Anal Fistula: What Are The Treatment Options?

An anal fistula is an abnormal pathway, or tunnel, between the lower anal canal and the skin around the bottom. It may arise from an infection in this area, or may be related to other conditions such as Crohn’s disease or previous radiotherapy.

It may cause the patient pain, swelling and discharge.

If someone is experiencing the above symptoms, the patient should seek help from a surgeon with a special interest in this condition. A careful assessment is needed of the patient’s bottom end. This is required to work out the position of the fistula and how it relates to the anal sphincter muscles. An MRI scan may be required to help with this assessment. It is also important to find out if the patient has had previous surgery to this area, previous childbirth and if the patient has any problems with controlling their bowels and wind.

Your specialist will then discuss the various treatment options. These may include placing a seton. This is soft thread, which is placed through the fistula. This allows any infected material to drain out, but it does not aim to cure the fistula. It usually provides significant relief to the patient.

There are a range of operations available to cure the fistula. The most effective way is for the anal sphincter muscle below the fistula to be cut, or divided. This has the best chance of a cure. However, there is a risk of reduced control of stool or wind. Much of this depends on how much anal sphincter muscle is divided.

Other treatments aim to cure the fistula without cutting any muscle. These may involve using lasers, or tiny video cameras with heater probes, tying off the fistula or using a flap of the lining of the anal canal to close the fistula. All of these may be effective, but carry a reasonable failure rate in some patients.