Why Choose Cedars-Sinai Marina del Rey Hospital for Anal Fistulae Treatment?
At Cedars-Sinai Marina del Rey Hospital, our specialists offer the most innovative methods to diagnose and treat anal fistulae. Upon diagnosis, our physicians choose the best treatment options available to relieve symptoms and treat the underlying condition.
An anal fistula, also known as a fistula-in-ano, is an inflamed tunnel-shaped cavity that traverses the anal canal through the opening of the anus. They can develop as a single channel (fistula) or as multiple channels (fistulae). This condition can be common for patients with a history of anal abscesses, especially if they did not heal properly. Abscesses are filled with pus and may leave behind a small empty cavity when drained, creating the anal fistula. Furthermore, anal fistulae are most commonly found in patients suffering from inflammatory bowel diseases, especially Crohn’s disease, or other conditions like diverticulitis, chlamydia, syphilis, or tuberculosis. Anal fistulae are not considered serious but can cause discomfort and pain. They do not heal on their own and most often require surgery.
Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital for Anal Fistulae
Anal fistulae almost always require surgical treatment. If left untreated they can become infected. There are several types of surgery that can be performed to treat anal fistulae, each having benefits and risks. Some of the most notable risks of anal fistula surgery are possible scarring, bleeding, pain, difficultly urinating, involuntary flatulence, or bowel incontinence.
Choosing the appropriate surgical procedure depends on the severity of the patient’s condition, the location of the fistula, and whether it is a single channel or multiple channels. Some of the most frequently performed surgeries for anal fistulae are:
- Fistulotomy: This surgical procedure consists of a lengthwise incision to the fistula. The benefit of this procedure is that it promotes healing from the inside-out and results in a smooth scar. One of the main disadvantages of this procedure is that in some cases the sphincter muscle might be affected, which can lead to incontinence issues.
- LIFT technique: This new procedure, also known as ligation of the inter-sphincteric fistula tract, is recommended for patients with anal fistulae passing through the sphincter muscles, where a fistulotomy would not be a good option.
- Seton technique: This procedure is generally recommended for patients with an anal fistula that has developed through a portion of the anal sphincter muscles, thus making other surgical approaches risky. During this procedure, the surgeon places a seton stitch in the fistula and leaves it there for several weeks in order to keep it open, drain, and accelerate the healing process. In order to fully heal a fistula, the patient might need to undergo this procedure repeatedly.
- Advancement flap procedure: This type of procedure is most likely to be carried out when the fistula passes through the muscles of the anal sphincter. Although this procedure is considered less effective than a fistulotomy, it is useful when trying to avoid damaging the sphincter muscles.
- Bioprosthetic plug: A bioprosthetic plug is a piece of animal tissue that is used to block the internal opening of the anal fistula. Some studies have found the bioprosthetic plug to be effective, however, there is not enough evidence of its long term results just yet.
Drugs and Other Treatments Needed for Anal Fistulae
Again, for most patients suffering from anal fistulae, the best treatment options are surgical interventions. Very few non-surgical treatments exist. However, doctors may prescribe certain medications in order to relieve some of the patient’s symptoms and avoid infections:
Calcium channel blockers »
Fibrin glue injections »
The five different types of anal fistulae differ in their relationship with the external and internal muscles of the sphincter. This is a surgical classification method and is known as the Parks classification.
Submucosal fistulae »
Suprasphinteric fistulae »
Extrasphincteric fistulae »
Intersphinteric fistulae »
Transphinteric fistulae »
Symptoms of Anal Fistulae
Some of the most common symptoms associated with anal fistulae are:
- Pain that worsens when you sit or when you contract the anus
- Swelling, irritation, and redness around the anus
- Blood and pus discharge
- Bowel movements issues
Diagnosis of Anal Fistulae
The most frequent methods used to diagnose anal fistulae are:
- Physical and rectal examination: This type of examination is very effective as specialists can easily notice the presence of a fistula opening through the skin.
- Proctoscopy: During a proctoscopy, the specialist uses a special tool called a proctoscope to investigate the interior part of the rectum.
- Sigmoidoscopy: The specialist might also recommend a flexible sigmoidoscopy, which will allow him to investigate the sigmoid colon.
- Imaging tests: In order to further analyze the location and nature of the anal fistulae, the specialist may recommend different imaging tests such as fistulography, ultrasound scans, MRI scans, or CT scans.
Risk Factors for Anal Fistulae
The most important risk factors that influence the development of anal fistulae are:
- Anal abscesses: These abscesses are the main risk factor for anal fistulae and between 20% and 50% of patients suffering from an anal abscess will also develop an anal fistula.
- Inflammatory bowel diseases: Patients who are suffering from inflammatory bowel diseases, namely ulcerative colitis and Crohn’s disease, are very susceptible to anal fistulae.
- Systemic diseases: Patients who are suffering from certain conditions, such as diabetes, tuberculosis, and HIV, have an increased risk of developing anal fistulae.
- Trauma: People who have a history of anal trauma are also more likely to suffer from anal fistulae.
- Radiation therapy: In some cases, radiation therapy administered to the anal area can influence the development of anal fistulae.
- Anorectal cancer: Anal fistulae can sometimes be associated with anorectal cancer.
Causes of Anal Fistulae
The main causes of anal fistulae are:
- Anal abscesses: This is considered the main cause of anal fistulae. One in every four people suffering from an anal abscess will develop an anal fistula as well.
- Crohn’s disease: This condition affects the digestive system and can sometimes favor the development of anal fistulae.
- Diverticulitis: The inflammation and infection caused by this condition can also trigger the development of anal fistulae.
- Hidradenitis suppurativa: This skin condition causes scarring and abscesses, which in turn can lead to anal fistulae.
- HIV and tuberculosis: Patients suffering from these systemic conditions can develop anal fistulae as well.
Patients suffering from anal fistulae are strongly recommended to follow their doctor’s advice when choosing a treatment method. Generally, the best way to permanently cure an anal fistula is surgery. However, patients can try alternative treatments to relieve some of the symptoms associated with anal fistulae. The most popular alternative treatments are:
- Turmeric milk: Drinking a mix of turmeric, milk, and honey can be beneficial for patients who are suffering from an infection. This concoction has antibacterial properties.
- Ginger tea: Another drink that can be consumed when suffering from anal fistulae is ginger tea. Ginger is known to alleviate stomach pain, nausea, muscle stiffness, can help with constipation, and can also boost the immune system. Adding cloves to ginger tea can boost its benefits.
- Oregano oil: Oregano has anti-inflammatory, anti-viral, antibacterial, and antibiotic properties, thus, drinking a teaspoon of oregano oil mixed with 100 ml of water two times a day can reduce swelling, improve immunity, and alleviate pain.
- Manuka honey: Drinking one tablespoon of manuka honey dissolved in warm water two times a day can speed up the body’s natural healing process.
- Grapefruit seed extracts: Applying an ointment made of grapefruit seeds over the area affected by the anal fistulae will have a sanitizing effect. The grapefruit seed extract is an effective natural antibiotic.
- Nirgundi oil: Apply this oil to the anal fistulae to reduce inflammation and prevent the formation of bacteria.
- Tea tree oil: This oil is popular for its anti-inflammatory, antiseptic, antiviral, and antibacterial properties. It can also be used as an ointment when treating anal fistulae.
The formation of anal fistulae cannot always be prevented but some of the most effective ways to avoid developing anal fistulae are:
Are you suffering from anal fistulae? You can always learn more about colorectal problems and how to treat and cure them by getting in touch with our specialists at Cedars-Sinai Marina del Rey Hospital.