Fistula – Symptoms
Common symptoms of fistula include:
- Pain, itchiness, swelling and red rashes around your anus
- Bleeding from pores around the anus
- Painful, hard and straining bowel movements
- Foul-smelling ooze (pus) from a hole near the anus
Fistula – Causes
In most cases, an anal abscess causes anal fistula. An anal abscess is a pus-filled lump in the anus. It happens when a gland inside the anus gets blocked or clogged due to an infection.
An anal abscess, if left untreated, grows in size, and punches a hole in the skin inside the anus so that the pus can find a way to drain. This creates a tunnel which is known as a fistula.
Fistulas can also be caused due to chronic constipation or diarrhoea and strained bowel movements.
Fistula – Diagnosis
To check for an anal abscess or a fistula, your doctor or nurse will look at your anus and do a “digital rectal exam.” During a digital rectal exam, your doctor or nurse will put a gloved finger into your anus and rectum to feel for lumps or anything abnormal.
He or she might also order an “imaging test,” such as an MRI or a CT scan.
Fistula – Treatment
There are a few natural remedies which you can adopt to ease the symptoms to a certain extent. These include:
- Sitz baths – Sitting in warm water several times a day can provide relief as it helps keep the rectal area clean and prevents bacteria build-up.
- Increased personal hygiene – Do make it a point to practice effective hygiene to keep the anal region clean and bacteria-free as not doing it can lead to further infection
- Using a cushion or pillow to sit on several times a day can is also known to make people comfortable
However, surgery is the only option to treat a fistula effectively. You can choose from various surgical options:
- Laser Closure of Anal Fistula – Radially emitted laser energy using optical fibre is used to seal the fistula. This is a minimally invasive surgery with no major safety concerns. It is performed under general anaesthesia and can be done in a very short duration. It is important to choose the right proctologist and hospital for laser treatment of fistula as it needs experience to perfect it.
- Fistulotomy – This is the traditional treatment and is the most common way of treating fistula. The proctologist shall cut along the whole length of the fistula to open it up so that it drains and heals as a flat scar. However, a fistulotomy can result in fecal incontinence if some of the sphincter muscles are cut open.
Seton Techniques – If the risk of incontinence is high, the doctor may open up the fistula by inserting a seton – a piece of surgical thread and keeping it inside for several weeks. This method allows fistulas to drain. To cure it completely, the doctor may tie tighter setons to cut through the fistula slowly. This involves several sittings with the doctor.
Fistula – Risks & Complications
Fistula surgeries carry a few risks as any other surgical procedure. Some of them include:
- Bowel incontinence due to cutting open sphincter muscles
- Infection – this may require treatment using antibiotics
- Recurrence of the fistula may occur in certain cases despite surgery
The level of risk depends on the location of the fistula and the specific procedure that is adopted to treat it.
Fistula – Pre Op Care
Fistula treatment is done under general anaesthesia. The doctor will ask for following fasting requirements for general anaesthesia – generally for up to 6 hours before the surgery. You may be given a laxative to clean your bowels completely before the surgery.
You may even need an enema (bowel washout) before the surgery. Anti-clotting injection may be given right before the surgery starts.
Fistula – Post Op Care
You will need to rest until the effects of the anaesthesia pass. The doctor may recommend having fluids to start eating and drinking when you feel ready.
A nurse will clean the wound and redress it the morning after the surgery. It is normal to have some bleeding afterwards. The wound will have to be redressed constantly till it completely heals leaving behind a scar.
You may be prescribed painkillers, antibiotics and laxatives by the doctor to heal faster.
Preventive measures can help you manage your fistula better and can also help you recover faster after your surgery.
- Include more roughage in your diet to help with your bowel movement
- Avoid spicy food preparations or dairy products as they can irritate the area for surgical area, and can be constipating
- Drink lots of water
Avoid caffeine and alcohol