What is a Perianal Fistula?
A Perianal Fistula is an abnormal tube-like passage or connection that connects two independent organs or blood vessels.
It usually occurs as a result of injury, infection, post-operative complications, or surgical treatment.
This condition, originating from the Latin term “fistula,” which translates to “tube,” commonly occurs around the anus. It can arise due to various factors, including abscesses, surgical procedures, or Crohn’s disease.
Fistulas can show different symptoms depending on where they are located in the body. For example, when they occur between the intestines and bladder, they can often lead to symptoms such as urinary tract infections or blood in the urine (hematuria).
Fistula surgery is often performed as a treatment, during which the fistula is closed. However, the treatment approach may vary depending on the severity of the condition and the needs of the patient.
What are The Types of Perianal Fistula?
In principle,
It can be seen anywhere in the body.
However, it most commonly develops in the intestines and anus.
Fistulas that open to various organs can also develop in the urinary tract.
Anal Fistula
Anal fistulas are abnormal, tunnel-like structures that form between the end of the intestine and the skin surrounding the anus. They usually occur as a result of an abscess that develops as a result of an infection near the anus.
When the abscess drains, a small canal may remain. Anal fistulas can cause unpleasant symptoms such as discomfort and skin irritation.They usually do not heal on their own. In most cases, they need to be closed surgically. The most important cause of anal fistulas is abscesses that develop around the anus.
It is estimated that between one in every two to four individuals will develop an anal abscess.
Anal fistulas usually require surgery because they rarely heal if left untreated.
Urinary Tract Fistulas
A urinary fistula is an abnormal connection between the organs that make up the urinary tract and the skin or another nearby organ.
Urinary fistulas can cause incontinence and infection.
They often occur after various surgeries, due to trauma, as a complication of certain diseases, or due to radiation therapy.
They most often occur as a result of damage to the bladder during abdominal or pelvic surgeries, such as hysterectomy (removal of the uterus) and cesarean sections.
Most urinary fistulas are repaired surgically.
They most often occur between the urethra and the vagina. The abnormal connection can cause stool and urine to leak from the vagina. There are many types of fistulas that can occur in the urinary tract.
-
Vesicovaginal Fistula:
It is seen between the vagina and bladder. It is the most common type of urinary tract fistula in women. The most common cause is a history of hysterectomy surgery.
-
Enterovesical Fistula:
It is found between the bladder and the intestine. It is one of the most common urinary tract fistulas.
-
Vesicouterine Fistula:
It is found between the bladder and the uterus.
-
Ureterovaginal Fistula:
It is found between the vagina and the ureter. The ureter is the tube-shaped organ that carries urine between the kidneys and the bladder. Most fistulas in this group occur due to previous hysterectomy or other pelvic surgical procedures.
-
Uretrovaginal Fistula:
It is found between the vagina and the urethra. The urethra is the section of the urinary tract that removes urine from the body.
-
Colovesical Fistula:
It is between the large intestine and the bladder.
-
Rectovaginal Fistula:
The vagina is located between the rectum (the last section of the large intestine).
Other Fistulas:
-
Enteroenteric Fistula:
It occurs between two different parts of the intestines.
-
Enterocolic Fistula:
There is an abnormal connection between the small intestine and the large intestine.
-
Enterocutaneous Fistula:
It occurs between the intestines and the skin.
-
Enterovaginal:
It occurs between the vagina and the intestines.
These fistulas can occur in different parts of the body and cause various health problems. And they usually require surgical intervention.
Why Do Perianal Fistula Form?
Reasons for Fistula Formation:
Fistulas can occur for a variety of reasons.
-
Non-Healing Abscesses:
Abscesses that do not heal for a long time and are constantly filled with body fluids can extend to the skin, a body cavity or an organ and cause fistula formation.
-
Rips During Childbirth:
Serious vaginal tears or infection in episiotomy incisions during childbirth can lead to rectovaginal fistula formation between the vagina and rectum.
-
Digestive System Surgeries:
Fistula formation can be observed in the intestines after such surgeries. Fistulas can also occur after radiation therapy applied in cancer treatment.
-
Chronic Inflammatory Bowel Diseases:
Diseases such as Crohn’s disease or ulcerative colitis, some sexually transmitted infections, HIV and tuberculosis can cause fistula formation.
-
Cancer:
The damage caused by cancer tissue can trigger fistula formation. Radiotherapy applied in cancer treatment can also cause fistula formation.
-
Medical Devices:
Inflammation of wounds caused by incorrect use of medical devices such as catheters or endoscopy can lead to fistula formation.
-
Diverticulitis:
Infection of small sacs in the colon can cause fistula formation.
-
Hidradenitis Suppurativa:
This chronic skin disease can cause abscesses and scarring, and can lead to fistula formation.
-
Surgeries:
Rectal or hemorrhoid surgeries near the anus, hysterectomy, cesarean section, and surgeries performed on the back wall of the vagina can cause fistula formation.
These various causes can lead to fistula formation in different parts of the body and often require surgical intervention.
What are The Symptoms of a Perianal Fistula?
