What Is An Anorectal Fistula (Perianal fistula)

An anorectal fistula (perianal fistula) is a narrow abnormal tunnel originating in the anus or rectum and extending to the surface of skin surrounding the anus, or occasionally into vagina, or other adjoining structures

  • They usually develop in people with tuberculosis or Crohn’s disease and in those who have previously had anorectal abscesses.
  • They may discharge pus constantly and may cause pain.
  • Physical examination and probing with viewing scopes can confirm the diagnosis.
  • Surgical treatments are the usual option but latest advancements include minimally invasive as well as non-surgical options.

When anorectal abscesses have drained spontaneously, or by the doctor, the resulting empty space may not close completely by tissue repair. In half the cases of drained abscesses, fistulas or channels open up which often leads to the surface of the skin around the anus. The origins of most fistulas are in the glands found deep in the anal and rectal walls and often, no specific reason is found for their abnormal development. People who have tuberculosis and those who have Crohn’s disease are found to be more prone to developing anorectal fistulas. Those who have had injuries involving the anus and rectum, and those suffering from diseases like diverticulitis, tumors or different types of cancers, also have a greater chance of developing this abnormal condition. In infants, more often in boys, fistulas may be present as a birth defect. Injuries to the vaginal area during childbirth may cause fistulas to open between the rectum and the vagina. Cancer and radiation therapy also may result in such fistulas.

Symptoms and Diagnosis

Constant discharge of pus is the most common symptom of anorectal fistula. If infection is present, it may precipitate pain. It may be possible for the doctors to see the outlets of the fistulas in the area around the anus or it can be felt under the surface of the skin. The depth and the direction of the fistula can be assessed by inserting a probe into the channel; and viewing through an anoscope inserted into the rectum, the opening of the channel on the other side can be detected. The disorder that may be causing the abnormal condition, such as Crohn’s disease or cancer, can be detected by the help of a long flexible viewing tube called sigmoidoscope.

Treatment Of Perianal Fistula

Surgery to open up the fistula called fistulotomy used to be the only option for anorectal fistula until recently. It often included an incision being made on the sphincter, and consequently, it had the risk of causing loss of control of bowel movements, if the sphincter is cut too deeply. In latest procedures, a flap is stretched over the internal opening to seal off the fistula or fibrin glue or tissue plugs are used to fill up and close the tunnel.

Drug treatment for Crohn’s disease often helps an existing fistula to close and decreases the chances of new ones developing. Surgery is not usually attempted in people having frequent diarrhea or Crohn’s disease, due to the additional risk of delayed healing of wounds making matters worse.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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