Fistula is an abnormal formation of connection or hollow tract between the external opening on the skin and anal canal. There are different types of fistulas and are intersphincteric fistula, trans-sphincteric fistula, supra-sphincteric, and extra-sphincteric. The occurrence of supra-sphincteric fistula and extra-sphincteric fistula is rare but these are associated with a high risk of complications and recurrence.
What are the causes & symptoms of Fistula?
Regardless of age and gender, anyone can get affected by a fistula. A few of the reasons or causes of fistula are abdominal injury or trauma, overweight [obese], and inflammatory bowel disease, anorectal cancer, radiation treatment for cancer, diverticulitis [disease that forms small pouches in the intestine and become inflammed], and tuberculosis, etc.
Individuals with any of the above conditions should follow all the instructions suggested by the doctor to reduce the chances of occurrence of a fistula. However, any individual with fistula can suffer from symptoms like
- Smelly discharge from the anus
- Severe pain in the anal region
- Bleeding with poop
- Irritation of skin around the anus
- Intense and severe abdominal pain
- Pain while urinating
Contact the best fistula surgeon or doctor to get diagnosed and treated for fistula. Fistulas are not curable or treatable on their own and would require surgical intervention. If fistulas are diagnosed in the early stage, then lifestyle modification and diet changes along with the usage of antibiotics can reduce the effects of fistula and can delay its progress. In case fistulas become severe and are not treatable with medications, surgery is the best and safest way to get rid of fistulas.
Factors that increase the risk of recurrence of fistula:
Successful fistula surgery is defined as complete healing of the anal wound without any external or internal openings along with no perianal discharge. In any case, if the fistula reappears after complete healing of the surgical wound within one year after the surgery is known as recurrence of fistula.
Several risk factors can be responsible for the recurrence of fistula and a few of them are:
- Type of fistula:
The type of fistula and its anatomy can predict the onset of the recurrence of fistula even before the surgery. Trans-sphincteric, supra-sphincteric, and extra-sphincteric fistulas are more complex and difficult to eradicate than simple intersphincteric fistulas.
- Anatomy of fistula:
The nature of the primary tract also plays a role in the recurrence of the fistula. Curved tracts such as horse-shoe and semi-horse shoe fistulas are typically more difficult to excise or lay open. A single fistula tract is easier to deal with than secondary extensions.
- Pathology of fistula:
Pathology of fistula can determine the outcomes of surgery and treatment. If fistula occurs as a secondary to a specific disease such as Crohn’s disease, then there is a high chance for the recurrence of fistula after the surgical treatment.
- Medical comorbidities:
The medical comorbidities of the patient, namely diabetes mellitus, also contribute to the failure of healing after anal fistula surgery owing to the delayed healing and weak tissue immunity caused by the disease.
- Previous fistula surgery:
Individuals with a history of previous fistula surgery are typically at higher risk to experience recurrence of anal fistula.
Using immunosuppressive drugs and steroids to treat anal fistulas that are secondary to chron’s diseases can impair the healing process after the surgery. This results in persistence and recurrence of the fistula. So, before using any medications, discuss with your doctor, and follow all the instructions.
- Experience of the surgeon:
As discussed, several factors can increase the risk of recurrence of fistula and amongst those, the experience of surgeons along with some technical considerations is the primary factor.
- Selection of surgery:
The selection of surgery according to the type and nature of fistula is important for the successful treatment of fistula. Performing a simple lay-open surgery for a complex fistula results in the failure of healing the fistula tract and leads to fistula recurrence.
- Identifying the opening of fistula:
Identifying the openings is a crucial step in fistula surgery. Failing to do so can lead twenty  times more likely to recur the fistula. Furthermore, this can cause a possibility of creating a false tract which leads to secondary fistula surgery.
- Improper excision of fistula tracts:
The primary tract of the fistula should be completely exterminated either by lay open, excision or using a laser. Correspondingly, any secondary branches or expansions should be destroyed as well. Any associated abscess cavities should be well-drained. Missing secondary tracts or abscess cavities are correlated with a three to fivefold higher risk of recurrence of fistula.
- Unhygienic wound care:
To achieve a successful outcome of fistula surgery, wound care is important. Caring wound helps in achieving a complete heal of the wound and reduces complications. Failure to maintain adequate hygiene of the anal wound may end with a persistent or recurrent anal fistula.
Fistula is a medical condition that is with a high risk of complications and recurrence. Many risk factors could increase the risk of recurrence of fistula following a fistula surgery. By choosing a well-experienced surgeon, maintaining hygienic wound care, and following all the instructions provided by the surgeon and doctor can reduce the risk of recurrence of fistula.