VNA Hospitals
A Unit of APAV Healthcare Private Ltd |1, Navjeevan Vihar, Malviya Nagar,New Delhi, India
VNA Hospitals
A Unit of APAV Healthcare Private Ltd
1, Navjeevan Vihar, Malviya Nagar,New Delhi, India
Everything You Need To Know About Anal Fissure
Table Of Index
What is Anal Fistula?
An anal fistula is a tunnel that runs from the anal opening and connects the skin around it. An anal fistula mostly forms after an infection that did not heal properly. In human anatomy, the external opening through which feces are expelled is known as the anus. Multiple small glands that make mucus are located inside the anus. When these glands get clogged and infected due to dirt and debris, it can lead to the formation of an abscess. Most of these abscesses turn into an anal fistula.
How does Anal fistula form?
When the abscesses that form near and around the anal mucosal tissues are not treated, it tends to keep growing and worsening over time. Eventually, the abscess punches out like a hole making its way outside the skin.
Types of disease
Causes
- Trauma to the anal tissues
- Infection in the anal gland
- Radiation from cancer treatment
- Crohn’s disease
- Sexually transmitted disease
- Tuberculosis
- Diverticulitis
Symptoms
- Pain and swelling around the anus
- Frequent anal abscesses
- Foul-smelling bloody drainage from anal opening
- Bleeding along with stool
- Pain during bowel movements
- Fever, chills and fatigue
Diagnosis
In most cases of anal fistuila, the anorectal specialist is able to diagnose it just through a physical examination. In case the condition of the anal fistula is sever, the doctor might require to do an examination of your rectum and anal canal. The commonly performed tests to diagnose anal fistula are:
Digital examination – In this test, the fistula specialist inserts a gloved, lubricated finger into the rectum to check if there are any kind of abnormal growths.
Visual inspection – The proctologist or the anorectal surgeon might examine the lower rectum using a proctoscope, an anoscope or a sigmoidoscope. Using any of these devices, the doctor will carefully examine the lining of your anal tissues to check the severity and depth of your anal fistula.
Anoscopy – Anoscopy allows the anorectal doctor to examine the inner lining of your anus and rectum. The test checks for abnormal growths, bleeding, inflammation, and conditions such as diverticulosis.
Sigmoidoscopy – Flexible sigmoidoscopy is a useful test to look for an underlying aetiology in fistula-in-ano.
Imaging tests – Your physician may also order an ultrasound or MRI of the anal area to get a better view of the fistula tract.
Self-diagnosis of anal fistula is not very difficult if you are well aware of the symptoms. If you think you have hemorrhoids, you can be pretty sure about it by checking the anal area and if there is any abnormality near the anal opening. If you have anal fistula, you are also to experience constant irritation in your anal skin that can make it difficult for you to sit or sit on the tilet seat. You may also experience smelly and foul discharge from and near your anus, and in rare occasions, you may also pass blood along with your stool. Additionally, there might be swelling and redness in you anal area and you may experience high fever.
Most proctologists or anorectal surgeons diagnose anal fistula through physical examination alone. Once you visit the doctor’s clinic, the doctor may ask you a few questions to understand your condition better and to determine the best line of treatment.
- Do you have a family history of anal fistula?
- When did you start having the symptoms?
- Do you pass blood with your stool?
- What are your dietary and lifestyle habits?
- What is your fitness regime like?
- When do you feel the pain mostly?
The doctor may also do a digital rectal examination to diagnose the severity of the fistula tract and to locate the internal openings.. The proctologist may also suggest tests like colonoscopy, sigmoidoscopy, and anoscope to check for the presence of any gastrointestinal disease. In these tests, the doctor inserts a small camera to check for any abnormalities in the anus, rectum, and colon. In some cases, the doctor may also suggest flexible sigmoidoscopy to check if there are any secondary branches (one internal opening but multiple external openings) of the fistula.
Risks & Complications
Like any other surgical treatments, there are potential risks and complications associated with surgery if anal fistula too. Common complications may include:
Infection – When incisions are made in the skin, every surgery carries some risk of infection. The same is with the procedure of fistulectomy. In certain cases, where the fistula tract is too deep, the doctor might need to perform the surgery in several stages. In that case, there is a high possibility that the fistula might spread throughout the body and cause systemic infection. In case of infection from anal fistula, the doctor might prescribe antibiotics. If the infection is too severe, the patient might even require to get admitted to a hospital and undergo intravenous administration of antibiotics.
