An anal fistula is an abnormal tunnel-like hollow passage or tract that starts from within the anus (the opening through which stool passes out of the body) and ends on the skin near the anus. These abnormal connections are referred to as fistulas caused by several factors like infections, injuries, and genetics. An anal fistula may be present if you have had an abscess in your anus. The most common reason for these openings is a surgery done to treat medical conditions like abscesses or infected veins — also called venous malformations.

If the development of anal abscess takes place, the risk of anal fistula development is enhanced. Certain risk factors for developing anal fistula involve the following:

  • Diabetes
  • Radiation therapy (for rectal cancer)
  • Smoking
  • Dermatosis
  • Excessive spicy food intake
  • Tuberculosis
  • Hyperlipidemia
  • Sedentary lifestyle
  • HIV Aids
  • Alcohol consumption
  • Sexually transmitted diseases (Syphilis and Chlamydia)

Five common reasons for anal fistula in men

The following are some of the reasons for this condition:

  1. Injury to the perianal region due to surgery or childbirth
  2. Crohn’s disease
  3. Ulcerative colitis
  4. Perianal abscess
  5. Injury to the anal region

Diagnosis

Anal fistulas are usually diagnosed during a physical exam. You’ll be asked to lie down on your side with your knees pulled up to your chest. This position relaxes the sphincter muscle, allowing the doctor to better view and feel the opening of the fistula. In addition, you may have one or more of the following tests:

  1. Anal fistula plug
  2. Fistulotomy
  3. Seton placement

Treatment

The treatment goals are to close the fistula, avoid damage to the anal sphincter, and prevent a recurrence. Treatment options may include:

  1. Medicine: Certain medicines may help control inflammation and pain. A short course of antibiotics may help fight the infection that could delay healing.
  2. Fibrin Glue: A non-surgical option where the primary benefit is that it can shorten hospital stays for patients. The overall goal of treatment is to avoid the development of a chronic fistula, which can be achieved by covering the internal opening with healthy, granulating tissue.
  3. Drainage: Your doctor may place a small tube called a seton in the fistula tract. This can help reduce pressure from pus build-up and allow the fistula to heal without closing. It also decreases the risk of making an incontinence problem worse. A seton is typically left in place for four to eight weeks.
  4. Surgery: Surgical procedures can correct most anal fistulas, but there is a chance that surgery might cause temporary or permanent fecal incontinence or make it worse. Options include:
    • Fistulotomy (also called fistulectomy). This type of surgery is commonly used to treat simple fistulas and those with only one internal opening and one external opening. The surgeon makes an incision along the length of the tunnel, allowing it to heal open rather than closed, which helps prevent a recurrence.
    • Laser ablation is the primary treatment for anal fistula. Laser ablation is a surgical procedure that uses heat from a laser to destroy unwanted tissue, such as tumors. It can also be used to remove warts, birthmarks, and other blemishes. It’s less invasive than other treatments and has a lower risk of complications than surgery, but it isn’t suitable for everyone with an anal fistula.
  5. Advancement flap procedure or mucosal advancement flap procedure. In these procedures, your surgeon uses tissue from inside.

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