What are Anal Fistulas?
An anal fistula is an abnormal tunnel-like connection between an internal opening inside the anus and an external opening at the bottom skin near the anus.
Some facts to know about anal fistulas:
- It can present as an incomplete fistula with the closure of the external opening.
- It also occurs with the complexity of anal abscess.
- The average age is 40 years.
- The incidence of an anal fistula: 1,69 cases per 10,000 people.
- About 50% of patients develop a fistula after drainage of an abscess, not every patient develops
- Some people ignore the fistula when they are asymptomatic. However, they still require medical attention
- The fistula can be complicated into multiple tracts from internal to external openings.
Types of Anal Fistula
Based on the tunnel passing through the internal and external sphincter, anal fistulas can be defined as:
- Extrasphincteric fistula (5%) – The internal opening is high above the anal canal, the external opening is further to the anus, and the tunnel goes around both sphincter muscles. This less common type usually originates from the rectum rather than the anus. It doesn’t come from an anal gland. This fistula is very rare.
- Suprasphincteric fistula (20%) – The internal opening located at the area-, the external opening further to the anus, the tunnel passes through your internal sphincter and then goes around the external sphincter.
- Suprasphincteric fistula (20%) – The internal opening link to the dentate line, the external opening close to the anus, the tunnel passes through the internal sphincter and the external sphincters.
- Intersphincteric anal fistula (45%) – The internal opening is below the dentate line, the external opening close to the anus, the tunnel passes through the internal sphincter but spares the external sphincter.
- Superficial anal fistula (20%) – The tunnel does not pass through the sphincter. It more commonly occurs in chronic anal fissures with sentinel pile secondary change.
Based on the complications, the number of tunnels, and the damaging percentage of the passing through the external sphincter, they can be divided into two types:
A simple anal fistula is characterized by having only one fistula tract, and it passes through less than 30%-50% of the external sphincter.
On the other hand, complex anal fistulas present with multiple tracts that pass through more than 30%-50% of the external sphincter, traversing the anterior anus (particularly in women), being associated with radiation or Crohn’s disease, or when the patient’s sphincter function becomes dysfunctional (as seen in a type of anal fistula where the anal muscle tone is weak, potentially leading to incontinence).
Based on the location of the internal opening, it can be divided into:
- High anal fistula
- Low anal fistula
Common causes
An anal fistula, often known as an “anorectal fistula,” is a common condition that impacts the anal region. Typically, anal fistulas originate after the ulceration or drainage of pus from an anorectal abscess.
As the anorectal abscess heals, there is a gradual size reduction; however, during this process, feces continue to enter the abscess cavity, forming a tunnel in the affected area. As the condition progresses into a chronic state, scar tissue builds up around the cavity, resulting in the establishment of a chronic infectious tract – the anal fistula.
- Anal abscesses that have not healed properly.
- Inflammatory bowel diseases such as Crohn’s disease.
- Previous anal surgeries or trauma.
- Infections or inflammation of the anal glands.
Risk Factors
- Chronic inflammation can increase the risk of cancer in the long term.
- If one tunnel fistula lacks appropriate treatment, it can lead to multiple tunnels.
- Repeated infection of new fistulas could increase the risk of general infection.
When to seek a professional physician?
The clinic’s anorectal doctor also highly advises whoever experiences the symptoms below to seek anorectal professional health providers. Early diagnosis and treatment can help prevent complications and promote faster recovery. A healthcare professional can provide an accurate diagnosis and recommend an appropriate treatment plan based on the specific characteristics of the fistula.
- Persistent anal pain or discomfort
- Drainage of pus or fluid near the anus
- Recurrent abscesses or infections in the anal region
- Itching, swelling, or redness around the anus.
How the anal fistulas are Diagnosed in our clinic.
- History of symptoms: e.g. history of abscesses, intermittent oozing of foul-smelling secretions), pain, itching, the colour of discharges, etc.