Fistula symptoms depend on where the abnormal connection occurs. A perianal fistula may cause constant pain or swelling in the anus. A fistula between the bowel and bladder can cause recurring urinary tract infections. Fistulas between two sections of the bowel may not cause any symptoms. Fistula symptoms include pain, fever, tenderness, itching, pus or foul-smelling discharge. Symptoms vary depending on the severity and location of the fistula.
Anal Fistula Symptoms
- Irritation of the skin around the anus
- Constant, throbbing pain that increases when sitting, moving, defecating or coughing
- Foul-smelling discharge around the anus
- Pus or blood during defecation
- Swelling, redness and increased heat around the anus if there is an abscess
- In some cases, difficulty controlling bowel movements
The tip of the fistula can be seen as a small hole in the skin near the anus.
However, this may be difficult for the patient to see for himself.
Urinary Tract Fistula Symptoms
- Vaginal fluid leakage
- Continuous urine leakage from the vagina
- Bad odor from the vagina
- Feces leakage from the vagina
- Frequent urinary tract infections
- Gas discharge from the urinary tract while urinating
- Irritation of the genital area skin in women
- Abdominal pain
How is Perianal Fistula Diagnosed?
Fistula Diagnosis and Imaging Methods:
Fistulas are generally diagnosed based on the symptoms reported by the patient and a physical examination. If required, advanced imaging techniques can also be utilized to confirm the diagnosis.
Here are some of these methods:
-
Anal Fistula Tests:
- Anoscopy is a procedure that involves the use of a specialized instrument to examine the interior of the anus and rectum.
- Your doctor may request an ultrasound or MRI of the anal area to better see the fistula tract.
- Sometimes your surgeon may need to examine you under anesthesia in the operating room to diagnose a fistula.
-
Computerized Tomography (CT):
A CT scan is an effective imaging method for identifying the location and severity of a fistula.
-
Barium Enema:
In this procedure, a barium solution is introduced to enhance X-ray imaging of the colon. It is particularly useful for detecting fistulas in the intestinal tract.
-
Colonoscopy:
This technique involves examining the inner lining of the intestines and plays a crucial role in diagnosing intestinal fistulas.
-
Sigmoidoscopy:
Focused on evaluating the inner surface of the rectum and sigmoid colon, this procedure aids in identifying fistulas in these specific areas.
-
Upper Endoscopy:
This diagnostic approach is used to inspect the upper digestive organs, including the stomach and duodenum.
-
Fistulogram:
A contrast dye is injected into the fistula to assess its structure and pathway, with an X-ray used for visualization. In the case of rectal fistulas, the dye is introduced through a procedure similar to an enema, while for fistulas that open onto the skin, it is delivered via a small tube. To ensure comprehensive imaging, the patient’s position is adjusted, allowing for pictures to be taken from various angles.
Perianal Fistula Treatment
There are several methods for treating fistulas.
Surgical intervention is necessary.
Treatment is also supported by antibiotics.
However, antibiotics alone do not cure the condition.
Surgical treatment is necessary.
Ensuring recovery is essential. It is recommended to intervene as soon as symptoms appear.
Because the longer you wait, the worse this problem will get.
How is Perianal Fistula Surgery Performed?
Fistula surgery is a surgical procedure performed to close or correct the fistula. There are various types of applications of this surgical procedure.
The types of fistula surgery that the doctor will decide on by looking at the physical examination and test results can be as follows:
-
Fistula Flap Surgery:
This procedure involves closing the fistula through the transfer of an appropriate tissue.
-
Connection Completion Surgery:
The procedure involves sealing the fistula by reconnecting and repairing the two ends of the irregular passage.
-
Fistula Chamber Closure Surgery:
This approach closes the fistula by filling it with a tissue graft or by using a tissue expander material.
-
Endorectal Flap Surgery:
In this technique, the fistula is repaired using tissue rerouted through the rectum, with access to the site obtained via the anus.
-
Seton Application:
A string or similar material is placed around the fistula to facilitate drainage and promote faster healing.
-
Fistulotomy:
A surgical procedure that involves cutting the skin and surrounding tissues near the fistula. This method aims to clean the fistula mouth and heal the fistula.
What are The Risks of Perianal Fistula Surgery?
The patient’s general health status, age, fistula size and location are factors that affect the risk of surgery. Although fistula surgery has a very high success rate, there are risks of fistula surgery as in every surgical procedure.
While not common, the potential risks associated with fistula surgery include the following:
- Bleeding
- Infection
- Intestinal injury
- Bladder injury may occur.
What are The Things to Consider After Perianal Fistula Surgery?
Proper post-operative hygiene is essential for a smooth recovery. After using the toilet, the surgical site should be cleaned gently to avoid irritation. It‘s equally important to ensure the area remains dry to prevent any complications. Maintaining a balanced diet is another key factor during this phase.
Incorporating adequate fiber into your meals helps promote regular bowel movements, while staying well-hydrated by drinking plenty of fluids supports overall healing. Some discomfort or pain is normal after surgery, and prescribed painkillers can help manage it effectively.
It‘s advisable to avoid strenuous activities, as excessive pressure on the surgical area can interfere with the healing process. Routine follow-ups with your doctor are critical for tracking progress and addressing any issues that may arise. Additionally, habits like smoking and drinking alcohol should be avoided, as they can significantly slow down recovery and increase the risk of complications.