Anal Fistula

The symptoms of an anal fistula include:

• a small hole near your anus (the opening of the tunnel)

• discharge such as pus, blood, or faeces from the tunnel opening

• redness and inflammation around the tunnel opening

If you also experience pain or a fever, it may imply that there’s an ongoing abscess that will require more urgent attention.

Most fistulas develop after an infection of your anal glands, which produce mucus to lubricate your anus. An infection can lead to a pus-filled abscess. 

When an abscess has drained or discharged itself, the skin will usually heal over. Sometimes, however, a small hole is left on the outside. This usually means that a fistula (tunnel) has developed between your anal gland and the outside opening. 

Other less common causes include: 

• Crohn’s disease

• diverticulitis

• hidradenitis suppurativa

• tuberculosis (TB)

• HIV

Risk factors

You have a higher chance of developing an anal fistula if:

• you’re male

• you’re in your 30s or 40s

• you’ve had an abscess drained before

• you have an inflammatory bowel disease, including Crohn’s disease

• you’ve experienced trauma in your anal area

• you’ve been through treatment for anal cancer

During your consultation, your consultant will ask you about your medical history and symptoms and examine you. 

Quite often, an anal fistula diagnosis can be made without further investigation. However, sometimes the best way to properly examine an anal fistula is under a general anaesthetic. This is because an internal examination can be uncomfortable.

Occasionally, an MRI scan is needed to better understand your anatomy and to guide your treatment.

If there’s any doubt about the underlying cause, your consultant may also arrange some investigations to rule out Crohn’s disease as the cause. This would include a colonoscopy or a CT scan of your abdomen.

If there’s an underlying condition, such as Crohn’s disease, you’ll need to treat and manage it to prevent recurring anal fistulas.

However, if your anal fistula developed as a result of an infection, you may be able to prevent another one from developing with these lifestyle and bowel habit changes:

• eat plenty of fibre-rich foods such as beans, vegetables, fruits, and whole grains

• take fibre supplements

• drink plenty of water to avoid getting dehydrated

• avoid straining during bowel movements

It’s unlikely that an anal fistula will heal on its own, so it’s important to seek treatment. 

If it’s left untreated, it may lead to further complications, including:

• reccuring and persistent infections and fistulas

• an extended fistula, where the tunnel spreads in new directions

• anal cancer

The majority of anal fistulas can be easily treated. However, this treatment needs to be performed by an expert for it to be safe and effective.

The most effective treatment involves cutting through the fistula and a small amount of your sphincter (the muscle around your anus). This is known as laying open. It has the highest chance of cure but isn’t suitable to treat all fistulas, as sometimes it can result in minor incontinence.

Alternatively, your consultant may recommend placing a thread through your fistula. This allows the fluid to drain without collecting around your anus. This procedure is called placing a seton. This doesn’t heal the fistula but allows your symptoms to settle before more definitive surgery can be offered.

In rare cases, a fistula can be more complex to treat. Under these circumstances, your surgeon will discuss other treatment options — which may involve multiple operations — with you.

Minimally invasive options include the use of a fistula plug, laser treatment, or video-assisted irrigation and washing of your fistula tract. More invasive treatments include procedures to remove your fistula tract, known as a LIFT procedure, or a plastic surgery procedure called an advancement flap.

If you have Crohn’s disease, the treatment of fistulas can be quite different. The general principles remain the same, with the use of surgery to control and treat the infection and to define the anatomy of your fistula. However, if you have Crohn’s disease, you’ll be started on medication once the infection has resolved to try and heal your fistula.

At Welbeck, our colorectal specialists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment.