Anal Fistulas: Symptoms, Treatments, and Pressure Tests - Surgery

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Anal fistulas are abnormal connections between the anal canal and the skin surrounding the anus. They often arise from an infection in the anal glands, leading to the formation of an abscess that can drain pus. Symptoms of anal fistulas typically include pain, swelling, and discharge of pus or blood from the opening near the anus. Patients may also experience discomfort during bowel movements and may notice changes in bowel habits, such as increased frequency or a feeling of incomplete evacuation, as you've described.

Given your history of recurrent anal fistulas and the recent changes in your bowel habits, it is crucial to consult with a colorectal specialist. The symptoms you are experiencing, such as the inability to fully evacuate your bowels and increased frequency of bowel movements, may indicate a complication related to the fistula or an underlying issue such as anal sphincter dysfunction.


Understanding Anal Pressure Tests
An anal pressure test, often referred to as anorectal manometry, is a diagnostic procedure used to assess the function of the anal sphincter and the rectum. During this test, a small, flexible tube with a balloon at the end is inserted into the rectum. The balloon is inflated to measure the pressure exerted by the anal sphincter muscles at rest and during contraction. This test can help determine if there is any weakness or dysfunction in the anal sphincter, which could contribute to symptoms of incontinence or difficulty with bowel movements.


Symptoms of Anal Incontinence
If you are experiencing anal incontinence, it may manifest as:
1. Inability to Control Bowel Movements: This can range from minor leakage to complete loss of control.

2. Urgency: A sudden, strong need to have a bowel movement that can be difficult to control.

3. Incomplete Evacuation: The sensation that you have not fully emptied your bowels after a movement, leading to frequent trips to the bathroom.

4. Discomfort or Pain: This can occur during bowel movements or as a result of straining.


Treatment Options
For your situation, treatment options may include:
1. Surgical Intervention: If the anal fistula is recurrent and causing significant symptoms, surgical options may be necessary. This could involve fistulotomy or other techniques to ensure complete healing and prevent recurrence.


2. Medications: Depending on the underlying cause of your symptoms, medications such as stool softeners, anti-inflammatory drugs, or topical treatments may be recommended to manage discomfort and improve bowel habits.

3. Dietary Changes: Increasing fiber intake can help regulate bowel movements and reduce straining, which may alleviate some symptoms.

4. Pelvic Floor Therapy: If there is evidence of sphincter dysfunction, pelvic floor physical therapy may help strengthen the muscles and improve control.

5. Regular Follow-Up: Continuous monitoring and follow-up with your healthcare provider are essential to manage your symptoms effectively and adjust treatment as necessary.

In conclusion, your symptoms warrant a thorough evaluation by a colorectal specialist, who can perform the necessary tests, including anorectal manometry, to assess sphincter function and determine the best course of action. Early intervention can help prevent further complications and improve your quality of life.