Anal Fistulas: Causes, Symptoms, and Treatment Options

Anal fistula

Last month, I underwent surgery for hemorrhoids at the hospital.
After the operation, I went home to take medication and soak my buttocks.
I experienced pus every day.
During my first follow-up appointment and the last one, I asked the doctor about a large lump that I had to push back in after using the restroom, but the doctor assured me that the wound was healing well.
However, by the final follow-up, I was told that the wound looked good.
As I thought about it more, it felt increasingly strange and painful.
The next day, I went back to the clinic where I had my initial hemorrhoid treatment, and they informed me that the surgery was not performed correctly and that I had inflammation.
They prescribed medication, gave me an injection, and told me to apply ointment at home.
Unfortunately, it did not improve and developed into a fistula, requiring another surgery.
When I inserted my finger to apply the ointment, I felt a sharp tip inside.

Jun, 20~29 year old female. Ask Date: 2020/09/14

Dr. Ke Fangxu reply Surgery

It is normal to have discharge from the wound before healing after hemorrhoid surgery.
As for the prolapse after using the restroom, it needs to be evaluated by a physician to determine if it is an unresolved external hemorrhoid or excess skin.
It could also be rectal mucosal prolapse.
If you feel a prickly tip upon examination, it may be due to non-absorbed sutures.
It is recommended that you have your surgeon check to see if a fistula has formed.

Reply Date: 2020/09/14

More Info

Anal fistulas are abnormal connections that form between the anal canal and the skin surrounding the anus. They often develop as a complication of anal abscesses, which are collections of pus that can occur due to infections in the anal glands. Understanding the causes, symptoms, and treatment options for anal fistulas is crucial for effective management and recovery.

Causes
The primary cause of anal fistulas is the formation of an anal abscess. When an abscess occurs, it can create a tunnel that connects the infected gland to the skin. Other potential causes include:
- Inflammatory bowel diseases: Conditions like Crohn's disease and ulcerative colitis can lead to fistula formation.

- Trauma: Injury to the anal area can result in fistulas.

- Radiation therapy: Treatment for cancers in the pelvic area can damage tissues and lead to fistulas.

- Sexually transmitted infections (STIs): Certain STIs can also contribute to the development of anal fistulas.

Symptoms
The symptoms of an anal fistula can vary but typically include:
- Pain and discomfort: Especially during bowel movements or when sitting.

- Swelling and redness: Around the anus, indicating inflammation.

- Discharge: Pus or blood may leak from the opening of the fistula.

- Recurrent abscesses: Patients may experience repeated infections in the anal area.

- Foul odor: Due to the discharge from the fistula.

Diagnosis
Diagnosis usually involves a physical examination by a healthcare provider. They may also use imaging studies, such as an MRI or ultrasound, to assess the fistula's extent and complexity.

Treatment Options
Treatment for anal fistulas typically requires surgical intervention, especially if they do not heal on their own. Common surgical options include:
- Fistulotomy: The most common procedure, where the fistula tract is opened and allowed to heal from the inside out.

- Seton placement: A seton (a piece of surgical thread) may be placed in the fistula to help drain it and promote healing.

- Advancement flap procedure: Involves using tissue from nearby areas to close the fistula.

- Ligation of the intersphincteric fistula tract (LIFT): A newer technique that aims to minimize damage to the sphincter muscles.

Postoperative Care
After surgery, it is essential to follow your healthcare provider's instructions for care and recovery. This may include:
- Pain management: Taking prescribed pain medications as needed.

- Wound care: Keeping the area clean and dry to prevent infection.

- Dietary adjustments: Eating a high-fiber diet to avoid constipation and straining during bowel movements.

- Follow-up appointments: Regular check-ups to monitor healing and address any complications.

Conclusion
If you suspect you have an anal fistula or are experiencing symptoms following anal surgery, it is crucial to consult with a healthcare provider. Early diagnosis and appropriate treatment can significantly improve outcomes and quality of life. If you have concerns about your recovery or the effectiveness of your previous treatments, do not hesitate to seek a second opinion or further evaluation from a specialist in colorectal surgery.

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