What is an anal fistula?
It is an abnormal connection between your anal canal (back passage) to the surrounding skin which can happen due to various reson explanied below.
What causes anal fistula?
Most fistulas are caused by simple hair follicle infection which was not treated completely/properly.
There are millions of hair follicles in one’s body. Any one of them around anal canal can get infected. Infection is more in people who sit for long time and more so who sit in unhygienic or hot/sweating environment (ex: long distance drivers). When the infection happens and there is pus collection if it is drained appropriately then chances of fistula formation decreases drastically.
If pus is not drained then body has to discharge the pus and there are only two directions. If it bursts out of skin and infection gets completely cured then fistula does not form. If it bursts into anal canal then fistula is formed or worst case it bursts into skin but residual infection spreads slowly in different directions then complex fistula is formed. There are certain conditions like Crohn’s which predisposes one to having fistula. These conditions are rare in India.
Are there different kinds of fistula?
Fistula’s can be classified depending on the involvement of sphincter muscles and internal opening as shown in the picture.
What are the symptoms of Fistula?
Recurrent discharge of pus around the back passage which stops and starts . People end up taking antibiotic each time and with time fistula will become more complex and difficult to treat. If there is collection of pus then it cam present at abscess in which case abscess needs to be treated first then fistula at a later stage.
How is Fistula treated?
Only way to cure the fistula is by surgery. Most of fistula are simple and do not involve sphincter muscles so cutting it out fully will cure the fistula. If fistula involves sphincter muscles then cutting out fistula in one operation is not solution as it might cure fistula but it will one with incontinence. If sphincters are damaged one would loose control over the passing the stool and might have to run to toilet every time one gets sensation or there is prospect of passing on its own. So in these scenarios patient will need to have patience and might need two/three operations.