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Anal fistula

Anal fistula

ANAL FISTULA: WHAT IT IS AND ITS TYPES

Perianal abscess and fistula represent two different stages of the same pathology:

  • an anal abscess represents the acute phase of an infection that originates in microscopic glands located within the anal canal and presents itself as a circumscribed accumulation of pus localised more or less close to the surface;
  • anal fistulas represent the chronic evolution of an abscess, they are tubular-shape lesions that connect the area of origin of the infection with the surrounding skin.

There are various types of anal fistulas and their most common classification is that of Parks which divides them into five groups:

  • surface;
  • intersphincteric;
  • transsphincteric;
  • over-sphincteric;
  • extra-sphincteric.

Depending on the type of route they follows, fistulas can be defined as:

  • simple or branched;
  • complete or incomplete;
  • internal or external;
  • horseshoe.

If their origin is taken into account, the following are defined:

  • trauma (including surgery);
  • congenital;
  • from inflammatory bowel diseases;
  • labour induced.

 

WHAT GENERATES AN ANAL FISTULA

The factors that can lead to the development of an anal fistula are numerous, among which we can mention:

  • local trauma;
  • repeated alteration of the faeces consistency;
  • anal ulcers;
  • HIV and diseases that compromise the immune system;
  • rectal cancer;
  • tuberculosis;
  • sexually transmitted diseases;
  • post-surgical complications.

 

SYMPTOMS: ANAL FISTULA MANIFESTATION

Patients with anal fistula have a series of similar and quite evident symptoms: irritation around the anus, itching, burning, pain. During defecation, these symptoms tend to accentuate, accompanied by the secretion of pus or serous material from a small orifice formed near the anus. In some cases the patient may also experience fatigue and fever. The progression of the channelling and fistula formation process, with its consequent chronicisation, can favour serious damage to the sphincters.
 

DIAGNOSIS AND CARE: HOW TO CURE AN ANAL FISTULA

A proctological assessment by a specialist, accompanied by a careful history, is sufficient to diagnose the simpler fistulas. The specialist usually proceeds anyway with an endoanal ultrasound performed in order to evaluate the fistula’s way (route) and identify any orifices thereof. The study of the more complex fistulas requires more in-depth and detailed examinations such as magnetic resonance imaging (MRI).

How can an anal fistula be cured? Anal fistulas seldom regress totally. Both in the acute and in the chronic phase, the treatment of fistula is exclusively of the surgical type and usually provides for a programming of several interventions. Surgical techniques are numerous and the choice is made according to the type of fistula and the general condition of the patient.

Postoperative hospitalisation times are generally very short (24-48 hours) and the postoperative course is carried out at home. Postoperative pain is mild or moderate and is easily controlled with normal pain relief medications. As simple as it may be, post-operative wound care can be as important as surgical therapy itself and should not be underestimated.

The wound must be followed daily, the bottom of it must be gently cleaned; the mechanical cleansing of the secretions is indeed considered a fundamental element for healing. The medical market has a number of new advanced dressings, including disposable biocompatible sponges, made of hydrophilic polyurethane suitable for the management of wounds of varying surface and depth.

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