Fistula ani is the formation of the small duct between the tip of the large intestine and the skin around the anus or rectum. This condition is formed as a reaction to an anal gland infection that develops into an anus abscess, where a pus or lump filled with pus is formed. The fistula will look like a duct or a small hole after pus comes out. In addition to abscesses, anal fistulas are also at risk for sufferers of lower gastrointestinal disorders, such as Crohn's disease . As a result, patients feel pain or discomfort in the skin around the anus.
Treatment of anal fistula is done after careful examination, especially in the anal area. The main choice of treatment for fistula is surgery. There are several surgical techniques that can be performed according to the fistula conditions that occur. The goal of surgery is to protect the sphincter muscle ani which regulates bowel movements and thoroughly correct anal fistulas to prevent recurrence.
Symptoms of Fistula Ani
The symptoms shown by anal fistulas include:
- Exit blood or pus during bowel movements.
- The area around the anus swells and becomes red.
- Pain in the anus is getting worse when sitting or coughing.
- Fever and feels tired.
- Alvi incontinence .
- Skin irritation around the anus.
- There is pus around the anus.
Causes and Risk Factors of Fistula Ani
An anal fistula is caused by an anus abscess that does not heal completely leaving a small canal or hole in the skin near the anus. This is the most common cause of anal fistula. About 50 percent of people with anus abscess are at risk of developing anal fistulas.
Besides being caused by an anus abscess, anal fistula can also occur due to a number of conditions, including lower gastrointestinal tract or anal area. These conditions include Crohn's disease and hidradenitis suppurativa . In addition to these diseases, several infections such as tuberculosis or HIV infection, as well as diverticulitis can also cause anal fistulas. Other causes of anal fistula are postoperative complications near the anus and post radiotherapy for colon cancer.
Diagnosis of Fistula Ani
Physical examination, especially in the anal area and beyond, will be performed by a doctor if the patient has symptoms of anal fistula. In order to establish a diagnosis, investigations need to be carried out, including:
- Scanning Scanning examination aims to get a more detailed picture, in this case the condition of the anal area and its abnormal duct (fistula). Scanning can be done with X-rays (fistulography), ultrasound, CT scan, and MRI.
- Anaskopi . This examination uses a special instrument in the form of an anuscope to see the condition in the anal canal.
- Proctoscopy. Examination with a special device that has this lamp aims to see the condition in the anus. Proctoscopy can see deeper into the rectum, the last part of the large intestine.
- Fistula probe. Examine the fistula with special tools and coloring to see the location of the open fistula,
- Colonoscopy. A colonoscopy is an examination with a small hose with a camera inserted through the anus to see the condition of the large intestine. The aim of the colonoscopy is to find out if the fistula is caused by another disease, such as Crohn's disease or ulcerative colitis .
Treatment of Fistula Ani
An anal fistula cannot heal on its own, so treatment is needed. The main treatment method that is carried out is through surgery. However, like a medical procedure, anal fistula surgery has several risks, including difficulty in regulating bowel movements (external incontinence) and re-emerging fistulas.
Anal fistula surgery is preceded by an initial examination of the anus accompanied by general anesthesia. This examination will determine the surgical technique to be performed by considering the position of the fistula.
One of the surgical techniques that can be done is the seton placement technique. In this procedure, a surgical thread is placed on the fistula so that the position is opened so that pus from the abscess can come out. The thread attached will be gradually tightened during control after the action. After the wound heals completely, the thread will be removed. The purpose of this action is to drain pus, triggering the growth of connective tissue and breaking the channel or fistula. This action also reduces the risk of complications from Alvi incontinence.
Another option that can be considered is the procedure for tissue enhancement (advancement flap) taken from the rectal wall or the end of the large intestine. The network is used to patch fistula channels. The next surgical technique that can be done is the installation of special made plugs. These plugs will be absorbed by the body itself and eventually close the fistula. Other options that can also be considered are removal of the fistula ducts following inflamed tissue and glands. This action is called litigation intersphincteric fistula tract or LIFT.
While the most widely performed procedure for fistulas is fistulotomy or surgical skin and muscles at the location of the fistula, so that there is an open hole. The fistula is dredged and cleaned and left open. This condition allows healing to occur from the inside to the surface of the fistula channel.
Anal fistula surgery can be done with or without hospitalization. In some cases, patients must stay up to several days. Postoperatively, the doctor will prescribe painkillers and antibiotics to deal with pain and prevent postoperative infections. In addition, special treatment is needed in treating postoperative wounds. Among them are soaking in warm water 3-4 times a day, taking laxatives so that the stool becomes soft, consuming high-fiber foods and drinking lots, and using a buffer in the anal area to fully recover. Patients can return to normal activities after being declared cured by a doctor.