Diagnosis
In case your doctor suspects you might have symptoms that are indicative of anal fistula, he/she will likely refer you to a specialist in rectal and colon disorders. This specialist will take your medical history and conduct a physical examination to check for possible symptoms of fistula.
Some of the diagnostic techniques for fistula include:
- Anoscope: This equipment enables the specialist to examine the inside of your anal canal
- Fistula probe: This is a thin and long probe that the specialist guides via the outer opening of the fistula. The specialist may inject a special dye that reveals if the fistula opens inside or outside the anal canals
- Ultrasound: This test entails the use of sound waves to develop an image of your anal areas.
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Can fistula be treated permanently?
In case the anal fistula is at its early stages, your doctor will likely recommend medication and lifestyle changes. A diet modification entails a diet rich in dietary fibre, taking a lot of fluids, and exercising. A stool softener or soaking in a warm bath several times a year are some of the other remedies for managing fistula. On the other hand, in case the condition is at an advanced stage, your doctors will order various tests, such as Endoscopy, Fistulagraphy, MRI, and Ultrasound. These tests will give more clarity regarding the condition. Surgical removal of the fistula helps to correct the condition permanently.
Non-surgical treatment
The use of fibrin glue is a common treatment to correct anal fistula where there is no surgery involved. During the procedure, the doctor injects fibrin glue into the fistulous tract. The fibrin glue seals the fistula tract and allows it to heal. This is a painless and effective technique. Nonetheless, there could be the recurrence of fistula or complications months after the treatment. The method is thus less effective in comparison with surgery.
Surgery
The overarching objective of fistula surgery is to aid in healing while also protecting the sphincter muscles against potential damage. In case the sphincter muscles get damaged, the patient may develop bowel incontinence. Fistula surgery is administered under general anaesthesia. For some patients, however, local anaesthesia might be helpful. Some of the surgical techniques usually carried out to tear fistula include:
Fistulotomy
This is by far the most common form of surgical technique, accounting for nearly 90% of all fistula surgeries. During the procedure, your doctor will make an incision along the entire length of the fistula. Sometimes, the doctors may need to cut a portion of our anal sphincter so that he/she can access the fistula. The doctor scrapes the opened sphincter thoroughly and flushes out the content. Healing of the open car may take up to 8 weeks.
Seton technique
This procedure entails having a thin rubber or surgical thread in your fistula tract to permit complete draining of the contents. The ends of these surgical threads are tied, ensuring it remains firmly in place.
Sealing the fistula with a plug or special glue
This procedure entails closing the inner opening of your fistula followed by filling the tunnel with a plug or special glue. This material is ultimately absorbed by your body.
Laser
This is a relatively new technique that involves closure of the fistula by administering laser energy via a radial fibre. There are no cuts or stitches involved, plus the technique is associated with instant relief for the patient. It is therefore a fast, non-invasive, and effective permanent treatment of fistula.
LIFT procedure
The acronym LIFT stands for ligation of the inter-sphincter fistula tract. The technique is recommended in case fistulotomy is deemed as being too risky. The procedure entails cutting the skin above your fistula. This enables the doctor to separate the sphincter muscle from the fistula. This is followed by the sealing of the fistula at either end. The doctor will then cut it and leave it lying flat.
Final words
Fistulas will not correct on their own and as such, there is a need to administer treatment. While lifestyle modification and medication can offer relief from fistula, these methods do not provide a permanent solution to the problems. However, surgery provides a permanent solution to fistula. There are various surgical procedures to treat fistulas, the choice of which is determined by various factors such as the position of the fistula, the patient’s preference, and cost. An initial examination by a specialist in rectal and colon disorders is usually recommended to identify the most appropriate type of surgery irrespective of the type of surgery that a patient opts to undergo, the aim should be to ensure the sphincter muscle is not damaged as this can lead to the development of bowel incontinence.
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