It consists of the inner and outer holes in the anus area and a canal connecting these holes. These holes are called fistula mouth. The inner mouth is located in the inner part of the anal canal, which is the last part of the large intestine, and the outer mouth is located a few cm around the anus. As a result of the inner mouth's constant contact with defecation, there is chronic non-healing inflammation in the canal and purulent discharge that constantly contaminates the underwear.
How is anal fistula diagnosed?
- One or more fistula holes (mouths) around the anus
- Intermittent pus-filled, foul-smelling discharge from this fistula mouth that contaminates underwear
- Skin irritation and itching around the anus due to discharge
- Sometimes slightly painful hardness extending from the fistula mouth to the anal canal
- Abscess formation around the anus as a result of clogging of the fistula mouth; Symptoms such as these suggest anal fistula disease.
How is anal fistula diagnosed?
The diagnosis of anal fistula is largely It is determined by examination. During the examination, the outer hole of the fistula is seen, the extent to which it goes inside is checked with the stylet, and the inner hole is detected by seeing the exit of the stylet from the inner hole. In some patients, this examination is not possible. The definitive diagnosis for these patients is made by Perianal MRI. If necessary, anal ultrasound or tomography can be performed.
How does anal fistula occur?
Anal fistula and anal abscess occur in the same way. As we explained in anal abscess, when the ducts of the glands 1-1.5 cm inside the anal canal are blocked for various reasons, inflammation occurs in the glands and as the inflammation progresses, it turns into an anal abscess. These abscesses can develop very quickly and be severe, or they can be milder with a slow, chronic course. One-third of abscesses treated with surgical intervention disappear spontaneously. Most of the abscesses that drain poorly create a channel between the inner and outer mouth with chronic inflammation. It constantly produces purulent discharge and turns into a fistula.Also;
-Crohn's disease
-Diverticulitis
-Hidradenitis suppurativa
-Tuberculosis and HIV
-Anal surgical interventions; Diseases such as these may cause anal fistula formation.
How is anal fistula treated?
The main treatment method for anal fistula is surgery. Four types of fistula are defined according to the relationship of the anal fistula channel with the muscles that enable defecation in the anus. Fistulas in which the fistula channel passes under or near the bottom of the muscles are considered simple fistulas and surgery is relatively easier. The surgery called Fistulotomy can be performed without causing much damage to the muscles. However, when a fistulotomy is performed in fistulas formed by the fistula channel passing over or near the top of the muscles, since most of the muscles will be cut, it will not be possible for the patient to defecate and therefore fistulotomy surgery cannot be performed. Such fistulas are called "seton surgery" and materials that will remain in the fistula channel for months. treatment is carried out by placing it.
What are the treatment methods of anal fistula?
-Fistulotomy; It can be successfully applied in simple fistulas. Surgically, the fistula channel is cut out or curetteed and cleaned thoroughly. The wound is left open for secondary healing without being stitched. Healing is achieved in 3-4 weeks with antiseptic sitz baths.
-Seton surgery; It is applied to patients where the fistula tract passes over the muscles and there is a high risk of inability to ablution if fistulotomy is performed. Inside the fistula canal The silicone rope passed through it is kept in the form of a ring for months. While removing the thread, which the body perceives as a foreign body, healing is achieved by sliding the fistula tract down. The success rate is lower than fistulotomy.
-Fibrin glue; The fistula tar is scraped and cleaned and fibrin material is injected into it to ensure that it adheres and heals. It is a new method. There are insufficient number of long-term follow-up and studies on treatment success and relapses.
-Laser treatment; It is the process of burning the fistula tract by entering it with a laser. Since this is new, like the fibrin glue method, there are not enough research results on long-term follow-up.
Also; Surgical methods such as bioprosthetic plate and flap operations are also applied.
What are the risks of fistula treatment?
-Inflammation: The area where the operation is performed. � Considering the situation, inflammation is inevitable and sometimes progresses and causes serious consequences.
-Recurrence of fistula; The recurrence rate of interventions performed in complicated fistulas is high.
-Inability to defecate; It is a nightmare for both doctors and patients. The risk of occurrence in complicated fistula operations is high and can turn the patient's life into a nightmare.
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