Anal Fistula
An anal fistula is an abnormal connection between the anal canal and the skin near the anus.
It usually develops after an infection in the anal glands which forms an abscess that drains on its
own
or surgically, leaving a tunnel. Fistulas can cause discomfort, drainage, and recurrent infections
if untreated.
Who Gets Fistulas?
Anal fistulas can affect anyone, but are more common in:
- Adults aged 30–50 years
- Patients with a history of anal abscesses
- People with Crohn’s disease or inflammatory bowel disease
- Those with chronic infections around the anal area
Symptoms
- Persistent drainage from the anal opening
- Pain or swelling around the anus
- Recurring abscesses
- Itching or irritation near the affected area
- Fever in case of infection
Investigations
- Clinical examination (inspection & palpation)
- MRI fistulogram – gold standard to define fistula path
- Endoanal ultrasound
- Proctoscopy to rule out underlying conditions
Treatment Options
- Conservative management: Only for minor asymptomatic fistulas, hygiene, sitz
baths, antibiotics if infected.
- Surgical treatment:
- Fistulotomy – opening the fistula to heal naturally
- Seton placement – for complex fistulas to allow drainage
- Advancement flap – for high or complex fistulas
- LIFT procedure (ligation of intersphincteric fistula tract)
- Fibrin glue or plugs – minimally invasive options
- Post-operative care: Sitz baths, stool softeners, high-fibre diet, and hygiene
to prevent recurrence.
Prevention & Advice
- Maintain good anal hygiene
- Treat abscesses promptly
- Eat a high-fibre diet to prevent constipation
- Avoid straining during bowel movements
- Follow-up after surgery to monitor for recurrence