Anal fistulas are pathologically altered passages (fistulae) in the perianal area, which in most cases are attributable to a proctodeal infection with abscess formation. A surgical procedure or fistula cleavage is the primary therapeutic measure for anal fistulas.

What are anal fistulas?

Anal fistulas are pathologically altered passages (fistulae) in the perianal area, which in most cases are attributable to a proctodeal infection with abscess formation.

Anal fistula (also called fistula ani) refers to a pathologically changed, tubular connection between the outer anal region (outer fistula opening) and the anal canal or the rectum (inner fistula opening).

Anafisteln usually have inflammatory changes, which is why purulent discharge empties through the fistula, which may possibly be mixed with stool.

Depending on the anatomical localization and its course, intersphincteric (between the two anal sphincters), extrasphincteric (sphincterous), submucosal (located between the rectal mucosa and inner anal sphincter), trans-sphincteric (subcutaneous anal sphincter), subcutaneous and suprasphinctic (between sphincter and pelvic floor muscle) anal fistulas differentiated.

causes

Anal fistulae can be attributed in most cases to smaller anal abscesses (accumulations of pus) in the area around the inner sphincter located Proktodealdrüsen or a direct infection of one of these anal glands.

If there is inflammation of a proctodeal gland, it causes clogged ducts and finally abscess formation. If these smaller abscesses empty spontaneously or as a result of surgical drainage, the leaked secretion can cause further inflammation. Through a tissue remodeling then develops a stable connective tissue anal fistula as connection and transport path for the purulent discharge to the outside.

In addition, anal fistulas are in rare cases associated with inflammatory diseases of the intestinal tract such as Crohn's disease (chronic inflammatory disease of the gastrointestinal tract), diverticulitis (inflammation of the diverticulum of the colon), ulcerative colitis (chronic intestinal inflammation) or cryptitis (inflammatory disease of the rectum).

Symptoms, complaints & signs

In the two stages of anal fistula different symptoms and complaints occur. In the acute stage, there is an abscess, usually characterized by pain in the anal area, redness and swelling, and fever. Those affected feel a general feeling of sickness, which increases as the disease progresses.

When the abscess opens out, a fistula develops. At this stage, the original symptoms disappear and new symptoms appear. These include weeping spots, itching and pain, as well as bleeding and bruises in the affected area. During bowel movements, the fistula may open and bleeding may occur.

If pathogens get into the anal fistula, there is a risk of inflammation. An infection manifests itself by the fact that the fistula increases in size and causes strong, throbbing pain. The redness also spreads. Externally, an anal fistula is recognized by its resemblance to a pimple or boil.

In addition, fistulas usually persist over a longer period of time, often without causing noticeable discomfort. However, a chronic course can lead to skin changes, infections and sensory disturbances of the skin. Scars can also be left behind if there is no or improper treatment.

Diagnosis & History

Anal abscesses and fistulas are associated with the same clinical picture, with anal fistulas being termed chronic and anal abscesses an acute form of illness.

As a rule, anal fistulas, in contrast to abscesses that can be very painful, cause only minor discomfort and are manifested by chronic wetness, purulent discharge of secretions and occasional bleeding in the anorectal area, which may cause pustules or pustules in the affected area and contaminated underwear,

Occasionally anal fistulas also manifest on the basis of a temporarily occurring stinging. The exit of the anal fistula or the outer fistula opening is in many cases extremely discreet and recognizable only in the context of a closer examination by a sinking into the skin level.

Full removal of the anal fistula has a very good prognosis and about 95 percent cure permanently, while in incomplete divisions and chronic inflammatory diseases of the gastrointestinal tract, the recurrence rate is higher.

complications

Anal fistulas can lead to various complications. First, a fistula on the anus worsens control of the bowel movement and can cause diarrhea, constipation and similar digestive problems. As a result, it can lead to allergies and hemorrhoids, which are always associated with other complaints such as itching, infections and inflammation.

If the anal fistula is not treated adequately or improperly, the fistula tracts continue to increase. Often it comes to the formation of abscesses, which can lead to a seizure to a blood poisoning. Constant contact with bacteria increases the risk of the anal fistula becoming inflamed and of attacking the delicate tissue on the anus; Often this is accompanied by the formation of other anal fistulas and sometimes also with severe pain and itching.

The treatment of anal fistulas often causes rebleeding, as it is treated on the open wound. There is also the risk of infection and the formation of further fistulous tracts. As a result, it can lead to a strong scarring, which makes the stool more difficult. To avoid this, anal fistulas should be treated immediately after diagnosis.

When should you go to the doctor?

An anal fistula is an inflammation on the anus, which should normally disappear on its own. In some cases, however, an existing fistula can cause inflammation that necessarily requires medical treatment. Frequently, a strong itching also arises in this context, so that the affected person often scratched at this point. This can result in an open wound from the fistula, which can even lead to inflammation in the worst case.

Inflammation of the anus should always be assessed early by a doctor, otherwise an abscess may even develop from such inflammation. An abscess is a cavity filled with pus. Under certain circumstances, this fluid can even enter the bloodstream, which can lead to life-threatening blood poisoning. If the person dispensed at this point on a corresponding treatment, then of course with further complications can be expected.