Bowel incontinence – If the fistula surgery is not performed by an expert anorectal surgeon, there are chances that the anal sphincter muscles may get damaged. The anal sphincter muscles are responsible of keeping the anus and controlling the bowel movements. In any case, if the sphincter muscles are damaged, the strength of the anal muscles are compromised which may cause leakage of feces. This condition is known as bowel incontinence. Bowel incontinence is estimated to affect 3-7 percent of the total patients who undergo anal fistula surgery.
Anal fistula recurrence – An estimated 7-21 percent of patients who have undergoes surgery for anal fistula suffer from recurrence of anal fistula after surgery. The chances of recurrence is ten highest in case of treatment of anal fistula through fibrin glue.
If you are diagnosed with any anorectal disease including anal fistula, it is always better to undergo treatment without delay. In the words of a senior proctologist at Pristyn Care, “Home remedies should not be relied for long duration if you have been diagnose with anal fistula or any other anorectal disease. Home remedies can only help reduce the severity of symptoms such as pain, swelling, soreness, redness, and inflammation in the anal region. For a permanent cure, undergoing surgery is the only safest and best method.”
If left untreated, anal fistula can lead to the following complications:
- Unbearable pain – Untreated fistula-in-anal can cause severe and unbearable pain in the anal area. The pain can get worse with time and even the condition might be complex to treat. Untreated anal fistula is likely to cause foul smelling anal discharge that can hamper your lifestyle and make you feel embarrassed.
- Unable to sit or walk – Diseases like anal fistulas can make you feel uncomfortable while sitting and walking. So, it is advised to undergo surgery as soon as you are diagnosed with any of them.
- Extension of anal fistulas – An untreated anal fissure can extend into the internal anal sphincter muscle that holds your anus closed. In such cases, it is difficult to heal the fissure and can cause severe pain and discomfort that would require medication therapy along with surgical intervention.
Complications that can be caused as a result of delayed treatment for anal fistulas may also include:
- Sharp pain during bowel movements
- Burning and itching sensation in and around the anus
- Leakage of pus from the anus
- Formation of skin tags or lumps at the anal area
- Development of anal ulcers.
Prevention of anal fistula:
Here are some of the tips that can help you prevent anal fistula:
- Consuming high-fibre diet – One of the easiest ways to prevent anal fistula is to prevent passing of hard stools. To prevent hard bowel movements, the best thing to do is stock up your diet with fiber-rich food. If you want to avoid getting anal fistula, it is crucial to eat at least 25-30 grams of fiber per day. Some foods rich in fiber are:
Whole grains, oatmeal, and brown rice
Beans and lentils
Vegetable and Brussel sprouts
Fruits such as bananas, apples, pears, and berries
- Drink sufficient water – Water along with a fiber-rich diet is very important for the prevention of any anorectal disease. Drinking enough water prevents constipation and hard stools which in turn decreases the need to strain while passing a bowel movement. To prevent anal fistula, drinking enough water throughout the day is extremely important. It will help your digestive system function properly.
- Maintain cleanliness and dryness in your anal region – Anal fistula often forms as a result of clog and blockages in the anal canal. Long term accumulation of dirt and debris leads to the formation of anal fistula. To prevent this, it in crucial to clean the anal area every time you pass a bowel movement. Don’t leave the area wet after cleaning, pat it well and dry so that there’s no bacteria or infection.
- Don’t strain while passing stool – Do not strain while making bowel movements. Straining can make the condition of the anal skin worse and lead the anal fistula to aggravate in nature. It is equally important to take care that you don’t spend long hours sitting on the toilet seat. The longer you sit on the toilet seat, the more you are likely to strain while making your bowel movements worse.
- Regular exercises – Almost all anorectal diseases have a direct relation with physical activities and how you keep your body active. Staying physically active keeps the colon active and functions in a regular manner. But that being said, you should know which exercise is good for you and which is not. Avoid any activity that puts strain and pressure on your abdominal region. Do not lift weights. Do not sit in one place for long hours. Indulge in moderate physical exercises regularly.
When to consult a doctor for anal fistula?
Most people tend to ignore the early symptoms of anal fistula. Not knowing the symptoms of the disease can make you ignorant of the fact as to when to approach the right doctor. Getting medical treatment and professional help can help you avoid timely complications of the condition. If you experience any of the following signs, it could be an indication of anal fistula. Without further delay, you should consult with an anorectal surgeon in that case:
- If you see/ notice foul-smelling discharge from your anal area.
- If you see blood in your stool or blood in the toilet seat/ tissue paper, consult with a doctor at the earliest. Blood in the stool can be a common sign for most anorectal disease and not fistula-in-ano alone. Hence, this symptom needs to be discussed with the doctor to evaluate the condition and to determine the best line of treatment.
- When no medication and home remedies provide you relief or effective results from your symptoms.
