Anal fistula: Causes, Symptoms, Risk Factors, Diagnosis, Treatments & Best Doctors or Hospitals For Anal Fistulas
Anal fistula is a small tunnel that connects an infected gland in the rectal canal to the opening around the anus.
The anus is the outer opening through which feces are ejected from the body as excretion once the food gets digested. There are many glands inside the anus which are responsible for producing mucus that lines the inner skin for a smooth movement of feces. Sometimes, these glands clog and get infected. This phenomenon leads to an abscess – a collection of pus built up within the tissues. Such abscesses if not treated on time, may develop into a fistula.
Causes & risk factors of anal fistula
The most common causes of an anal fistula include clogged glands in the anus which develop into abscesses within this structure. There might be certain medical conditions which increase the risk of developing an anal fistula such as:
- STDs (Sexually Transmitted Diseases)
- Cancer & radiation used for treating cancer
- Crohn’s disease (an intestinal inflammatory disease)
- TB (Tuberculosis)
- Diverticulitis (a disease which occurs when tiny bulging pouches form in the large intestine & become inflamed)
Sign & Symptoms of anal fistula
Anal fistula is an unnatural condition which is an extension of the abscesses formed inside the anus. The following may be the possible symptoms of this disorder:
- Recurring anal abscesses may develop inside the anus
- Anal opening & the surrounding areas may have pain & swelling
- Inflammation of the skin around the anus
- A persistent throbbing pain when you sit down, move around or cough
- Passing bloody or foul-smelling pus from the fistula when you poo
- High temperature (fever) if you have an abscess or fatigue, etc.
Diagnosis of anal fistula
To diagnose this condition, your doctor at Yashoda Hospital & Research Centre, Nehru Nagar, Ghaziabad may examine the area around the anus and look for any opening or fistula tract on the skin. Then, s/he will try to find out the deepness and direction of the fistula tunnel.
In some cases, fistulas are invisible, so the following may be used to diagnose anal fistula:
- Anoscopy: It is a diagnostic procedure in which a special instrument called anoscope is used to examine the anus and the rectum for any abnormality.
- Ultrasound or MRI: When it is not possible to determine the affected areas with anoscopy, your doctor may ask you to get an Ultrasound or MRI done to obtain a better view of the fistula canal developed inside the anus.
Ultrasound or sonography is a type of imaging method in which high-frequency waves are used to create images of the structures within your body.
MRI stands for Magnetic Resonance Imaging. It is a diagnostic procedure in which strong magnetic fields, magnetic field gradients and radio waves are used to produce images of the body organs.
- Examination under anesthesia: Your doctor may examine you in the operation room to diagnose the fistula.
If the fistula is confirmed, your doctor may further do some tests like blood tests, x ray and colonoscopy in order to determine whether this condition is not related to Crohn’s disease or not. It has been seen that around 25% people who suffer from Crohn’s disease have the chances of developing anal fistulas.
- Colonoscopy is a diagnostic procedure used to detect any changes or abnormalities in the large intestine and rectum. In this procedure, a flexible, lighted tube is inserted into the colon and the areas within are then examined for any possible changes.
Best Treatments for anal fistula
Since fistula involves the formation of unwanted structures within the body, it is necessary to remove them through surgery. Based on the types of anal fistulas, your doctor at Yashoda Hospital & Research Centre, Nehru Nagar, Ghaziabad may resort to any of the following treatments:
- Fistulotomy: This kind of surgery is performed when the sphincter muscles (circular muscles responsible for constriction of anal orifice or opening) are not involved or only a little part of the muscle is involved in forming the fistula. In fistulotomy, the skin and muscle over the fistula tract are cut open which allows the fistula tract to heal.
- Advanced flap procedure: Under this procedure, a flap or a piece of tissue taken from the rectum, is used to cover the fistula. Complex fistulas are treated with this method. Advanced flap procedure involves the following steps:
➢ Elevating the flap or piece of tissue from rectum to form a trap door ➢ Coring out of the infected gland and epithelized internal opening
➢ Suturing of the internal sphincter defect
➢ Closing the wound with the flap
➢ Providing appropriate drainage
- LIFT Procedure: The Ligation of the Intersphincteric Fistula Tract (LIFT) is used to treat the anal fistulas that pass through the anal sphincter muscles. Since sphinctermuscles are an extremely important part of the body and fistulotomy may damage them, and hence LIFT procedure is used instead, to ensure a safe treatment. During the procedure, skin above the fistula is cut and sphincter muscles are moved apart after which the fistula is tied off.
- Stem Cell Therapy: This treatment is suitable for complex anal fistulas caused due to Crohn’s disease. Mesenchymal stem cells are injected in the perianal fistulas to treat them because this type of cells is associated with immunomodulatory action which help in lessening the inflammatory response and reduce the activation of CD4 T lymphocytes and promote formation of regulatory T-Cells. Besides, these cells have regenerative capability. Thus, with this method, fistulas get treated and healed better.
Best doctors for treatment of anal fistulas at Yashoda Hospital & Research Centre, Nehru Nagar, Ghaziabad, the best in the whole of Delhi NCR:
Dr. Ashish Gautam is a renowned and extremely experienced gastrointestinal, bariatric and trauma surgeon, the best in Delhi NCR. He has performed over 20,000 laparoscopic procedures such as lap colorectal, lap bariatric, laparoscopic common bile duct surgeries and video-assisted thoracoscopic surgeries.
Dr. Ashish Gautam has received extensive surgical training at S.N. Medical College, Maulana Azad Medical College, Lok Nayak Hospital and Sushruta Trauma Centre. After this training, he pursued his fellowship in minimal access and bariatric surgery.
Apart from the previously mentioned achievements, Dr. Ashish Gautam is famous for his expertise in serious trauma and gunshot injury surgeries along with treating breast disease and cancer surgeries. He also has experience in thyroid and parathyroid surgeries through advanced minimal access approach.