Anal Fissure/Fistula

Anal Fissure/Fistula

Overview

Fissure implies a tear whereas fistula is an opening in the outer anal skin to the rectum. Due to strain while passing stools, the sphincter muscles stretch and tend to tear. This generally heals over time. But in certain cases, due to excessive pressure, the condition gets worse leading to a tube-like opening which is more complex to treat.

Signs and symptoms

Anal fistulas or fissures often cause pain during bowel movement, urination, swelling around the anus, pus discharge from the sphincter muscle, pain and redness.

Causes and risk factors

When the fluids in the anal glands get accumulated, there are chances of bacteria build-up into small pockets called as abscess which cause a hole in the skin and the tunnel that connects the gland to the opening. The other risk factors that aid the formation of a fistula are trauma, inflammatory bowel disease, radiation therapies and systemic diseases like TB, HIV.

Complications

The common complications of Anal fistula/fissure are infections in the tract, bowel incontinence where the sphincter muscles lose control and lead to leakage of faeces.

Diagnosis

Anal fissures automatically heal by themselves over a few days but fistulas need medical intervention. Anal fistulas are easy to diagnose through physical examination and by identifying the presence of fluids or blood in the anal region. Further, a colon specialist will perform colonoscopy of the anal region, or use imaging of the rectal regions to examine the sphincter muscles and surrounding area.

Surgery

The location of the fistulas can create a threat of incontinence if any surgical complications arise. The treatment options include Fistulotomy which is done in two stages, where the fistula is cut open then cleaned, flattened and restitched; Rectal flap advancement where some tissues of the rectal wall are used to create a flap to cover the repair while the fistula is opened; Seton placement which uses a latex string to drain the fluids from the fistula and Fibrin glue (made fibrous protein) and collagen plugs which are used to fill in and seal the opening. Ligation of the inter-sphincteric fistula tract (LIFT) is the other treatment advised in which the fistula is artificially widened using a seton, later treated and sealed. More invasive surgical options like muscle flap, stoma and ostomy are available if needed.

Prevention

Anal fistulas can recur even after surgical treatment if proper care is not taken. The basic steps to prevent onset include maintaining a high fibre diet, drinking a lot of fluids, maintaining body hygiene, regular exercising and lifestyle management.

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