Hernia, Thyroid, Anorectal and Breast Surgery Specialist
Dr Sunil Garg
General Surgeon and Laparoscopic Surgeon
Hernia, Thyroid, Anorectal and Breast
Surgery Specialist
Questions to ask your doctor.
Is my anal fistula serious?
Can I try home remedies for temporary relief from my condition?
Do I need to undergo surgery for my condition?
How many days off should I take if I undergo laser surgery for anal fistula?
When will I be able to get back to my regular work life after surgery?
Will my fistula recur after laser surgery?
Shall laser surgery cost heavy on my pocket?
Will surgery provide me permanent relief from the pain and discomfort?
How can I prepare for the surgery?
How long will it take me to recover after the surgery?
Will your team help me throughout the treatment and after?
Treatment options & cost
- Fibrin glue – Fibrin glue is a therapeutic for anal fistulas which activates thrombin to form a fibrin cloth. The procedure helps close the fistula tract mechanically. Fibrin glue is a liquid sealant thought to assist in fistula tract healing by stimulating migration and activation of fibroblasts.2 It is a tempting treatment modality: the technique is simple, repeatable, and involves only minor surgical trauma to the anal sphincter. Fibrin glue treatment is very easy to use and is considered as a good treatment for people who are not in favor of surgery. However, fibrin glue is not the best replacement for skilled anorectal surgery.
- Seton placement – This procedure involves placing a suture or a rubber band (also known as seton) in the anal fistula that is progressiveley tightened. The rubber band lets the fistula heal behind the seton. The treatment is non-invasive and the risk of recurrence is also quite low.
Once you have developed anal fistula, antibiotics or home remedies alone will not cure the condition. You will require surgical intervention to get the condition treated. Surgical options for anal fistula treatment include:
Fistulotomy – In this treatment, the fistula is opened and allowed to heal from inside out. The surgery is usually an outpatient procedure. As such, the patient can return home the very same day.
Laser surgery for snal fistula – Laser treatment for the closure of fistula-in-ano is a minimally invasive and low-complication treatment which is considered as the most effective treatment for complex fistulas. The treatment does not cause any severe damage or injury to the sphincter muscles.
There’s no denying that if you have developed anal fistula, the best thing to do is get professional help. But additionally, you can include self-care measures in your daily regime that may not only aid in reducing the symptoms but also help the fissure heal in a much shorter time.
Sitz baths – Sitz baths is one of the highly beneficial home remedy for almost every anorectal problem including anal fistula. Sitz baths may help in not only reeieving pain of the anal area but also speed up th ehealing process. Sitz bath is basically feeling a palstic tub with warm water and soaking you anal area for 15-20 minutes in the wtaer. The tubs used for the treatment can be brought from any drugstore. You can add epsom salts and additives in the water too, but only after recommendation from your healthcare provider.
Eating more fiber – If you have any anorectal disease or disorder, eating a sufficient amount of fiber may help prevent stools from being hard and prevent constipation and diarrhea. FIber rich diet can aid you in passing stools easily which may be less traumatic to the anal opening. Some examples of fiber-rich food are:
- Beans
- High-fiber bran cereal
- Split peas
- Chickpeas
- Lentils
- Pigeon peas
- Wheat bran flakes
- Avocados
- Soybeans
Use stool softeners – Using stool softener may prevent complications such as constipation. Stool softeners usually are quite effective in case of any anorectal diseases and cause no side effects. Stool softeners pull more water into the digestive tract that softens the stool. However, most doctors do not recommend using stool softeners for more than a week or ten days. Once you stop using stool softeners, it is important that you make lifestyle changes and continue healthy food.
Take care of the perianal skin – You want to prevent or maage anal fistula? The trick is to keep your perianal skin clean after bowel movements. If the jet spray is hurting your skin, you can skin the area with wet wipes. Make sure to rub or pat dry the area after passing stool each time. Remember to be gentle with your skin.
- Beans
- High-fiber bran cereal
- Split peas
- Chickpeas
- Lentils
- Pigeon peas
- Wheat bran flakes
- Avocados
- Soybeans
- Eat a high-fibre diet.
- Avoid lifting heavyweights.
- Use a stool softener that can aid you in having smooth bowel movements.
- Stay hydrated. Drink at least 8-10 glasses of water every day.
- Do not strain while passing a stool.
