Anal Fistula is a chronic granulous track which communicate between the anorectal canal and the perianal skin.
There may be several external openings but only one internal opening
Anal Fistula usually result from :
1.breakdown of anorectal abscesses
2.follows surgery for anal fissure
3.Less common causes are:
lymphogranuloma
carcinoma of rectum
ulcerative colitis,
tuberculosis
Symptoms are:
1.pain especially on sitting down
2.purulent painless discharge(pus) near the anus
3.Recurrent perianal abscesses(pockets of pus around the anus)
4.pruritis ani(itch in anus)
Diagnosis is by:
1.thorough examination of the perianal region
2.Rectal examination and palpation of the fistula track
3.Pass a probe through the perianal opening to determine the length of the track
4.Sigmoidoscopy and colonoscopy to detect internal opening and other lesions in the rectum and large intestine
5.Barium enema to exclude any ulcerative colitis and regional ileitis
There are 2 types of anal fistula:
1.High level fistulas penetrate the levator ani-muscle of the anal sphlinter
2.Low level fistulas are below the levator ani and are more common.
Treatment of lowlevel fistula:
lay open the track and curette(scrape the lining and debris in the track out
Treatment of high level fistula:
open the track from within the ischiorectal fossa
colostomy may be necessary for multiple fistulas or very high internal opening
General treatment:
1.Treatment of associated diseases like diabetes, ulcerative colitis,regional iliatis, carcinoma
2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed
3.toilet and dressing of the wounds, with application of antibiotic creams
4.tub baths of the anal region several times a day in plain, warm water for about 10 minutes
Prognosis is good with surgery.
Rarely there may undesirable complication like rectal incontinence.
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