Book Appointment. An anal fistula usually develops as a result of an anal abscess which is drained or bursts. Around half of people who develop an anal abscess will go onto develop an anal fistula. An anal fistula is a track which forms between the inside of the anus and the skin on the outside. This track will continue to drain pus like material and occasionally faecal matter. Once a fistula has formed it is very unlikely to heal without treatment. The Surgeon will take a full history and carry out a clinical examination.
Usually this will involve a rigid sigmoidoscopy and sometimes a proctoscopy as well. Often if the doctor is able find the inner and outer openings of the fistula and no special investigations will be required. If it is not possible to find the fistula or if the problem is longstanding or recurrent, an MRI scan or endoanal ultrasound scan will be recommended.
Sometimes the area may be too uncomfortable to examine then the consultant may recommend carrying out an examination under anaesthetic to confirm the diagnosis, and if possible, the fistula can start to be treated at the same time. If you are over the age of 40 and have had any bleeding or change in bowel habit the consultant may recommend endoscopic examination of the bowel either by flexible sigmoidoscopy.
An anal fistula usually requires surgical treatment in order to heal. An anal fistula may often pass through the muscles surrounding the anus. These muscles are important for maintaining continence. It is very important that when fistulae are treated this muscle is not damaged excessively so that a patient has trouble controlling their bowels.
Fistula surgery can be difficult, and some patients may require repeated procedures in order to get their fistula healed.
