Summary about Disease
An anal fistula is a small channel that develops between the end of the bowel (anus) and the skin near the anus. It's often the result of a previous or current anal abscess. Anal fistulas can cause pain, swelling, and discharge near the anus. Treatment usually involves surgery.
Symptoms
Pain that is constant, throbbing, and worse when sitting down
Swelling and redness around the anus
Pus or blood draining from around the anus
Fecal incontinence (in some cases)
Painful bowel movements
Skin irritation around the anus
Fever, chills, and fatigue (if an infection is present)
Causes
Anal abscess: Most anal fistulas result from an infection in an anal gland that leads to an abscess. The fistula forms as the abscess drains.
Inflammatory bowel disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause fistulas.
Diverticulitis: Inflammation of pouches in the colon can sometimes lead to fistula formation.
Trauma: Injury to the anal area can, rarely, cause a fistula.
Sexually transmitted infections (STIs): Certain STIs can contribute to fistula development.
Cancer: Rarely, anal cancer can lead to a fistula.
Radiation therapy: For cancer treatment in the anal region.
Medicine Used
4. Medicine used
Antibiotics: Prescribed to treat infection associated with the fistula or abscess. (e.g., Metronidazole, Ciprofloxacin) Note: Antibiotics alone are typically not a cure for the fistula itself but can help manage infection.
Pain relievers: Over-the-counter or prescription pain medications to manage discomfort. (e.g., Ibuprofen, Acetaminophen, Opioids)
Stool softeners/Laxatives: To reduce straining during bowel movements.
Infliximab/Adalimumab: In patients with Crohn’s disease, these medications may help to close the fistula. Disclaimer: Always consult a doctor for a prescription.
Is Communicable
No, an anal fistula itself is not communicable or contagious. It is not caused by a virus or bacteria that can be spread from person to person through casual contact. However, if the fistula is related to an STI, the STI is communicable.
Precautions
Good hygiene: Gently clean the anal area with mild soap and water after each bowel movement.
Avoid straining: Prevent constipation by eating a high-fiber diet and drinking plenty of fluids.
Sitz baths: Soaking in warm water several times a day can help soothe the area and promote healing.
Manage underlying conditions: If the fistula is related to IBD or another condition, follow your doctor's treatment plan.
Prompt treatment of abscesses: Seek medical attention immediately if you suspect an anal abscess.
Avoid anal sex: Until the fistula is completely healed.
How long does an outbreak last?
An anal fistula is not an "outbreak" like a viral infection. It's a chronic condition that, without treatment, can persist indefinitely. It will continue to cause symptoms (pain, drainage) until it is surgically treated, or the underlying cause (like Crohn's) is effectively managed. Symptoms may fluctuate in intensity, but the fistula itself will remain.
How is it diagnosed?
Physical exam: A doctor will visually inspect the anal area to look for signs of a fistula opening.
Anoscopy: A small scope is inserted into the anus to visualize the anal canal.
Proctoscopy/Sigmoidoscopy/Colonoscopy: To examine the rectum or colon.
Fistulography: X-ray/CT scan after injecting contrast dye into the fistula opening to visualize the tract.
MRI: Magnetic resonance imaging can provide detailed images of the fistula and surrounding tissues.
Endoanal Ultrasound: An ultrasound probe is inserted into the anus to visualize the fistula tract.
Exam under anesthesia (EUA): Examination in the operating room may be necessary to fully evaluate the fistula tract.
Timeline of Symptoms
The timeline can vary, but a typical progression might look like this:
Initial Stage: Often starts with pain and swelling near the anus, potentially indicating an anal abscess.
Abscess Drainage: The abscess ruptures and drains pus, relieving some pain but leaving an open sore.
Fistula Formation: A persistent drainage occurs, indicating the formation of a fistula tract. The track does not heal without intervention and can develop months to years after the initial abscess.
Chronic Stage: Intermittent or persistent pain, drainage, and discomfort continue until the fistula is treated.
Important Considerations
Early Diagnosis and Treatment: Delaying treatment can lead to more complex fistulas that are more difficult to treat.
Surgical Expertise: Fistula surgery should be performed by a surgeon experienced in this area, as improper technique can lead to complications like incontinence.
Recurrence: Even with surgery, fistulas can sometimes recur.
Underlying Conditions: It is crucial to identify and manage any underlying conditions that may be contributing to the fistula.
Impact on Quality of Life: Anal fistulas can significantly impact a person's quality of life due to pain, discomfort, and social embarrassment.