Treatment of anal fistula

An anal fistula (anal fistula) is a small tunnel that can form under the skin around the anal opening. In most cases, this is a consequence of a perianal abscess. The cause of anal fistula - fistula is a problem with the minor glands of the anal canal. When they become blocked and clogged, an infection forms, which causes a fluid-filled, pus-filled swelling at the site called a perianal abscess. This abscess often bursts spontaneously and subsequently a fistula may form. This is a condition that cannot be treated conservatively, but requires proctological intervention.

If the abscess does not spontaneously burst, the surgeon will open it and the pain will subside. Despite the best care, the wound will not heal completely and a small hole or non-healing "pimple" will remain. If the abscess occurs repeatedly in the same place, the most likely cause is an anal fistula.

Sometimes the symptoms begin gradually. First you notice dampness and itching. Even after thorough hygiene, the anus never stays clean for long, traces of blood or purulent secretion may appear on the underwear. Sometimes you will also notice uncontrolled passage of intestinal gases or traces of stool through the external opening of the fistula.

Other rarer causes besides abscess are diseases such as tuberculosis, sexually transmitted diseases or Crohn's disease, which affects the intestines.

Symptoms of complete anal fistula are accompanied by secretion of fluid, pus or blood. Moisture can lead to skin irritation, called irritant anal eczema with itching and traces of blood on the toilet paper. The secretion of pus causes an unpleasant odor, which may be the primary symptom. 

Treatment of anal fistulas

Does every anal fistula require surgery? Is there a treatment for anal fistula without surgery?

Unfortunately, healing the fistula without surgery is not possible. All hopes of curing anal fistula with medication or special wound care have not been fulfilled.

In specific cases In patients with chronic inflammatory bowel disease, new forms of antibody therapy and long-term antibiotic therapy may achieve some level of symptom control. Long-term drainage with silicone thread drains reduces pain by preventing abscess formation but does not heal the fistula. Stem cell therapy has so far only been approved for Crohn's disease patients and is in clinical trials. 

In the long experience and opinion of Dr. Stratene, who specializes in anal fistulas, a little active fistula that causes little discomfort to the patient can be left untreated under certain circumstances. We will discuss this option with each patient individually.

However, according to current guidelines, any anal fistula should be operated on. 

"Diagnosis of anal fistula is essentially an indication for surgery and serves as a prevention of recurrent septic process. Spontaneous healing of an anal fistula without surgery must be considered extremely unlikely". A - very rare - malignant degeneration of persistent fistulas has been described in the literature".

At our proctology center, we have many years of experience with all forms of anal fistula treatment.