Advanced Treatment of Anal Fistula

What is anal fistula?
Fistula is a chronic tunnel that forms around the anus and causes repeated infection/abscess formation and discharges (spotting/soilage seen on the underwear) or itching or a pimple near the anus that wouldn’t heal, this is a serious condition that could lead to serious complications and needs to be addressed early on in its course.

Do not get mixed up between anal fissure (a painful cut in anal skin) and anal fistula (a tunnel that forms and connect the anal canal with peri-anal skin)

Most anal fistula patients first develop a peri-anal abscess, they suddenly wake up with a red painful swelling in the skin surrounding their anus, they cannot sit comfortably, they can feel a little bump in the skin around the anal opening, it hurts if they press it, it is extremely tender, this is an anal abscess , a pocket of infection and pus trying to explode and drain to the outside which may happen spontaneously if the patient does not go to the doctor early enough, or it may be drained by the surgeon in a more precise and proper fashion (a procedure called I & D of abscess which stand for incision and drainage of abscess.)

Once the abscess drains to the outside surgically or spontaneously, most patients feel better as the pressure of the abscess tearing their peri-anal tissue disappears but in most cases the problem has not ended, they are left now with an anal fistula which is a small opening , it looks like a pimple that will never heal in the skin surrounding the anus which continues to secretes some yellowish at times bloody discharges… it stains the underwear or make the area wet and itchy.

The reason behind the formation of fistula:

Most anal abscess start and for unknown direct cause with a little infection in the anal canal mucous glands ( these are the glands in our anal canal that make some mucous to facilitate our stool passage during bowel movement ), if one of these glands get blocked, it develops into an abscess adjacent and to the outside of anal canal wall, this abscess expand and eventually ruptures or gets surgically drained into the skin near the anus.

As the infection and pus slowly clears, the connection ( the tunnel ) between the anal canal and the skin around the anus is formed. This is what we call a fistula. It is abnormal tunnel within which stool particles with all its bacteria can reside and causes repeated or continuous infection and discharges. It is not uncommon for fistula patients to report several bouts of abscess formation during his/her course after several previous surgeries to drain or eliminate his/her condition.

How do we treat Anal Fistula?

Anal fistula is a condition that demands respect and prompt accurate treatment by specialized surgeons who deals with these conditions frequently. The procedure is complicated and the reason is the difficulty in approaching this abnormal tunnel and destroying it without injuring the anal sphincter muscle (this is the circular muscle surrounding the anal canal and through which most anal fistula pass.)

It is a fact that a significant injury to anal sphincter muscle will cause a life-long incontinence and loss of control over the anal canal content release. This loss of control is a serious complication that unfortunately we see too often after an overzealous fistula surgery done by non specialized centers.

Fortunately 85% of anal fistula cases are below the sphincter muscle and therefore require simple laser Fistulectomy which we do at VeinCure in few minutes under local anesthesia. Laser wounds heal fast and in near painless fashion and do not interfere with patient’s daily activities at all.

For those 15% of patient when we suspect that their fistula is high (passing through significant portion of their sphincter muscle) we may order MRI or fistulogram or both to help us map the course of their fistula and develop the appropriate treatment plan.

Here again, we take great advantage of our Endolaser tools to cure high fistula with two stage procedure that respect the sphincter muscle and keep it intact. These are somewhat technical procedures with different options, all of them require less than half an hour to perform but they offer these complex fistula patients the best and safest chance of cure with minimal or no pain and discomfort. They can be explained by your VeinCure surgeon in detail upon your visit to one of our clinics. Most of our surgeons like to make a drawing to show you the path of your specific fistula and explain their planned treatment to get rid of it. It is all this accumulative experience of VeinCure clinics that make the treatment of the most complicated cases simple, but it is your responsibility to seek medical attention early on in your disorder and not delay your fistula treatment till it branches to several fistula(s) and destroy your sphincter muscle.

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