Fistula-in-Ano
An abnormal tunnel connecting the anal canal to the skin near the anus.
Overview
An anal fistula is an abnormal tunnel connecting the anal canal to the skin near the anus. It usually results from a previous perianal abscess that didn't heal completely. Fistulas don't heal spontaneously and require surgical treatment. The challenge is eliminating the tract while preserving sphincter function (continence).
Causes
- Previous perianal abscess (most common)
- Crohn's disease
- Tuberculosis
- Previous anal surgery
- Radiation therapy
- HIV/immunosuppression
- Rarely: cancer
Risk Factors
- History of perianal abscess
- Crohn's disease
- Diabetes
- Immunosuppression
- Smoking
- Previous anal surgery
Symptoms
Diagnosis
- Clinical examination (external opening visible)
- Proctoscopy
- MRI pelvis (gold standard for mapping complex fistulas)
- Endoanal ultrasound
- Examination under anesthesia (EUA)
- Goodsall's rule for predicting internal opening
Treatment Options
Surgical Treatment
Treatment depends on fistula complexity. Simple low fistulas: fistulotomy (laying open) with 95%+ cure rate. Complex/high fistulas: LIFT procedure or seton placement to preserve sphincter function. Dr. Bhagat uses MRI-guided surgical planning and sphincter-preserving techniques for all complex fistulas.
Recovery
Fistulotomy: Day-care procedure, wound heals in 4-8 weeks by secondary intention. LIFT: 1-2 days hospital stay, 3-4 weeks recovery. Regular sitz baths and wound care are essential. Recurrence rate: 5-10% for simple, 15-20% for complex fistulas.
Prevention
- Prompt treatment of perianal abscesses
- Don't let abscesses drain spontaneously
- Maintain good perianal hygiene
- Control underlying conditions (Crohn's, diabetes)
- Avoid constipation
Frequently Asked Questions
Can a fistula heal without surgery?
Will I have incontinence after fistula surgery?
Expert Consultation Available
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