Fistulas

Definition

Abnormal anatomical path that communicates the interior of the anus with the skin that covers the anal sphincter.

How does the disease occur

A percentage has a congenital origin and they frequently manifest in childhood.

The rest are acquired fistulas. Most are formed by inflammation and subsequent infection (giving rise to what we know as an abscess) of one of the glands located inside the anus whose mission is to contribute to the lubrication of the anal canal during defecation. The abscess may heal without sequelae, or it may lead to the formation of a fistulous tract or fistula.

There are diseases that predispose to the appearance of anal abscesses and therefore to the subsequent formation of an anal fistula, including inflammatory bowel diseases such as ulcerative or Crohn's colitis, intestinal tuberculosis, diverticulitis or tumors. Other processes such as rectal surgery, colorectal radiotherapy or as a complication of childbirth can be causes of anal fistulas.

There is a percentage in which the origin of the fistula is unknown.

Symptoms of the disease

Depending on its size and location, the fistula can be asymptomatic.

When it is symptomatic, it can manifest itself in the form of:

• Nonspecific symptoms such as anal itching or burning.
• Severe anal pain with bowel movements (which may last several hours) and light bleeding.
• Presence of pus and / or red blood in the patient's underwear, accompanied or not by a feverish sensation.

Diagnosis of the disease

Diagnosis of anal fistula is made by the proctologist or general surgeon in the office of the medical center or hospital.

The diagnosis is based mainly on:

• Appropriate physical examination of the patient
• Assessment of the symptoms that they present and their history of disease
• Result of the complementary studies that are carried out, generally an anal inspection by digital rectal examination, an anoscopy or an endoanal ultrasound to visualize the lesions and a rectal probe to determine the path of the fistula.
• Carrying out other complementary studies based on the findings found after the correct assessment of the patient to diagnose possible associated diseases.

Treatment of the disease

The only curative treatment for anal fistula is its surgical removal, but this treatment is not without risks and is therefore reserved for highly selected patients. Depending on the size and location of the fistula after surgery, anal or vaginal infection, stenosis of the anal canal, or lesion of the anal sphincter may appear, leading to permanent fecal incontinence.

The usual treatment for anal fistula is the use of antibiotics to fight infection, drainage of the underlying fistula or abscess, and measures to promote healing.

Disease prevention

Anal fistula often reproduces despite treatment.

Hygienic dietary measures such as proper nutrition, regular physical exercise, avoiding constipation and the consumption of spicy or toxic substances such as tobacco help to prevent the fistula from reappearing or increasing in size.

Patients with disease that favors the formation of abscesses or anal fistulas should undergo regular medical supervision.