The present bacteria and viruses can spread throughout the body, causing an infection. An elevated temperature or vomiting are the result, so it is essential to resort to the use of appropriate medication. Thus: An anal fistula can cause a variety of complications that usually require medical attention.

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Treatment & Therapy

Since spontaneous remissions in anal fistulas are very rarely observed, they are usually treated as part of a surgical procedure. A commonly used procedure is surgical splitting (fistulotomy) of the fistula canal secured by a button probe under local anesthesia and, if possible, sparing of the sphincter apparatus, in order to avoid impairments of the stool contraction.

In addition, a curettage (scraping) of the fistula floor is performed to remove the entire inflammatory material. The wound trench resulting from the procedure is kept open until the wound has completely healed, which should be rinsed regularly and the edges of the wound should be checked. An alternative procedure is the so-called fistulectomy, in which the fistula canal is excised.

However, depending on the course of the anal fistula canal, in some cases surgical cutting of muscular areas of the sphincter apparatus may be required, which may lead to fecal incontinence. In order to avoid impairments of the sphincter apparatus in anal fistulas extending through the latter, the fistula canal in this area may optionally be closed plastically with fibrin glue or a fistula plug, the recurrence rate here being somewhat higher.

In order to stabilize the local inflammation and minimize the risk of fecal incontinence, in many cases a temporary thread drainage is placed in advance of a fistula cleavage or excision, with the help of which the anal fistulas can be abdrainiert.

Outlook & Forecast

Through the anal fistula affected suffer from very unpleasant symptoms and symptoms, so it comes to a significant reduction in quality of life.

Most patients suffer from chronic wetting. This often leads to mental discomfort or depression, which can significantly limit the old-age of the person concerned. It can also lead to a bloody bowel movement, which can often lead to panic attacks. Also, pus and fistulas can form through the anal fistula, leading to itching or pain. Most patients also suffer from indigestion through the complaint and may continue to die of septicemia if the disease is not treated properly.

As a rule, the anal fistula can be removed with the help of surgical intervention relatively easily. It usually comes to the formation of a small scar, however, heals. Incontinence is thus completely prevented and limited. Early treatment leads to a positive course of the disease and the patient's life expectancy is not diminished by the disease. By an increased hygiene the anal fistula can be avoided.

prevention

Against anal fistulas, there are generally no preventive measures, as they manifest as a result of an abscess or a chronic inflammatory bowel disease against which there is no prophylaxis.

Thus, the exact etiology of the underlying anal abscesses is not fully understood, although frequent obstructions, hemorrhoidal complaints, diarrhea and certain sexual practices (including anal intercourse) are among the risk factors.

However, a switch to high-fiber diet and consistent hygiene of the anal and perianal area is recommended, although persons with adequate hygiene of anal fistulas may be affected.

In addition, in the presence of a highly sensitive intestinal and anal mucosa a waiver of preservatives and fragrances in the care products for the prevention of abscesses and correspondingly anal fistulas suggested.

aftercare

Anal fistula is treated surgically in many cases. The aftercare is directed in this context, especially on the wound and its complication-free regeneration. Here it is important, that is not worked with sharp cleaning agents. Soaps and shower gel are not appropriate here. It is sufficient to wash out the wound with lukewarm water and it is important that no coliform bacteria or other pathogens can accumulate in the wound that could cause an infection.

The mechanical irritation caused by dry toilet paper as well as wet wipes with chemical additives such as perfumes should also be avoided. Excessive hygiene is not only unnecessary, but can even be harmful in the aftercare. Also a chair regulation has a positive effect in connection with the aftercare of anal fistula. This should have a soft and voluminous chair as a goal.

The patient achieves this by a sufficient amount of drinking and a high-fiber diet. Here, the intake of psyllium husks has proven. The chair regulation serves to avoid a strong pressing during the stool, since this could impair the wound healing negatively.

Smoking also seems to adversely affect the wound regeneration of the anal fistula, so that a nicotine renunciation not only serves the general health, but also supports the aftercare of the anal fistula. Contact person for the aftercare of anal fistula are proctologist and family doctor.

You can do that yourself

A direct prevention against anal fistulas does not exist. Anal fistulas usually do not heal by themselves. Surgical treatment is therefore often the only effective therapy. The healing process after surgery can take several weeks, with larger fistulas also several months.

To support the healing a thorough hygiene in the anal area is recommended, which helps to prevent injuries and inflammation. It is advisable to cleanse the wound daily during the operation several times during a shower. Also, dressing changes and the use of ointments can help to ensure a high level of hygiene to optimize the wound healing process. Make sure you have a soft seat pad, so that the wound healing is not negatively affected. Bed rest also has a positive effect.

In addition, it is advantageous to take certain dietary measures in the period after surgery to prevent constipation or to make the stool less uncomfortable. In addition, a high-fiber, probiotic diet with many whole-wheat products and plant-based foods is ideal. In addition, care should be taken to drink enough. In addition to water, fruit juices as well as apple, grape and vegetable juices make bowel movements easier.

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