The anus is the opening through which faeces are expelled. Just inside the anus are a number of small glands that make mucus. Sometimes, these glands get clogged and can become infected, leading to an abscess. This abscess can tunnel out through a separate opening in the skin. This abnormal communication between the anus and the skin is called an anal fistula.
We can usually diagnose an anal fistula by examining the area around the anus. In many cases, there will be drainage from the external opening. Some fistulas may not be visible on the skin’s surface. We may order an ultrasound or MRI to get a better view of the fistula. Sometimes your surgeon will need to examine you in the operating room to diagnose the fistula.
Surgery is almost always necessary to cure an anal fistula. The goal of the surgery is to cure the fistula while preserving the anal sphincter function. The choice of operation depends on the anatomy of the fistula.
- Fistulotomy, Fistulectomy with Sphincter Repair
- Ligation of Intersphincteric Fistula Tract (LIFT)
- Mucosal Advancement Flap
- Video-Assisted Anal Fistula Treatment (VAAFT)
After the operation, you have to soak the surgical site a warm bath (sitz bath) 3-4 times a day to keep it clean. Depending on the extent of the infection before the operation, you might need daily dressing changes for a few weeks. After a well-performed operation, the fistula is unlikely to come back.