A B C D E F G H I J K L M N O P R S T U V W

ANAL FISTULA

What is an Anal Fistula ?

A fistula is an abnormal channel connecting the inside of the back passage (anal canal) to the surface of the skin around the anus.

How does an Anal Fistula occur ?

There are several glands within the wall of the back passage. Infection of one of these may result in an abscess which then extends on to the skin around the anus. When the abscess discharges, a permanent channel linking the anal canal with the skin may be produced. As a result, bacteria can find a way into the tissues and recurrent abscesses may form. Less commonly, fistulas occur as a result of underlying disease of the intestine.

Why does an Anal Fistula occur ?

The reason why the anal glands should become infected in some people is unknown. Fistulas can be linked to an underlying disease of the intestines such as Crohn's disease, ulcerative colitis or tuberculosis, or rarely, tumours of the rectum.

Treatment Involved for an Anal Fistula

When there is an abscess, the pus must be drained under general anaesthetic. At the same time, an examination is carried out to determine whether a fistula is present. If a fistula is demonstrated, the channel must be opened up to the surface of the skin. This will then allow nature to heal it from its deepest part. It is rare to find any underlying disease of the intestine, but should it be present, it will be picked up at this examination. Following the operation the wound may take from 2 to 6 weeks to heal, depending on its size. Longer periods are necessary occasionally. In the early stages of healing the dressings of the wound are very important to ensure that healing progresses properly. If healing is incomplete, the fistula may return. Dressings are performed once or twice a day and will initially be done in hospital. The first dressings may be a little painful but pain relief will be given. Later, dressings are painless. Daily or twice daily baths taken before the change of dressings are soothing and help the dressings to be removed. When sufficient progress has been made, the dressings may be done as an outpatient treatment or by a district nurse. Arrangements will be made for the wound to be checked regularly by the surgeon until healing is complete.

During Treatment for an Anal Fistula

It is very important that the dressings are changed regularly and the wound examined. This will be at least on a daily basis until sufficient progress has been made. After the initial dressings, the wounds are usually painless and painkillers are unnecessary. Itching may occur, due to the accumulation of moisture at the site of the wound. This will be relieved by bathing before the dressings are changed. It is important to avoid constipation, taking laxatives if necessary.

After Treatment for an Anal Fistula

Provided the dressings have been regularly performed, recurrence is unlikely. After healing is complete, any local pain, swelling, or discharge may indicate that there is a further problem and should be reported to the doctor.

If an Anal Fistula is Left Untreated

Recurrent abscesses around the anus would occur.

Effects on Family of an Anal Fistula

The daily routine on leaving hospital would have to be arranged in such a way as to allow the necessary dressings to be performed. This might involve regular visits to the hospital or waiting for the district nurse to call.