Anal Fistula is an abnormal passage that occurs between the interior of the anal canal or rectum and the outside skin surface. In certain cases it may be connected with the vagina or other pelvic structuresANAL FISTULA that may include the bowel. Fistulas may occur singly or in multiples and the major causes associated with it include tuberculosis, cancer and inflammatory bowel disease.
Causes
Anal fistulas most commonly develop as a result of an anal abscess which is a collection of pus and infected fluid. An anal abscess normally develops after a small gland, just inside the anus, becomes infected with bacteria or foreign matter. Abscesses are usually treated with a course of antibiotics. In most cases, you will also need to have the infected fluid drained away from the abscess.
If an anal abscess bursts before it has been treated, then it can sometimes lead to an anal fistula. A fistula may also occur if an abscess has not completely healed, or if the infected fluid has not been entirely drained away.
An abscess does not always develop into a fistula. Approximately half of all people who experience an anal abscess will go on to develop a fistula. There is no way of predicting when a fistula will develop.
Anal fistulas are also a common complication of conditions that result in inflammation of the intestines. Some of these conditions include:
Intersphincteric, Trans-sphincteric, Submusoal and Extrasphincteric fistula are the different types in the order of prominience.
Diagnosis
A fistula can be diagnosed through an anal ultrasound or using a Fistula probe.
Symptoms
The major symptoms are discharge of pus or stool near the anus that causes irritation in the outer tissue leading to itching, pain and discomfort.
There are different methods available to treat anal fistula
Fistulotomy
After locating the fistula's internal opening the tract is opened out and the contents are scraped and flushed out. The fistula is laid open and the sides are stitched onto the sides of the incision. In more complicated situations the tracts are removed as in the case of a horseshoe fistula. In certain cases more than one surgery is required depending on the amount of sphincter muscle removed.
Rectal Flap Advancement
In this technique the tract is brought out and a cut is made into the rectal wall to access and remove the fistula's internal opening. The flap is then stitched back in place later on. Transanal rectal flap advancement repair is an operation to treat trans-sphincteric fistula which leaves the external sphincter muscle essentially untouched
Seton Placement
A seton (silk string or rubber band) that is used to create a loop outside the fistula. This allows the fistula to continue to drain while healing. By tightening the Seton stitch, it can be used to gradually cut through the fistula wall. The fistula gradually heals over behind the cutting Seton thereby slowly moving the fistula until it is outside the body.
Fibrin Glue
Fibrin glue is made from plasma protein and is used to seal up and heal a fistula rather than cutting it open. The fistula tract is cleared and the internal opening is closed. The glue is injected through the external opening. The fistula tract can also be sealed with a plug of collagen protein and then closed.
The other general procedures are:
Few Major Hospitals for Treatment of Anal Fistula are:
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