Perianal Fistula

Causes of Perianal Fistula

The primary cause of a perianal fistula is an untreated or inadequately treated anal abscess. Other leading factors include:

• Chronic Infection: Persistent infections in the anal glands or surrounding tissues.
• Inflammatory Bowel Diseases: Conditions such as Crohn’s disease or ulcerative colitis that increase inflammation in the digestive tract.
• Surgical Complications: Rarely, complications from surgeries in the anal area may lead to fistula formation.
• Radiation Therapy: Treatments for rectal or anal cancer that can damage tissue and increase the risk of fistula development.
• Trauma: Injuries to the anal area may predispose individuals to this condition.

Symptoms of Perianal Fistula

Common signs and symptoms of a perianal fistula include:

• Recurrent Discharge: Pus, blood, or stool-like material leaking from the external opening of the fistula.
• Swelling or Pain: Discomfort or swelling near the anus, often accompanied by tenderness.
• Skin Irritation: Redness, itching, or discomfort around the fistula site.
• Fever or Fatigue: Systemic symptoms may appear if the infection worsens.
• Recurrent Abscesses: A key indicator of an underlying fistula is the development of persistent or recurring abscesses.

Diagnosis of Perianal Fistula

The diagnosis of a perianal fistula typically involves:

• Physical Examination: A thorough inspection of the anal area to identify external openings and signs of infection.
• Imaging Tests: MRI or ultrasound may be used to determine the depth and complexity of the fistula.
• Fistulography: A special X-ray procedure where dye is injected into the fistula to map its path.

Treatment Options

Treatment of perianal fistula aims to eliminate infection and promote healing. Common treatment approaches include:

Surgical Intervention:

• Fistulotomy: The fistula is surgically opened and flattened to heal from the inside out. Best suited for simple fistulas.
• Seton Placement: A surgical thread is placed in the fistula to keep it open and allow gradual drainage, often used in complex cases.
• Advancement Flap Procedure: A tissue graft is used to close the internal opening of the fistula and prevent recurrence.
• LIFT Procedure (Ligation of the Intersphincteric Fistula Tract): A minimally invasive technique targeting the fistula while preserving sphincter function.

Medication:

• Antibiotics to treat or prevent infection.
• Biologic therapies for patients with underlying inflammatory bowel disease such as Crohn’s disease.

Advanced Techniques:

• Fibrin glue, plugs, or laser therapy: Minimally invasive methods to seal the fistula and encourage healing in selected cases.

Complications of Untreated Perianal Fistula

If left untreated, a perianal fistula may result in:

• Chronic infection and persistent pain.
• Increased risk of recurring abscesses.
• Reduced quality of life due to discomfort and discharge.
• Rarely, progression to more serious infections in surrounding tissues.

Prevention of Perianal Fistula

Although not always preventable, certain steps may reduce the risk:

• Maintain good hygiene in the anal area.
• Seek early treatment for abscesses and other anal infections.
• Manage underlying conditions like Crohn’s disease or ulcerative colitis with the help of a healthcare professional.