7 Signs You Have an Anal Fistula

An anal fistula is an uncomfortable and often distressing condition that occurs when a small tunnel forms between the end of the bowel and the skin near the anus. 

Recognising the signs early is crucial for timely treatment and relief. This article provides an overview of the symptoms associated with anal fistulas and what surgery entails.

Pain and Discomfort

Pain and discomfort are the most prevalent signs of an anal fistula. This pain is usually concentrated around the anal area and can be persistent or intermittent. During bowel movements, the pain often intensifies, causing a sharp, stabbing sensation or a severe burning feeling. This discomfort doesn't always subside after a bowel movement; it can linger, making daily activities like sitting, walking, or even lying down uncomfortable.

The nature of this pain can vary depending on the size and location of the fistula. For some, the pain might be mild and manageable, but for others, it can be debilitating, impacting their ability to perform routine tasks. The constant discomfort can also lead to secondary issues, such as sleep disturbances and a decrease in overall quality of life. People experiencing such pain should seek medical advice to determine the underlying cause and explore potential treatment options.

Rectal Bleeding

Rectal bleeding is another sign of an anal fistula. You might notice bright red blood on the toilet paper, in the toilet bowl, or mixed with your stool. Sometimes there might just be a few spots of blood, while other times, it could be more substantial. 

This bleeding occurs because the fistula creates an abnormal connection between the bowel and the skin, allowing blood to escape. It is important to note that any form of rectal bleeding is a sign that should not be ignored. Consequently, if the bleeding is consistent or heavy, then immediate medical attention is required to rule out other serious conditions, such as colorectal cancer or inflammatory bowel disease.

Drainage

Drainage from the anus is one of the clearest indications of an anal fistula. This drainage can appear as pus, a foul-smelling discharge, or even a mixture of both. The discharge occurs because the fistula tract allows waste and bacteria to travel from the inside of the bowel to the skin surface. 

The drainage can cause significant discomfort and hygiene issues. It can lead to staining of underwear and a feeling of persistent wetness in the anal area. This constant moisture also further irritates the skin, leading to itching and inflammation. In some cases, the discharge might also contain blood, which can add to the discomfort and worry.

The presence of such drainage is a strong indicator that there is an infection or abnormal passage in the body that requires medical attention. Addressing this symptom promptly will prevent the infection from spreading.

Swelling and Redness

Swelling and redness around the anal area are common symptoms of an anal fistula. The affected area may appear inflamed and feel warm to the touch. This swelling is often a result of the body’s inflammatory response to the infection within the fistula tract.

The redness and swelling can make it difficult to sit comfortably and can also cause a visible lump near the anus. This lump might feel tender and can increase in size if the infection worsens. The swelling can sometimes cause a throbbing sensation, adding to the overall discomfort.

Persistent swelling and redness are signs that the body is fighting an infection. It's crucial to monitor these symptoms and seek medical advice to prevent the infection from spreading or causing further complications. In some cases, the swelling might be accompanied by fever, which indicates a more severe infection that requires immediate medical attention.

Itching and Irritation

Itching and irritation are also signs to look out for.. Itching is often caused by the continuous discharge from the fistula as the skin around the anus becomes inflamed and sensitive.

Scratching the area can provide temporary relief but often aggravates the condition, causing further irritation and even minor skin tears. These tears can become infected, leading to more severe symptoms and complications. Maintaining proper hygiene and keeping the area as dry as possible can help manage the itching, but persistent symptoms should be evaluated by a colorectal doctor.

Itching and irritation, while less severe than some other symptoms, can significantly impact daily life. The constant need to scratch can be embarrassing and uncomfortable, making it challenging to focus on daily activities or enjoy social interactions.

Recurrent Abscesses

Recurrent abscesses in the anal region are a significant sign of an anal fistula. Abscesses are painful, swollen areas filled with pus, and can develop when the infection within the fistula tract becomes severe. These abscesses might appear to heal on their own, but they often return, creating a cycle of pain and infection.

The recurrence of abscesses suggests that there is an underlying fistula that needs to be addressed. They might drain on their own, but this often provides only temporary relief. Surgical intervention is usually required to properly address the abscess and the underlying fistula.

Treatment for Anal Fistula

Treating an anal fistula typically involves a combination of surgical and non-surgical approaches, depending on the severity and location of the fistula. The primary goal of treatment is to eliminate the fistula while preserving anal sphincter function to prevent incontinence.

Surgical options for treating an anal fistula include fistulotomy, seton placement, advancement flap surgery, and the use of fibrin glue or plugs. Each of these procedures has its advantages and is chosen based on the specific characteristics of the fistula.

A fistulotomy involves opening the fistula tract and allowing it to heal from the inside out. This procedure is highly effective but may not be suitable for all fistulas, especially those involving the sphincter muscles. A fistulotomy is often recommended for simple fistulas where the risk of damaging the sphincter muscles is low.

A Seton placement involves placing a surgical thread within the fistula to keep it open and allow for gradual healing. This method is often used for complex fistulas or those that involve the sphincter muscles. The seton helps to drain the fistula while minimising the risk of incontinence.

For more complex fistulas, procedures such as advancement flap surgery or the use of fibrin glue or plugs to close the fistula tract may be considered. These methods aim to promote healing while minimising the risk of incontinence. Advancement flap surgery involves using a flap of healthy tissue to cover the internal opening of the fistula, promoting healing and preventing recurrence. Fibrin glue and plugs are used to seal the fistula tract, allowing it to heal from the inside.

After surgery, your doctor may prescribe antibiotics to manage any infection. Post-treatment care also involves regular follow-ups with a healthcare provider to ensure proper healing and to monitor for any signs of recurrence. Adopting a high-fibre diet and staying hydrated can also support bowel regularity. Reducing strain during bowel movements can also aid in the overall healing process.

Fistula Surgery in Singapore

Fistulas are uncomfortable at best and can be debilitating at worst. Having a specialist with you to assess, diagnose and treat this condition is crucial in ensuring a better quality of life.

At The Colorectal Clinic, we prioritise customised treatment for long-term colorectal health. If you need fistula surgery or want to enquire about the cost of treatment in Singapore contact us today.