- History of the anorectal treatment.
- Perianal area inspections and examination: Lump, colour, external opening.
- Anoscopy- the internal opening can be seen; also, it is necessary to find whether internal hemorrhoids or other anorectal disorders can be detected.
- Anal Fistula probe: The doctor will insert the examining probe from the external opening to diagnose the tract.
- DRE (Digital Rectal Exam).
Sometimes, the doctor will examine you under local anesthesia for a simple fistula. For suspecting complex fistulas, including recurrent disease and perianal Crohn’s disease, the doctor will recommend you take further imaging or examination such as MRI (Magnetic Resonance Imaging), EAU (endoanal ultrasound), fistulography, and even CT for an accurate diagnosis.
Our Treatment- Guoyi Proctology Therapy
Anal Fistula Minor Surgical Procedure
The anatomical course of the fistula tract is important in determining treatment. Depending on the height at which the fistula crosses the anal sphincter (continence muscle), the treatment will change.
A combination of treatments tailored to the individual’s specific condition and needs.
The primary treatment for an anal fistula is minor surgical intervention. The challenge in surgical management lies in ensuring that the surgical technique does not harm the anal sphincter, thereby protecting anal function while achieving a high cure rate. The goal is to minimize the chances of recurrence following surgery and to prevent any potential complications.
Guoyi Proctology Therapy employs a therapeutic approach that combines minor surgery with naturopathic medicine Ba Zhi San ointment to treat fistulas. This integrated approach is designed to achieve a recurrence rate of less than 2%. Significantly, this method is tailored to minimize the risk of complications, providing a well-balanced treatment strategy that emphasizes both the success rate and overall treatment outcomes.
Some basics about minor surgical treatment include:
- No fasting is required.
- No bedtime or hospitalization is required.
- Local anesthesia (No risks of general anesthesia).
- All-in-one solution that resolves complex anorectal disorders.
- Minimal pain compared to hemorrhoidectomy (i.e., the surgical removal of hemorrhoids).
- Possibility of same-day procedure.
- Used the benefits of Ba Zhi San ointment.
Post-treatment phase of anorectal disease
Since we understand the importance of post-treatment care, we take a very unique approach to this phase. During the post-treatment.
The main features of post-treatment are:
- Ba Zhi San anorectal Ointment Focus – A specialized treatment formulated to address the specific needs of anorectal disorders. Its therapeutic properties aid in healing and recovery
- Professional Application – Each treatment session involves the application of the B-Line ointment by a skilled doctor's assistant under the direct supervision of our senior doctor, which ensures the highest standard of care.
BZS (Ba Zhi San) Series Ointment
General Function
BZS (Ba Zhi San) ointments are cream-based medicines infused with a unique botanical formula that relieves pain, stops bleeding, reduces inflammation and swelling, combat infections, detoxifies the nearby tissues, eliminates slough, and promotes wound healing granulation. Each ointment serves a specific function at a specific location in the anal canal. In other words, your doctor will choose the best BZS (Ba Zhi San) ointments for you based on your symptoms, the location of the lesions, and previous responses to other types.
The BZS (Ba Zhi San) ointments restore proper muscle function and connective tissue, which resolves anal conditions. The pharmacological mechanism of these ointments includes the blockage of venous blood supply and the elimination of moisture from the body.
Personalized Therapy
The application of BZS (Ba Zhi San) ointments achieves an ideal treatment effect that addresses both symptoms and underlying causes, which reduces the treatment duration and prevents recurrence. Tailored formulations of BZS (Ba Zhi San) ointments are created based on diagnosis and symptoms, ensuring effective treatment for specific conditions. Personalized dosages maximize optimal results for each patient.
Prevention and lifestyle recommendations
Maintaining good hygiene practices, avoiding prolonged sitting or pressure on the anal area, managing underlying medical conditions effectively, and seeking prompt medical attention for symptoms or concerns can help reduce the risk of developing anal fistulas.
