A fistula is a thin, elongated tunnel that travels from an infected gland inside of the anal cavity to an opening on the skin that surrounds the anus. These openings can ooze fluid, bleed, or even result in difficulties with urination and bowel movements, as well as cause the patient to experience mild to severe pain. Fistulas often develop as a result of an anal abscess when the abscess breaks through to the outer skin, but they can also erupt as a result of inflammation, trauma, STDs, cancer, or following an infection that didn't heal correctly. Many times, anal fistulas are most effectively addressed with a surgical procedure, like a fistulotomy. At Houston Colon and Rectal Surgery, our colorectal specialists are highly trained when it comes to the detection and treatment of anal fistulas and abscesses. If you're experiencing significant pain, difficulties urinating or passing stool, or have noticed bleeding or pus oozing from the delicate skin near your anus, contact one of our North Houston or West Houston, TX offices and set up your one-on-one consultation with one of our board-certified surgeons.
"Dr. Azzimuddin diagnosed and resolved my issue in 2 weeks, that had been on going for 7 months. Although he is a surgeon his first statement was not let?s cut you open and see what we find (as I had been told by another surgeon)! His test showed the issue immediately. my intestines had a hole made from mesh from a previous surgery which resulted in my body creating a fistula. He scheduled surgery, operated, and fixed the issue, that was in Sept. 2015."- K. / Healthgrades / Feb 18, 2016
"After 2 surgeries from an ER doctor and one from another doctor, my fistula kept flaring up. I decided to get a second opinion from Dr Azimuddhin, and I was convinced to go for a third surgery. Right after the surgery I felt this time it would be all fixed. Because he did the procedure so clean and the incision was thoroughly stitched. I have never given any reviews, but the pain and the procedures I went through last year literally took a toll on me. Thanks to Dr. Azimuddhin, he treated me and solved my issue in merely couple of weeks. Please don’t wait or be scared to get help if you have any colon issues, go to him and get his expert opinion. "- Anonymous / Healthgrades / May 25, 2022
"Dr. Azimuddin quickly diagnosed my condition after about 9 months of not really knowing what was going on with me. I visited several doctors before finally deciding to make an appointment with Dr. Azi. He performed surgery on me (my first surgical procedure) to correct a colovesical fistula and I am so grateful for his expertise. Highly Recommend! Thank you Dr. Azi!"- G.S. / Google / Aug 30, 2022
"Dr. Azimuddin quickly diagnosed my condition after about 9 months of not really knowing what was going on with me. I visited several doctors before finally deciding to make an appointment with Dr. Azi. He performed surgery on me (my first surgical procedure) to correct a colovesical fistula and I am so grateful for his expertise. Highly Recommend! Thank you Dr. Azi!"- G.S. / Healthgrades / Aug 30, 2022
"I normally do not leave reviews, I am almost 4 months out from my surgery. I was so impressed with Dr. Azimuddin, he was very caring and empathetic with my concerns about my colon fistula surgery and post op pain management and my medications that I just could not stop taking that I had been on for years, He took the time and sat at his desk with me and went over my medications, records and concerns (fears...lol) that I had. Dr Azi did not know, but my daughter was the one who found him as I had been to another facility and decided I was not going to do this surgery, but after talking with Dr. Azi, I just felt like I was in good hands. I could see he took his work, patients and skills very seriously. Every staff member who worked with him had nothing but great things to say about this Dr. and everything we discussed; Dr Azi lived up to his words!! The ERAS pain management worked incredibly well with me, I was surprised how well it did work, that I did not need any opioids and I was not in any pain with this protocol, I was up and walking pretty quickly after surgery and released to go home 2 days after my surgery. During my last appointment, I joked with him and asked if he could do any and all my surgeries I would need because back in the day, General Surgeons were allowed to. My family and I are so grateful for this Dr.! Thank You Dr.Azi, you were my last interview as I was giving up on the medical establishment..... YOU ROCK!! Deb"- D.F. / Google / Oct 17, 2023
Signs and Symptoms
In many cases, patients with a history of anal abscesses are at an increased risk of developing fistulas. In fact, nearly 50% of abscesses result in fistulas forming. These small tunnels have been shown to develop in patients with Crohn's disease, STDs (sexually transmitted diseases), diverticulitis, tuberculosis, and certain cancers. Individuals who have endured trauma or received radiation treatment for cancer may also have a higher chance of fistulas forming.
Men and women with fistulas may experience:
- Anal pain
- Painful bowel movements or urination
- Redness and swelling around the anus
- Irritation of the skin around the anus
- Foul-smelling pus oozing from an opening near the anus
What to Expect
When you arrive at Houston Colon and Rectal Surgery for your appointment, one of our colorectal specialists will ask about your medical history. From there, we will conduct a thorough physical examination to look for visible signs of anal fistulas, such as bleeding or oozing fluid. While some fistulas can be spotted easily, others may not be as noticeable on the skin's surface. In this case, our team could administer certain imaging tests, such as an anoscopy or a colonoscopy. X-rays and CT scans may also be taken of the pelvic area to determine if any inflammation is present. You may also receive an MRI scan so our doctors can accurately map out the length and path of the fistula tract. Once we have fully assessed your condition, including the location of the fistula itself in relation to the sphincter muscles, we will be able to determine your best course of treatment action.
Surgery is nearly always necessary when it comes to the removal of anal fistulas. While there are currently no known treatments for this condition, many of these surgical procedures can be performed in an outpatient setting without the need for hospitalization. The most common fistula removal procedure is a fistulotomy, which is often performed when the fistula itself minimally involves the sphincter muscles. For this surgery, the sphincter muscles are divided to access the tunnel. Since fistulotomy can potentially impact a patient's continence (the ability to control bowel movements), great care is taken to determine whether this technique is ideal for your situation. A fistulotomy can be performed in conjunction with abscess drainage.
Another option for fistula removal includes fibrin glue injection, which eliminates the tunnel with an injection of fibrin glue and avoids affecting the sphincter muscles in the process. Anal fistula plug could also be an option for some who do not qualify for a fistulotomy. This treatment involves placing a long material throughout the fistula tunnel to fill the space and fuse with nearby tissue. While these avoid the sphincter muscles altogether and will likely not affect continence, the success rate for these treatments is substantially lower when compared to a fistulotomy.
Other solutions you may have are endoanal advancement flap surgery or LIFT (ligation of the intersphincteric fistula tract). Endoanal advancement flap surgery is generally reserved for more complex cases and involves the creation of a flap, which is then stretched to cover the opening of the fistula. Meanwhile, LIFT is a newer technique that makes an opening directly above the fistula. From there, the sphincter muscles are spread and the fistula itself is tied off. Regardless of the surgical technique that is chosen for you, our doctors will provide you with detailed information regarding your surgery and helpful post-operative care instructions.
ANAL FISTULA REMOVAL
When you seek out the advanced, specialized care of colorectal surgeons, you'll get to experience a full life once more. At Houston Colon and Rectal Surgery, our talented team regularly sees patients with a range of unique issues, including anal abscesses and fistulas. Using modern surgical techniques, we can remove the source of your discomfort and vastly improve your quality of life in the process. If you've been experiencing anal pain, bleeding, or oozing pus from the anus, contact one of our North Houston or West Houston, TX offices to learn more about your condition and treatment options.