry so that there’s no bacteria or infection.
    • Don’t strain while passing stool – Do not strain while making bowel movements.  Straining can make the condition of the anal skin worse and lead the anal fistula to aggravate in nature. It is equally important to take care that you don’t spend long hours sitting on the toilet seat. The longer you sit on the toilet seat, the more you are likely to strain while making your bowel movements worse.
    • Regular exercises – Almost all anorectal diseases have a direct relation with physical activities and how you keep your body active. Staying physically active keeps the colon active and functions in a regular manner. But that being said, you should know which exercise is good for you and which is not. Avoid any activity that puts strain and pressure on your abdominal region. Do not lift weights. Do not sit in one place for long hours. Indulge in moderate physical exercises regularly.
  • Myths & facts about Anal Fistula

    Myths and facts about laser treatment for anal fistula

    Myths & facts about Anal Fistula

    Many anorectal surgeons consider laser treatmentf or anal fistula as teh most effective treatment for anal fistula, most people are now aware of the same. There are several myths around the treatment that people believe to be true. Let’s bust the myths and help you be better informed about the treatment method.

    Myth 1: Laser treatment for anal fistula can damage the anal sphincter muscles.

    Fact: Fact check – laser surgery is the most effective and the safest surgical treatment out of all the procedures. Laser surgical treatment is advanced, scarless, bloodless and does not exhibit any pain in the patient. If performed by an expert anorectal specialist, the treatment can be highly relied on as it causes no harm to any organ and also guarantees quick recovery.

    Myth 2: Laser treatment is very costly and unaffordable.

    Fact: Since the treatment procedure is much more advanced and effective than conventional open surgeries, the cost is comparatively higher than the later. But it is definitely not unaffordable. At Pristyn Care, you can undergo laser surgery for anal fistula at a very reasonable price at the hands of the best proctologists.

    Myth 3: Laser surgery demands long downtime before you completely recover.

    Fact: The reality is actually opposite. In case of laser surgery, the recovery is much quicker and seamless than any other treatment procedures. Since there are no cuts, stitches and blood loss involved in laser surgery, the downtime is much shorter than any other surgical treatment methods.

When to consult a doctor for anal fistula?

Most people tend to ignore the early symptoms of anal fistula. Not knowing the symptoms of the disease can make you ignorant of the fact as to when to approach the right doctor. Getting medical treatment and professional help can help you avoid timely complications of the condition. If you experience any of the following signs, it could be an indication of anal fistula. Without further delay, you should consult with an anorectal surgeon in that case:

  • If you see/ notice foul-smelling discharge from your anal area.
  • If you see blood in your stool or blood in the toilet seat/ tissue paper, consult with a doctor at the earliest. Blood in the stool can be a common sign for most anorectal disease and not fistula-in-ano alone. Hence, this symptom needs to be discussed with the doctor to evaluate the condition and to determine the best line of treatment.
  • When no medication and home remedies provide you relief or effective results from your symptoms.

Questions to ask your doctor .

Is my anal fistula serious?
Can I try home remedies for temporary relief from my condition?
Do I need to undergo surgery for my condition?
How many days off should I take if I undergo laser surgery for anal fistula?
When will I be able to get back to my regular work life after surgery?
Will my fistula recur after laser surgery?
Shall laser surgery cost heavy on my pocket?
Will surgery provide me permanent relief from the pain and discomfort?
How can I prepare for the surgery?
How long will it take me to recover after the surgery?
Will your team help me throughout the treatment and after?

Treatment options & cost

  1. Fibrin glue – Fibrin glue is a therapeutic for anal fistulas which activates thrombin to form a fibrin cloth. The procedure helps close the fistula tract mechanically. Fibrin glue is a liquid sealant thought to assist in fistula tract healing by stimulating migration and activation of fibroblasts.2 It is a tempting treatment modality: the technique is simple, repeatable, and involves only minor surgical trauma to the anal sphincter. Fibrin glue treatment is very easy to use and is considered as a good treatment for people who are not in favor of surgery. However, fibrin glue is not the best replacement for skilled anorectal surgery.
  2. Seton placement – This procedure involves placing a suture or a rubber band (also known as seton) in the anal fistula that is progressiveley tightened. The rubber band lets the fistula heal behind the seton. The treatment is non-invasive and the risk of recurrence is also quite low.
Insurance coverage for Anal Fistula

Insurance coverage

Anal fistula treatment is generally covered under health insurance. Most insurance companies offer a specific amount of coverage for anal fistula and other anorectal diseases. The amount of coverage you have will depend on the policy you buy. 

One thing you should know is that medical treatment for anal fistula won’t be covered in the insurance policy. Only the expenses of surgical treatment are covered and you also need to be hospitalized for at least 24 hours to file for a claim. You can opt for cashless payment or get reimbursement claims from your insurance providers as well. 

If your claim is approved, you will be able to cover the entire cost of treatment, including diagnostic tests, medications, hospital stay, bed charges, and other consumables. Some of the best and most popular healthcare insurance providers are Oriental, Religare Health, Manipal Cigna, United India Insurance, Care Health, New India Insurance, Star Health & Allied, Bajaj Allianz General Insurance, ICICIA Lombard, Max Bupa Health Insurance.

