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Fistula: Why Surgery is the Best Option?

The anal fistula is characterized by the blocking of one or many glands in the anus, caused by an infected abscess. More than 50% of abscesses in the anus may turn into a fistula (a small tunnel connected the infected anal gland to the skin around opening of anus). Thousands of people are affected by this painful and irritating medical condition. The worst hit among the genders are females and to compound on the problems, recent studies show that 1 out of every 50 women enduring the pangs of Fistula end up getting proper treatment.

Even in the 21st century, fistula is seen as something that should not be disclosed to anyone.  So, a large majority of patients decide to hush up and go without any treatment. Well, the time has come to overcome this taboo and take the fistula treatment decisions in your own hand.

Who are prone to Fistula?

Fistula, which is a resultant of abnormal connections between two interior body parts, can develop between different parts such as esophagus and windpipe, bowel and vagina, etc. They can even develop between two blood vessels (artery and veins). While some patients are born with inherited fistula, others can develop this condition as a result of complications from a past surgery, infection, injury, Crohn’s Disease or Ulcerative Colitis.

Symptoms

As mentioned before, most people in India tend to give a blind eye to this painful medical condition. But steadfastness can relieve you from all the pain. It is important that you understand the signs of Fistula and visit a doctor at the earliest.

  • Intermittent bleeding around the anus
  • Pain and swelling around the anus
  • Abscesses around the anus
  • Painful bowel movements
  • Foul smelling Pus discharges from the anal opening with some blood coming out.
  • Skin irritability experienced around the skin near anus due to persistent drainage.
  • Feeling of fatigue along with chills and fever

Diagnosing the Problem

As mentioned before, when you see or feel any of the above mentioned symptoms you should waste no time in consulting a doctor. The non-complex fistulas can be easily diagnosed by the doctor by examining the affected area around the anus. In the physical examination the doctor would be looking for external opening on the skin surrounding the anus. Examination of the opening will give the doctor a fair idea about the depth and direction of blockage. But there are other types of fistula which may not be visible on the skin’s surface. In order to diagnose such types, the doctors would prescribe certain tests.

  • Fistulogram/Sinogram: In Fistulogram real time x-rays of the anus area are done using a barium based material to produce clear images and detect abnormal passage with the patient’s body. Sinogram on the other end assess the extent of this abnormal passage.
  • Anoscopy: A small plastic or stainless steel device is inserted into the anus of the patient in this test. This device helps the doctor get a detailed look at the tissues in the anal and rectal areas.
  • CT Enterography: With the help of special x-ray equipment and injections of contrast material, detailed images of small intestine and various structures around the abdomen and pelvis are seen. The test is conducted to determine extent of Fistula as well Crohn’s disease.
  • Colonoscopy: Before this test is conducted, the patient’s bowel should be completely empty. Done after applying general Anesthesia, a long and flexible instrument known as Colonoscopy is inserted through the rectum and taken to the large intestine. It allows the doctors to view the inner lining of the colon.
  • Lower GI Series: In this procedure the doctor uses x-rays coupled with barium to view images of large intestines. The application of barium makes the x-rays more prominent than usual. There are two types of tests: Single Contrast and Double Contrast.

Path to Cure

Most patients in India, under the influence of social taboos, think that their condition would be automatically healed. But, there is no such hope. In most scenarios surgical procedures can eliminate the problem and help the patient get back to normal pain free life. The type of surgery suggested by the doctor depends upon directions, depth and severity of the condition. There are many surgical options to cure fistula, these are:

  • Fistulotomy: This is the most widespread surgical option. In this procedure, the surgeon creates incision along the length of fistula and opens it up. When healed a flat scar is left behind. This treatment is applicable for causes where the fistula has not passed through much of the sphincter muscles.
  • Seton Technique: When the fistula is more severe than the above mentioned instance and it has significantly passed through the anal sphincter muscle, a piece of surgical thread (known as Seton) is left within the fistula to keep it open for several weeks. This helps in draining out of Pus and healing is attained over time. In this surgical technique there is no need to cut the sphincter muscles.
  • Advancement Flap Procedure: If the fistula has passed through the anal sphincter muscles and undergoing fistulotomy may hamper voluntary control over urination, then the advancement flap procedure is undertaken. In the procedure the fistula is cut out and the hole where it was entering the bowel is covered up with a flap-like tissue taken from the rectum. Though it avoids the need to cut the anal sphincter muscles, but it attains lower success rate than fistulotomy.
  • Bioprosthetic Plug: In some cases, where fistulotomy cannot be carried out, a cone shaped bio-prosthetic plug which is made of animal tissues is placed to block the internal opening of the fistula.
  • LIFT Procedure: LIFT (Ligation of the Intersphincteric Fistula Tract) is another surgical option when the fistulotomy is deemed too risky. In this surgery, an incision is made in the skin to separate the fistula and sphincter muscles. After this, the fistula is sealed from both the ends.
  • Fibrin Glue Method: This is the only non-surgical cure for anal fistula. A special glue is injected into the fistula, under general anesthesia. This glue seals and heals the fistula.

Life after Surgery

Most fistulas are completely cured after the surgery. However, after the surgery you might feel some discomfort in the affected area, so the doctor would prescribe painkillers. Apart from this, you would be advised to soak the incised area with warm water and take laxatives to soften the stool. Also, follow up visits to the doctor would be requested to detect the success of the surgery as well as any complexities that may arise.

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