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. Azimuddin was Great!! He was patient with me and took the time and explained all that I needed to do to have a recovery that would be quick and as painless as possible. Highly recommend him and his great staff for a job well done."- C.G. / Yelp / Jun 18, 2020
"Dr. Raphaeli is very friendly and professional and answered all of my questions. His staff is very helpful and courteous. I will continue to go to Dr. Raphaeli as necessary."- L.S. / Google / Jun 17, 2020
"Dr. Azimuddin (Dr Azi) is amAZIng :-) He is very knowledgeable, understandable, and patient (especially with those of us that may be a little stubborn and untrusting of doctors in general)"- L.B. / Google / Jun 16, 2020
"Dr. Azimuddin (Dr Azi) is amAZIng :-) He is very knowledgeable, understandable, and patient (especially with those of us that may be a little stubborn and untrusting of doctors in general)"- L.B. / Healthgrades / Jun 16, 2020
"I highly recommend Dr. Azimuddin. Very professional and a good personality with a sense of humor!He takes time to listen to the patient."- P. / Healthgrades / Jun 16, 2020
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 with Fistula
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.
Fistula Treatment Options
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.