The anal fistula, or perianal, is a kind of sore, which forms from the last portion of the intestine to the skin of the anus, creating a narrow tunnel that causes symptoms such as pain, redness and bleeding through the anus.
Usually, the fistula arises after an abscess in the anus, however, it can also be caused by inflammatory bowel diseases, such as Crohn's disease or diverticulitis, for example.
Treatment is almost always done with surgery and, therefore, whenever a fistula is suspected, especially if you have had an abscess, it is recommended to consult a proctologist to confirm the diagnosis and start treatment.
See what other common causes of pain in the anus or itching in the region might be.
Main symptoms
The main symptoms of anal fistula include:
- Redness or swelling of the skin of the anus; Constant pain, especially when sitting or walking; Exit of pus or blood through the anus;
In addition to these symptoms, abdominal pain, diarrhea, loss of appetite, decreased body weight and nausea may also occur if an infection or inflammation of the fistula occurs.
In these cases, it is recommended to consult a proctologist to diagnose the problem, with observation of the site or magnetic resonance imaging, for example, and initiate appropriate treatment.
How the treatment is done
To treat an anal fistula, and avoid complications like infection or fecal incontinence, you need to have surgery, called an anal fistulectomy, in which the doctor:
- Make a cut over the fistula to expose the entire tunnel between the intestine and the skin; Removes the injured tissue from inside the fistula; Place a special wire inside the fistula to promote healing; Gives stitches in place to close the wound.
To avoid pain, surgery is usually done with general or epidural anesthesia and, before starting the procedure, the doctor uses a probe to explore the fistula and assess whether there is only one tunnel or whether it is a complex fistula, in which there are several tunnels. In this case, it may be necessary to do more than one surgery to close one tunnel at a time.
In addition to anal fistulectomy, there are other methods of treating fistulas through surgery, such as grafts, plugs and special sutures, called setons, but these techniques depend on the type of fistula and the disease that caused it, such as Crohn's disease, in which it is necessary to use medications, such as Infliximab before any surgery.
How is recovery
After surgery, it is usually necessary to stay in the hospital for at least 24 hours to ensure that the effect of the anesthesia has disappeared and that there are no complications, such as bleeding or infection.
After that it is possible to return home, but it is recommended to rest for 2 to 3 days, before returning to work. During this period, it may be necessary to take antibiotics, such as Amoxicillin with Clavulonate, or anti-inflammatory drugs, such as Ibuprofen, prescribed by the doctor, to relieve pain and ensure that an infection does not arise. To reduce the risk of infection, hygiene of the region should also be maintained with water and a neutral pH soap, in addition to changing dressings, applying ointments with pain relievers at least 6 times a day.
During the postoperative period it is normal for the wound to bleed a little, especially when wiping toilet paper in the region, however, if the bleeding is heavy or if there is any type of acute pain it is important to return to the doctor.
In addition, in the first week it is also important to follow a diet to avoid constipation, since the accumulation of feces can increase pressure on the walls of the anus and hinder healing. See how to do this type of feeding.
When to go to the doctor
It is recommended to consult the proctologist immediately when it appears:
- Hemorrhage in the anus; Increased pain, redness or swelling; Fever above 38ºC; Difficulty urinating.
In addition, it is also important to go to the doctor in case of constipation that does not disappear after 3 days, even with the use of laxatives.
