...

What is an Anal Fistula?

A fistula is an abnormal connection between two organs or linings that are not normally connected. An anal fistula is an internal tract that develops between the bowel and the skin on the buttocks. A fistula typically appears as a hole in the skin near the anus.

In most cases, an infection in the anal glands or tissue results in an abscess that holds pus. Once the pus drains, the hollow remains, which is the resultant fistula. 

Anal fistulas usually do not heal by themselves. Typically, surgery is required to treat them.

What are the Symptoms of Anal Fistula?

Commonly reported signs of an anal fistula include :

  • Perianal skin irritation (skin surrounding the anus)
  • Discharge of pus or blood from the anus, which may have a foul odour
  • Swelling, itching, or intense pain in the anus
  • Fever and shivering if you have an anal abscess     

The inability to control one’s bowel movements or faecal incontinence may also be a symptom in some anal fistula cases.

When Should You Seek Medical Help?

Anal fistulas usually do not go away on their own. It is difficult to reliably identify an anal fistula by yourself because it appears externally as a hole close to the anus and may not be visually accessible. Leaving it untreated can lead to several complications. Some potential complications are :

  • Recurrence
  • Faecal incontinence
  • Fistula hole closure while leaving the tunnel open, which causes pain and swelling
  • Extension of fistula tunnel into multiple branches
  • In rare cases, life-threatening conditions like sepsis 

Timely diagnosis and treatment of anal fistulas can help prevent these complications. If you are experiencing any of the listed anal fistula symptoms, it is recommended that you consult a doctor to ensure an early diagnosis and treatment. If you have a history of anal infections or abscesses, consult a specialist as soon as possible to choose the best course of action.

What Causes an Anal Fistula?

Anal fistulas have several possible causes.

  • They usually occur as a consequence of an infection in the anal glands that leads to abscess formation.
  • Individuals diagnosed with certain diseases are at a higher risk of developing anal fistulas. These include :
    • Inflammatory Bowel Disease (Crohn’s disease)
    • Diverticulitis
    • Infectious diseases like HIV or tuberculosis
    • Chronic skin conditions
  • Anal fistulas can also be a possible complication of surgery related to the anus or prior anal injury.

Anal fistulas affect men more often than women. The exact reason for this susceptibility is unknown.

How is an Anal Fistula Diagnosed?

The doctor will start by inquiring about your concerns and symptoms, including their severity and duration, and a detailed medical history. It is important to mention any history of anal infections or anorectal conditions.  Then, the affected area will be examined to check for a fistula. The doctor may gently press the surrounding area to see if there is any tenderness or discharge. They may also insert a gloved and lubricated finger into the anus for an internal examination. Other tests for confirming the diagnosis include:

  • Anoscopy or Proctoscopy: Here, a medical device with an attached camera is inserted into the anus for clear visual examination.
  • Fistula Probe: Here, a thin probe is inserted into the fistula opening. It can be used to identify the other end of the fistula tunnel. This is usually done under general anaesthetic. 
  • Imaging Techniques : An ultrasound scan or an MRI may be performed. l.
Depending on whether you are experiencing pain or discomfort, the tests may be performed with or without sedation or under general anaesthetic.

What are the Treatment Options for an Anal Fistula?

In most cases, anal fistulas can be treated only with surgery. The complexity of the required surgery is dependent on the extent of sphincter muscle involvement in the fistula. The anal sphincter muscles are a ring of muscles in the anus responsible for its opening and closing. Damage to the sphincter muscles during anal fistula surgery may result in bowel incontinence, which is the inability to control bowel movements.

Surgery Options for Anal Fistula

  • Fistulotomy :
    This procedure is used to treat a simple fistula by cutting it open and allowing it to heal into a flat scar. Its success rate is exceptionally high.
  • Seton Placement :
    Seton is a surgical thread or rubber band that is looped through a complex fistula to keep it open, allowing complete drainage of pus before closing the tunnel.
  • Endorectal Advancement Flap Procedure :
    Instead of cutting a complex fistula open, tissue from the rectum is used to plug the internal end of the fistula tunnel.

  • Ligation of the Intersphincteric Fistula Tract (LIFT) Procedure:
    In this procedure, the complex fistula tunnel is tied off on both ends to allow it to heal without damaging the sphincter muscles

  • Fistula in Ano Laser Assisted Closure (FiLAC):
    Here at the Leicester Bowel Clinic, we specialise in using a probe with a laser tip that burns the fistula tract to encourage it to heal. This avoids any incision or cutting open any potential muscle/sphincters. Usually, we would encourage inserting a seton before laser ablation to increase the chances of success.
  • Fibrin glue & collagen plug :
    Fistulas can be repaired by sealing them shut instead of cutting them open. After draining the fistula, the inside opening is stitched closed, and the outside opening is sealed using a special kind of glue made from plasma protein (fibrin glue) or a plug made of collagen protein.

The doctor will take you through each anal fistula surgery option in detail and explain the benefits and risks associated with them.

Why Choose the Leicester Bowel Clinic?

Book a consultation with us to get treatment for your condition.

Our experienced surgeons prioritise your well-being, providing cutting-edge techniques for the best outcomes. From consultation to recovery, we maintain strict confidentiality and provide a secure, comforting environment. We offer medical and surgical therapies both in clinics under local anaesthesia and in theatres under general anaesthesia.

Want to book an appointment?

Connect with
us now

Book a consultation
Request a call back

Pricing

Consultations start at

£200

Request a call back by filling out the contact form to the right.

We look forward to assisting you!

request a call back

Our Locations

Leicester Bowel Clinic at Spire Hospital

  • Wednesdays evenings (Mr Runau) from 6:00 pm until 9:00 pm at: Spire Leicester Hospital Gartree Road Leicester LE2 2FF
  • To arrange an appointment directly with the Spire Leicester Hospital, please call the booking line on 0116 2653685

*Free on-site parking is available.

Frequently Asked Questions

01. Is a fistula a serious problem?

Fistulas can cause symptoms like pain, itching, swelling, discomfort, and a foul odour in their early stages. Left untreated, fistulas can lead to several serious complications. If you suspect that you have a fistula, it is recommended that you consult a doctor.

02. Will a fistula heal on its own?

Fistulas may heal for a short period of time but will invariably recur unless treated surgically. The longer a fistula is left untreated, the more severe its consequences will be.

03. What is the best treatment for a fistula?

Surgery is the only treatment for most cases of fistulas. While non-surgical options may work for certain cases, this is uncommon. Depending on the location and severity of the condition, different fistula surgeries are used for treatment.

04. How do you detect a fistula?

The doctor will listen to your symptoms and medical history and perform a physical examination. Diagnosis may also involve tests like an anoscopy or scans.