Anal fistula - Surgery - DoctorNDTV

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Anal fistula

Q. I am suffering from anal fistula on both sides of my anus for last 15 years. I am also constipated and find it related to the other problem because there is more irritation and pain at that time. What is the permanent cure for this?

A. An anal fistula is an abnormal communication between the anal canal or rectum and the perianal skin. This communication is formed by a tract, which in lay terms may be likened to a tunnel. This tract extends from the internal opening in the anal canal or rectum to the external opening in the perianal skin. The most common cause is infection of an anal gland resulting in a perianal abscess. This abscess may drain or rupture externally and heal. Alternatively it may rupture externally as well as internally into the anal canal or rectum and form a fistula. The fistulous tract is continuously infected by faeces from the rectum and therefore does not heal. However, the external opening may close from time to time resulting in abscess formation and is the cause of pain. This abscess subsequently ruptures with the relief of pain and the reformation of the fistula. Unless treated this may recur over several years.

Very rarely anal fistulae may be due to tuberculosis, diverticular disease or other inflammatory disease of the colon. A fistula may be either 'low' or 'high'. In a low fistula the internal opening is below the anal sphincter while in a high fistula it is above the sphincter. The anal sphincter is responsible for faecal continence. The vast majority of anal fistula are low and are easy to treat.

Treatment is by surgery. A low fistula can be laid open or cut open so that it can drain freely and heal. However, a high fistula cannot be laid open as the anal sphincter will be damaged and will result in incontinence. Here a nylon thread is passed through the tract and tied and left for several weeks to allow free drainage and eventual healing of fistula. More than one operation may be necessary for the cure of a difficult fistula-in-ano.

01 May 2001

Answered by
Dr. Prakash Khanduri
Consultant Gastro-Intestinal Surgeon, Liver Transplant Surgeon
St. Stephens Hospital & Pushpawati Singhania Research Institute,
New Delhi
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