While people can avoid visiting a practitioner for all other aches and pains, bearing a pain in their behind is not something they would prefer doing. The causes of pain could be anything from lumbar problems to hemorrhoids or fistulas. Many people know about hemorrhoids, better known as piles and many people know about lumbar issues, but people seldom hear about fistulas. So we’re going to help you understand what fistulas are and how they can be treated.
What is a fistula?
What are the symptoms of a fistula?
- Frequent abscesses
- Pain and swelling
- Bloody or foul-smelling drainage (pus) from an opening.
- Irritation on the skin from drainage.
- Pain with bowel movements.
- Fever, chills and a general feeling of fatigue.
What are its treatment options?
Not many anal fiistulas heal by themselves, most of them require surgical intervention for healing.
There are a lot of different procedures for different types of fistulas. Your surgeon will help you understand what is best for you based on the position of your fistula and if it’s a single channel fistula or has branched off in different directions. A few important treatment options are outlined here.
Fistulectomy is the most common and recommended surgery for anal fistulas. In this procedure the whole length of the fistula is cut open so that it heals as a flat scar. It is one of the most effective treatment for many anal fistulas but it is usually recommended only for fistulas that do not pass through much of the sphincter muscles. When it does pass through the sphincter muscle, it increases the risk of incontinence.
Seton is a surgical thread that is inserted in the fistula and left in it for several weeks to keep it open. This procedure allows the fistula to drain and helps it heal, while reducing or avoiding the chances of the need to cut the sphincter muscles. The seton thread allows fistulas to drain, but does not cure them. Tighter setons may be used to cut through the fistula slowly, that’s the only cure with seton threads. If the fistula passes through a significant area of the anal sphincter muscle, inserting a seton may be recommended.
Advancement flap procedure
Advancement flap procedure is recommended when fistulectomy holds the potential to put you at risk of incontinence and the fistula passes through the anal sphincter muscle. This procedure involves the cutting or removing the fistula and covering the hole that’s opening in the intestine with a flap of tissue taken from inside the rectum. This procedure does not have a success rate as good as that of a fistulectomy’s. But the procedure reduces the chances of requiring to cut the anal sphincter muscles.
Ligation of the intersphincteric fistula tract (LIFT) procedure involves making a cut in the skin above the fistula and moving apart the sphincter muscles.further the fistula is sealed at both ends and cut open in order for it to lie flat. The LIF procedure is recommended for fistulas that pass through the anal sphincter muscles. Mostly in cases where a fistulotomy would be too risky.
This procedure was introduced a few years back, but it has shown some promising results. Experts need to research some more to determine how well it works in the short and long term.
This procedure involves the insertion of an endoscope (a tube with a camera on the end) in the fistula. After the endoscope is inserted, an electrode is passed through it and is used to seal the fistula. Endoscopic ablation is considered a safe treatment options with no serious concerns.
Like other laser treatments, this one also involves using a small laser beam to close the fistula. Radially emitting laser fibre treatment seals the fistula from both the ends. The outcome of this procedure is not sure shot but there are no potential threats or concerns.
One non-invasive treatment option, using a fibrin glue to close fistulas involves the surgeon injecting a special glue into the fistula while you’re under a general anaesthetic. It helps in closing the fistula and encourages healing. The results of this procedure may not be long-lasting, but it can be a useful for fistulas that pass through the anal sphincter muscles as they don’t need to be cut.
Similar to seton threads is the insertion of a bioprosthetic plug. This treatment option is considered when fistulectomy poses as a potential threat for incontinence. A bioprosthetic plug is a cone-shaped plug made from animal tissue that’s used to block the internal opening of the fistula. Some studies suggest this may be an effective treatment, but more evidence is required to be certain.
What are the risks of anal fistula surgery?
The level of risk a treatment option carries, depends on factors like where your fistula is located and the procedure you have undergone. Speak to your surgeon about the potential risks of the procedure they recommend.
Some of the common risks of anal fistulas are infection, recurrence of the fistula and bowel incontinence. When you consult an experienced colorectal surgeon assisted with the best technology in the world, you end up negating the risks involved.
If you’re suffering from pain or if you suspect a anal fistula, we suggest you visit a specialist without delaying. Reach out to us for more information.