What is an Anal Fistula?
An anal fistula is an abnormal connection or tunnel between two areas. In the anorectal region, the most common cause of fistulas is from a blocked crypt or gland at the anorectal junction. The gland then becomes inflamed, and in an effort to expel its infected contents, expresses itself, usually as an abscess. As with thrombosed hemorrhoids, the collection of fluid within a fixed area, and the associated inflammation, becomes exquisitely tender. You may have systemic signs of illness, including fever. Once the abscess either drains spontaneously or is incised (cut open) and allowed to drain, the pain diminishes. However, a connection between the offending crypt and the outer opening, seen usually in the perianal region, may remain. Occasionally, the outer opening remains in the rectum, and the abscess and the fistula can only be identified by an examination, often under anesthesia. Rarely, the origin of the infection stems from the abdomen or pelvis, as in diverticulitis.
How is an Anal Fistula Treated?
A fistula may initially present acutely as an abscess. When an anorectal abscess is drained, about half of these abscesses remain as fistulas. Sometimes these fistulas may cross the anal sphincter muscles to their originating gland. The most effective treatment for managing these fistulas is fistulotomy, which connects the outer and inner openings and facilitates drainage of the inner opening. Unfortunately, division of the sphincter muscle or muscles may impair continence, and other alternatives exist for management of this difficult problem.
During creation of a mucosal advancement flap, a flap of the lining of the rectum may be created to cover the internal opening. Some studies report as high as 85% rate of cure, while others suggest the chance for cure is lower. Another approach entails injection of fibrin glue into the tract. The chance for cure is lower still, around 50 - 60%. Finally, a piece of suture or rubber band can be used to either hold the tract open, thus allowing for drainage, or can be gradually tightened, as in orthodontic braces, to gradually cut through the muscle in a graded fashion, where scar formation would be facilitated over time.
Your surgeon will discuss these and other options, with you. Fistula management is complex and requires knowledge of the special anatomy in this area and disease states in order to drain the infection and cure the fistula while maintaining continence.
The Division of Colorectal Surgery dedicated Anal Fistula Center has extensive experience in treating simple and complex anorectal fistulas. Fistulotomy, seton placement, advancement flap repair and LIFT procedures are performed by our surgeons and are individualized to the patient depending upon the nature and location of the fistula.
If you or someone you love is in need of care for an anal fistula issue, we’re here to help. Our team is available for consultations, second opinions, and to perform any colorectal procedure, should one be necessary. Call us at (212) 342-1155 or request an appointment online.