Insurance coverage for Anal Fistula
Recovery rate of Anal Fistula

Recovery Timeline

The healing capacity of every person is different and hence the timeline of recovery after anal fistula surgery varies for all. In most cases, recovery after open surgery for anal fistula takes around 2-3 months and complete recovery after laser surgery takes 1 month to 45 days.

Recovery after 1 month

For at least 1 month after anal fistula surgery, the patient needs to follow the recovery tips and recommendations by the doctor. It is advisable that the patient refrains from doing anything that puts strain on the surgical site. The patient should not eat anything too oily and spicy and consume only fiber-rich food. The patient should keep the surgical area free of any infection and take regular sitz baths.

Recovery after 2 months

After 2 months, the patient would experience much relief from the pain at the surgery site. But the scars might take some more time to disappear. The patient might get back to normal work life without any major complications and also resume normal dietary habits.

Recovery after 3 months

After 3 months, the patient would be free from all post-surgery discomfort. There would be no scars at the surgical site and the wound would be healed completely too. 

Recovery rate of Anal Fistula

Latest Research

  • Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula

  • Current imaging techniques for evaluation of fistula in ano: a review

FAQ

How can I know that I have a fistula?

If you have anal fistula, you are likely to experience these signs and symptoms:

  • itching and irritation in anal skin
  • pain & swelling
  • irritation
  • bright red color bleeding
  • foul-smelling pus drainage 
How long does it take to complete anal fistula surgery?

Usually, anorectal surgeons take around 1-3 hours to complete anal fistula surgery. However, the operation time may increase or decrease depending on factors like:

  • Age of the patient
  • Type of anal fistula surgery/treatment planned to perform
  • Size and severity of anal fistula
  • Presence of any underlying anorectal disease or disorder
What is the success rate of anal fistula surgery?

The success rate of anal fistula suregry can be as high as 95 percent if the suregry is performed by an epxert surgeon. The success of the surgery, post-surgery complications and possible recurrence of the condition, everything depends on how well the patient follows the advice of the doctor too.

How can I book an appointment with Pristyn Care doctor for treatment of anal fistula?

To book an appointment with Pristyn Care doctors for the treatment of anal fistula, you can either call us directly on the number emntioned on the page or fill the appointment form. Our medical representative will get back to you to schedule an appointment as per your convenience with an expert anorectal surgeon.

Can nitrolglycerin ointment provide relief from anal fistula?

Nitroglycerin cream  can provide temporary relief from anal fistula symptoms as it improves blood flow and speed up the healing process. It can be directly applied to the anal canal after dilution to get relief from symptoms of fistula. But the ointment should be used only after consulting with the doctor. However, it is to be kept in mind that no ointment can provide permanent cure to anal fistula. If you are diagnosed with the condition, you will need surgery sooner or later to permanently get rid of the condition.

Does exercise help with fistula symptoms?

Yes. Exercise can help to regulate your bowel movements and make symptoms of ana fistula less painful. Along with exercise, you must drink plenty of water to prevent constipation and aid your bowel movement. Exercise also improves the blood flow to the anal region that can help the fistula to heal properly once it is cleaned.

Is laser fistula surgery painful?

No. Laser fistula surgery is a painless and non-invasive treatment method. There won’t be any cuts, stitches, wounds, or scars involved in the procedure. The treatment is also carried out under anesthesia (either general or local depending on the patient) which means the patient will not feel any pain or discomfort during the surgery. Once the effects of the surgery wear off, the patient may feel a slight painful sensation at the surgical site which is completely normal. The doctor, most likely, would prescribe medicines to help ease the pain. With proper medication and ample rest, the pain is likely to fade within the next few days only.

Facts and statistics around anal fistula

Facts and figures around anal fistula:

  • Medical studies state that 23% of Indians have anal fistula.
  • 28% of individuals with anal abscess and 12% of individuals with underlying anal diseases have developed anal fistulas.
  • Each year between 50,000 to 1,00,000 women worldwide are affected by obstetric fistula.
  • Approximately 76% of patients with anal fistula preferred to undergo laser surgery, 14% choose to undergo open surgery, and the remaining 10% choose to follow home remedies, lifestyle changes, and dietary modifications.

Why choose Pristyn Care for anal fistula surgery?

  • Pristyn Care is a certified Centre of Excellence for anorectal treatments including diseases like anal fistula, piles and anal fissure.
  • Pristyn Care houses some of the top anorectal surgeons of the country who have years of experience in delivering surgical treatment for colorectal diseases with a high success rate.
  • Pristyn Care is associated with some of the top hospitals across India that are equipped with state-of-the-art facilities required to perform advanced anorectal surgeries.
  • Proctologists/ General Surgeons working with Pristyn Care do a thorough consultation in the case of every patient to understand the health condition and then determine the treatment method that will work best.
  • A dedicated ‘care buddy’ is assigned to every patient on the day of the surgery. We strive to make the whole surgical experience for our patients a seamless one. Once you reach the hospital, your dedicated medical attendant or ‘care buddy’ will take care of every paperwork and formality on your behalf.
  • To ease out the commuting process for our patients, we also provide free cab facilities to bring you from home to the hospital and help you return back home after the surgery.
  • A free-of-cost follow-up is provided to the patients within the first seven days after the anal fistula surgery.
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