Anal Fistula
- What is Anal Fistula?
- How is Anal Fistula Diagnosed?
- How is Anal Fistula Diagnosed?
- How Does an Anal Fistula Form?
- How is Anal Fistula Treated?
- What are the Treatment Methods of Anal Fistula?
It consists of an inner and outer hole in the breech region and a canal that connects these holes. These holes are called fistula mouths. The inner mouth is located inside the anal canal, which is the last part of the large intestine, and the outer mouth is located a few cm around the anus. As a result of the constant contact of the inner mouth with stool, there is a chronic non-healing inflammation in the canal and a purulent discharge that constantly contaminates the underwear.
How is Anal Fistula Diagnosed?
One or more fistula holes (mouth) around the breech
Intermittent pus-filled, foul-smelling discharge from the mouth of this fistula that soils underwear
Irritation and itching of the skin around the anus due to discharge
Mild painful stiffness, sometimes extending from the mouth of the fistula to the anal canal
Abscess formation around the anus as a result of obstruction of the fistula mouth; symptoms such as anal fistula disease.
How is Anal Fistula Diagnosed?
The diagnosis of fistula in the rectum is made mostly by examination. In the examination, the external hole of the fistula is seen, it is checked how far it goes inside with the stylet, and the inner hole is determined by seeing the exit of the stylet from the inner hole. In some patients, this examination is not possible. For these patients, the definitive diagnosis is made with Perianal MRI. If necessary, anal ultrasound or tomography can be performed.
How Does an Anal Fistula Form?
Anal fistula and rectal abscess are formed in the same way. As we explained in breech abscess, when the ducts of the glands 1-1,5 cm inside the anal canal are blocked for various reasons, inflammation occurs in the glands, and when the inflammation progresses, it turns into anus abscess. These abscesses may develop very rapidly and be severe, or they may be milder with a slow, chronic course. One-third of the abscesses treated surgically, and most of the abscesses that drain spontaneously, form a channel between the chronic inflammation and the inner and outer mouth. It makes a continuous pus discharge and turns into a fistula.
-Crohn’s disease
-Diverticulitis
-Hidradenitis suppurativa
-Tuberculosis and HIV
-Anal surgical interventions; Diseases such as anal fistula can cause the formation of.
How is Anal Fistula Treated?
The main treatment method of anal fistula is surgery. Four types of fistula are defined according to the relationship of the anal fistula canal with the muscles that keep the stool in the rectum. Fistulas in which the fistula channel passes under or near the muscles are considered simple fistulas and their operation is relatively easier. The operation called fistulotomy can be performed without causing much damage to the muscles. However, in fistulas formed by the fistula channel passing over or near the top of the muscles, when fistulotomy is performed, most of the muscles will be cut, so it will not be possible for the patient to hold his stool and therefore fistulotomy operation cannot be performed. This type of fistula is treated by placing materials called seton surgery and which will remain in the fistula channel for months.
What are the Treatment Methods of Anal Fistula?
-Fistulotomy; It can be successfully applied in simple fistulas. Surgically, the fistula canal is cut and removed or cleaned thoroughly by curettage. The wound is left open for secondary healing without suturing. Healing is achieved in 3-4 weeks with antiseptic sitz baths.
-Seton surgery; It is applied in patients where the fistula tract passes over the muscles and there is a high risk of incontinence if fistulotomy is performed. The silicone thread passed through the fistula channel is kept in the form of a ring for months. Healing is achieved by sliding the fistula tract down while throwing the thread that the body perceives as a foreign body. The success rate is lower than fistulotomy.
-Fibrin glue; The fistula tartar is cleaned by scraping, and fibrin is injected into it to adhere and heal. It is a new method. The number of long-term follow-up and studies on treatment success and relapses is insufficient.
-Laser treatment; It is the process of entering the fistula tract with a laser and burning it. Since it is new like the fibrin glue method, there are not enough research results about its long-term follow-up.
Moreover; Surgical methods such as bioprosthetic plate and flap operation are also applied.