Anal fistulas are irregular, abnormal tunnel-like structures formed between infected anal glands and the skin surface near or in the anus. There are mucus glads in your anal region, when these get blocked or infected it can lead to the formation of an abscess. Abscesses can often lead to an anal fistula developing from within the lining of the anal cavity to the skin/mucosal surface. 

Anal fistulas typically require surgical intervention and you must consult a doctor if you notice symptoms suggestive of anal fistula.

What causes anal fistulas?

Anal fistulas connect infected anal glands to the soft lining of the anal area, these glands can become clogged and infected. An infected gland is called an abscess and these abscesses create a pathway to the external surface to drain the pus. Once drained, it may recur again if the source of infection is not cleared off completely.

Other conditions that affect or cause inflammation in the anal region or lower digestive area can also increase the risk of fistulas. These may include:

• Crohn’s disease which results in inflammation of the intestines
• Cancer and cancer treatments (particularly radiation)
• Trauma (such as through the insertion of foreign objects)
• Sexually transmitted infections like syphilis and chlamydia
• Tuberculosis (a bacterial disease)
• Diverticulitis (a disorder affecting the large intestine with bulging sacs)

Symptoms of anal fistula 

While pain and bleeding are typically the first signs of an anal fistula, stay informed on any other possible signs that you can watch for: 

• Irritation to the skin in or around the anus 
• Swelling, pain and throbbing in the anal region which may feel worse during bowel movements, coughing, sitting down 
• Blood or pus draining from the anus or from an area near the anus (the severity of pain may reduce after it drains out)
• Red and sore skin around the anus
• Bleeding or pus when you pass stools
• Foul smell from the anal region 
• A high temperature (with or without chills) due to infection

Also Read: Is Anal Sex Safe? A Comprehensive Guide to Risks and Safety Measures

Home remedies on anal fistula

Although surgery is required for an anal fistula, there are some other options you can use for symptomatic relief. These can be effective for temporary relief while you await your surgery: 

1. Sitz Bath – A sitz bath involves soaking the anal area in regular warm water to bring temporary relief from irritation, swelling and pain. Generally, a sitz bath can be taken several times a day (check with your doctor), as often as you need relief. Be sure to use a clean tub each time. Your doctor may also advise some disinfectants like betadine to be added to water.
2. Stool Softener – There are certain laxatives and stool softeners that may be helpful if you struggle with constipation. However, you should not use any of these without first speaking with your doctor. Stool softeners can ease the passage of waste which may ease the pain you experience when going to the toilet. 
3. Use soft seating – Even sitting down can result in additional pain when you have a fistula. You can use a small pillow, some soft rolled-up cloth (such as a towel) or a doughnut pillow to get more comfortable. This is especially useful if you need to be seated a lot during the day (such as for work)
4. Ointments for pain relief – These creams will require a prescription from your doctor. You may be able to use this cream at home or it may be applied at the clinic itself. Anaesthetic and antibiotic creams help to dull the pain and may cut down the amount of swelling in the region. Use this only under the supervision and permission of your doctor. 
5. Hydration – Not consuming enough water can worsen your situation. Your digestive system needs to be running in good shape so that the fistula doesn’t get worse. With sufficient water, your stools will not be hard and this will lower the pressure against the fistula. Hydration is also important to maintaining your overall health.
6. Manage fibre intake – Be careful with the amount of fibre you consume during this time. Your doctor may advise you to consume more fibre or less, depending on the condition of your fistula. To add more fibre to your diet you can include whole grains, veggies, fruits, nuts and other fibre-rich foods. 
7. Avoid spicy foods – Your doctor may advise you to reduce or completely avoid spicy, oily foods. All of these can result in additional pain and could potentially increase the bleeding. You should also try to avoid anything that can cause constipation or inflammation such as coffee, alcohol, refined sugar and fast food.
8. Personal Hygiene – Maintaining personal hygiene is one of the most important aspects of taking care of yourself when you have an anal fistula. Be gentle when cleaning the area always, use a gentle shower rather than toilet paper or other methods. Always ensure that your hands are clean before and after you clean up. 

Fistula-in-ano often occurs following anorectal abscess.In my practice i have see 30% to 70% of patients diagnosed with an anorectal abscess will already have a fistula present on exam

Dr. M.G. Kartheeka, MBBS, MD

When to seek professional help for anal fistula

Since anal fistulas can cause serious pain and complications if left untreated, you may need to visit your doctor when you spot any of the symptoms mentioned above. Pain and discomfort in the anal region can be due to fistula, anal fissure, piles or even cancer. This needs to be clinically evaluated and diagnosed by a doctor. 

Once your doctor diagnoses your problem, they will give you an idea of what your options are to proceed. You may need to undergo further diagnostic tests (such as some blood tests, anoscopy, CT Scan, MRIs or ultrasounds). 

Walking regularly is a low impact way to keep your body moving and reduce the associated pain with fistula in ano.Keep a name to work for at least 30 minutes a day regularly to reduce the pain in the anal  region.

Dr. Ashish Bajaj, M.B.B.S., M.D.

Conclusion

Anal fistulas can be very discomforting due to the constant pain, it may also cause stress and anxiety since this kind of issue will be abnormal for most people. It is important to consult your doctor, follow their advice and stay calm. In most cases, surgery is needed for an anal fistula. There are plenty of advanced techniques that can be performed quickly and enable a smooth recovery. Be sure not to ignore any of the signs of anal fistula as this may potentially lead to complications and worsening pain. 

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Disclaimer: The information included on this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.