- Cost of anal fistula surgery in Delhi – Rs. 40,000 to Rs. 50,000
- Cost of anal fistula in Bangalore – Rs. 38,000 to Rs. 52,000
- Cost of anal fistula in Gurgaon – Rs. 40,000 to Rs. 50,000
- Cost of anal fistula in Pune – Rs. 35,500 to Rs. 45,000
- Cost of anal fistula in Jaipur – Rs. 37,000 to Rs. 45,000
- Cost of anal fistula in Bhopal – Rs. 40,000 to Rs. 50,000
- Cost of anal fidstula in Coimbatore – Rs. 40,000 to Rs. 5,000
Insurance coverage
Recovery Timeline
FAQ
If you have anal fistula, you are likely to experience these signs and symptoms:
- itching and irritation in anal skin
- pain & swelling
- irritation
- bright red color bleeding
- foul-smelling pus drainage
Usually, anorectal surgeons take around 1-3 hours to complete anal fistula surgery. However, the operation time may increase or decrease depending on factors like:
- Age of the patient
- Type of anal fistula surgery/treatment planned to perform
- Size and severity of anal fistula
- Presence of any underlying anorectal disease or disorder
The success rate of anal fistula suregry can be as high as 95 percent if the suregry is performed by an epxert surgeon. The success of the surgery, post-surgery complications and possible recurrence of the condition, everything depends on how well the patient follows the advice of the doctor too.
To book an appointment with Pristyn Care doctors for the treatment of anal fistula, you can either call us directly on the number emntioned on the page or fill the appointment form. Our medical representative will get back to you to schedule an appointment as per your convenience with an expert anorectal surgeon.
Nitroglycerin cream can provide temporary relief from anal fistula symptoms as it improves blood flow and speed up the healing process. It can be directly applied to the anal canal after dilution to get relief from symptoms of fistula. But the ointment should be used only after consulting with the doctor. However, it is to be kept in mind that no ointment can provide permanent cure to anal fistula. If you are diagnosed with the condition, you will need surgery sooner or later to permanently get rid of the condition.
Yes. Exercise can help to regulate your bowel movements and make symptoms of ana fistula less painful. Along with exercise, you must drink plenty of water to prevent constipation and aid your bowel movement. Exercise also improves the blood flow to the anal region that can help the fistula to heal properly once it is cleaned.
No. Laser fistula surgery is a painless and non-invasive treatment method. There won’t be any cuts, stitches, wounds, or scars involved in the procedure. The treatment is also carried out under anesthesia (either general or local depending on the patient) which means the patient will not feel any pain or discomfort during the surgery. Once the effects of the surgery wear off, the patient may feel a slight painful sensation at the surgical site which is completely normal. The doctor, most likely, would prescribe medicines to help ease the pain. With proper medication and ample rest, the pain is likely to fade within the next few days only.
Facts and statistics around anal fistula
Facts and figures around anal fistula:
- Medical studies state that 23% of Indians have anal fistula.
- 28% of individuals with anal abscess and 12% of individuals with underlying anal diseases have developed anal fistulas.
- Each year between 50,000 to 1,00,000 women worldwide are affected by obstetric fistula.
- Approximately 76% of patients with anal fistula preferred to undergo laser surgery, 14% choose to undergo open surgery, and the remaining 10% choose to follow home remedies, lifestyle changes, and dietary modifications.
Why choose Pristyn Care for anal fistula surgery?
- Pristyn Care is a certified Centre of Excellence for anorectal treatments including diseases like anal fistula, piles and anal fissure.
- Pristyn Care houses some of the top anorectal surgeons of the country who have years of experience in delivering surgical treatment for colorectal diseases with a high success rate.
- Pristyn Care is associated with some of the top hospitals across India that are equipped with state-of-the-art facilities required to perform advanced anorectal surgeries.
- Proctologists/ General Surgeons working with Pristyn Care do a thorough consultation in the case of every patient to understand the health condition and then determine the treatment method that will work best.
- A dedicated ‘care buddy’ is assigned to every patient on the day of the surgery. We strive to make the whole surgical experience for our patients a seamless one. Once you reach the hospital, your dedicated medical attendant or ‘care buddy’ will take care of every paperwork and formality on your behalf.
- To ease out the commuting process for our patients, we also provide free cab facilities to bring you from home to the hospital and help you return back home after the surgery.
- A free-of-cost follow-up is provided to the patients within the first seven days after the anal fistula surgery.
Testimonials
Kind words said to us and our colleagues in our journey till now
Some Kind Words
Our Sincere Gratitude
Appreciation from our Patients and their Full Recovery are our Accolades. Here are a few kind words from our patients after they got their treatment/surgery done by Dr Vineet Malhotra and Dr Abhishek Mishra.
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1, Navjivan Vihar, Geetanjali Enclave
Landmark, Opposite HDFC Bank
Malviya Nagar, New Delhi - 110017 - +91 80 681 66666
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