Fistula ani or anal fistul is a medical condition in which a small abnormal channel is formed between the inside of the anus which is the hole where feces come out and the surrounding skin. Wounds around the anus can occur due to infection of the glands in the anus which causes an abscess or sac filled with pus. If the abscess is not cleaned properly, a channel or path can form connecting the area inside the anus to the surface of the skin.
Causes of Anal Fistula
The cause of non-healing wounds around the anus or anal fistula is an infection in the small glands around the anus. These glands function to secrete fluids that make it easier for us to defecate. If these glands are blocked or wounds are found, it can cause bacteria to accumulate and form abscesses or boils. When this abscess does not heal completely, or is cleaned properly, a small channel can form that connects the inside of the anus to the surrounding skin and this is called an anal fistula.
Further causes that can trigger the appearance of anal fistula include:
1. Anal Gland Infection
Lumps in the anus or anal fistulas are most often caused by infections in the small glands in the anus. These infections can cause an abscess to form. If the abscess is not healed or cleaned properly, a fistula can form.
2. Injury and Inflammation of the Anus
Trauma or injury to the anal area either due to physical injury can cause infection. In addition, chronic inflammation around the anus, such as due to inflammatory bowel disease , can cause tissue damage, infection and develop into an infection around the anus.
3. Crohn's disease
Crohn's disease is a chronic inflammatory bowel disease that can affect the entire digestive tract, including the anal area. Recurrent inflammation around the anus can lead to fistulas.
4. Post-operative complications
Surgery in the area around the anus or rectum, for example to treat hemorrhoids or abscesses can sometimes cause complications that trigger the formation of anal fistulas. In addition, an imperfect healing process or infection after surgery can also cause this problem.
5. Anal Fissure
An anal fissure is a small tear in the wall of the anus caused by constipation, chronic diarrhea, or other trauma. Unhealed fissures can become infected and develop into abscesses, which can cause a lump in the anus.
6. Colon tumors or cancer
Although rare, tumors or cancers around the anus or colon can press on surrounding tissue and cause infection. In such cases, treatment for the tumor or cancer usually includes treatment for the fistula.
Recognize the Symptoms of Anal Fistula
Anal fistula has quite typical symptoms so it is easy to recognize. The following are the symptoms or signs of anal fistula that you need to know:
1. Pain around the anus
One of the main symptoms of anal fistula is pain or soreness in the area around the anus, especially when sitting, moving, or having a bowel movement. This pain can be constant or occur when there is pressure on the area.
2. Discharge of pus and irritation
Anal fistula causes purulent discharge through the skin near the anus. This discharge can have an unpleasant odor and cause irritation, itching, and redness of the skin around the anus.
3. Fever and chills
If an anal fistula is caused by an active infection, general symptoms such as fever or chills may occur. Fever indicates that the body is fighting an infection, and this can be a sign of a more serious problem.
4. Pain during bowel movements
Fistulas can cause pain and discomfort during bowel movements due to pressure on the affected area. This pain can cause people with anal fistulas to avoid bowel movements, which can eventually lead to constipation.
These symptoms can vary from mild to severe, depending on the size of the fistula and how long the condition persists without treatment.
Anal Fistula Treatment
The following are efforts that can be made to treat lumps in the anus or anal fistula:
1. Fistulotomy or fistulectomy procedure
Fistulotomy or fistulectomy is the most common surgical procedure used to treat anal fistula. And for simple fistulas, this procedure has a high cure rate. but has the risk of pain, slow wound healing, recurrent infection and the most frightening is the cutting of the valve muscle around the anus which we call the Anal Sphincter causing incontinence (unable to hold bowel movements).
2. Seton
A seton is a special piece of thread or rubber that is placed through the fistula tract to keep the tract open and allow pus or infection to drain properly. This procedure is usually performed in complex cases.
3. LIFT Procedure
Ligation of Intersphincteric Fistula Tract is a newer and more popular surgical method for treating anal fistulas, especially those between the sphincter muscles ( intersphincteric ) and has high success in certain types or cases of anal fistula.
4. VAAFT Procedure
Video Assisted Anal Fistula Treatment. It is a procedure for handling anal fistula using a small camera inserted from the external wound of the fistula to the wound inside the anus. This procedure is usually used in cases of complex and recurrent anal fistula, usually in certain circumstances a branch (secondary track) can be found causing the patient not to recover.
5. FiLAC Procedure
Fistula Laser Closure. This procedure is one of the minimally invasive procedures, aimed at destroying the fistula tract using laser energy. This procedure is claimed to be minimally painful and scarring.
Prevention of Anal Fistula
To reduce the risk of developing an anal fistula, here are some things you can do:
- Maintaining cleanliness: Clean the anal area well after defecation to prevent infection.
- Treat infections promptly: Check for and treat abscesses or infections around the anus before they develop into fistulas.
- Treat diarrhea promptly: Treat ongoing diarrhea promptly to prevent irritation and inflammation in the anal area.
- Implement a healthy diet: Consume foods high in fiber and drink enough water to ensure smooth bowel movements.
If you experience symptoms that indicate an anal fistula condition such as persistent pain around the anus, swelling, discharge of pus, or discomfort during bowel movements, see a doctor immediately. Early treatment is essential to prevent further infection and more serious complications. Lumps in the anus cannot heal on their own and require medical treatment. By getting the right diagnosis and treatment early on, you can speed up the healing process and avoid bigger problems later on.
Article written by dr. Okkian Wijaya Kotamto, Sp.B.SubBDig, FINACS (Surgeon Specialist – Digestive Surgery Subspecialist, EMC Hospital Tangerang).