• Shruti GOCHHWAL

Anal Fistula: A disease you never want to have

An anal fistula is the disease of the anus characterized by a swollen node around the anal region. It usually develops as an abnormal communication between the epithelial surface of the anal canal and perianal skin. It’s a very common problem and occurs mostly in people with previous anal infection. Fistula in the anus resulting from an anal infection or abscess originates from the anal glands that start to drain making anal fistula even worse.

What are the Various Types of Anal Fistula?

Anal fistula

Man suffering from anal fistula, Credits: pixabay


There are four types of Anal Fistula which are described as follows:

  1. Inter sphincteric Fistula: This form of fistula involves the sphincter muscles and generally occurs between the anus’ external and inner sphincter muscles. Then it gradually passes through the internal sphincter muscles close towards the anus.

  2. Tran sphincteric Fistula: This form of fistula originates between the external and inner sphincter muscles in the region behind the anal area. It flows across the outer sphincter and the anus away from the ischiorectal fossa to the perineum. It is sometimes called a horseshoe fistula, since it often takes a U-turn and may form many outside openings.

  3. Supra Sphincteric Fistula: The gross anal fistula is about 5 percent. The abscess is caused by the supra-levator between the inner and outer sphincter muscles. This stretches between the puborectal muscles and the levator ani downwards. It is an inch or so away from the anus.

  4. Extra Sphincteric Fistula: It occurs when a foreign body enters the rectum, or because of the Crohn’s disease and rectal carcinoma, as the name suggests. It starts from the rectum or sigmoid colon and devolves into the anus’ tissue.

What are the Symptoms of Anal Fistulas?

Pain, redness and itching due to anal fistula

Pain, redness and itching due to anal fistula, Credits: pixabay


  1. Anal fistulae may irritate the skin, cause itching, swelling, redness, and pain in the anus and around the anal region.

  2. The area may feel sore and tender

  3. Pus discharge and blood can be seen with the movements of the bowel

Treatment options for Anal fistula

Anal fistula treatment is carried out by two methods:

  1. Traditional Surgical Method

  2. Laser Surgery

These are further explained as follows:

Traditional Methods of treatment

Anal fistula

Representation of anal fistula, Credits: pixabay


Treatment of anal fistula through traditional methods is performed very cautiously in order to reduce the risk of bowel restriction in individual. There are various treatment options available which are listed below:

  1. Fistulotomy

This is done in the fistulous tract and the surrounding tissue by making an incision. It is performed by making an incision on the fistulous tract and the surrounding tissue. The surgeon will then scrape off all the pus and its contents which are then flushed out. After flushing out the sides are stitched to lay open the fistula.

  1. Advancement Rectal Flap

In patients with poor muscles the operation is performed. During this operation, the surgeon cuts the rectal wall like a flap in order to reach, scrape and scratch the pus from the fistula’s internal opening.

  1. Seton Placement

A silk thread or a rubber band is attached to facilitate the drainage in this procedure.

  1. Fibrin Glue or Collagen plug

Fibrin glue is a process where the surgeon will use Fibrin glue or collagen plug to monitor tract contents after they are draining. The internal opening is stitched and closed.

  1. Laser Surgery for Anal Fistula

Laser operation is one of the specialized care options for Anal Fistula patients. Laser energy passes near the anal fistula, which shrinks and kills the epithelium of the fistula. It is very brief and patients will restart work within 24 hours.

Anal fistulas can be a most embarrassing situation for the person who is suffering from the same. But with proper treatment, hygiene and lifestyle management the disease can be managed.

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