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Anal Fistula

Lee Surgery and Endoscopy was founded by Dr. Lee Chin Li, with the mission to deliver accessible and quality healthcare to our patients. We are committed to ensuring your comfort from consultation to procedures.

What is an anal fistula?

An anal fistula is an abnormal passageway that forms between the anal canal and the skin near the anus. It is commonly developed near your anal glands, especially in the upper part of your anus (butthole). Anal fistulas occur due to an infection (perianal abscess) in an anal gland, which causes pus to accumulate, and form a tunnel. That is why anal fistulas are also known as perianal fistulas.

Additionally, the types of anal fistulas classification are based on their location, such as:

  • Extrasphincteric fistula: an extrasphincteric fistula occurs when the infection goes around both sphincter muscles. However, this type of fistula is less common.
  • Intersphincteric anal fistula: an intersphincteric anal fistula is when the infection passes through the internal anal sphincter muscles and then goes through the space between the internal and external sphincter muscles.
  • Superficial anal fistula: a superficial anal fistula is when the infection travels from the lower part of the anal canal, below the anal glands, and through the nearby skin, thus bypassing the muscles. However, this type of fistula does not originate from the anal gland.
  • Suprasphincteric fistula: a suprasphincteric fistula occurs when the infection passes through the internal sphincter and around the external sphincter.
  • Transsphincteric fistula: a transsphincteric fistula is when the infection travels through both layers of the anal sphincter muscles.
Anal fistulas, or perianal fistulas, occur due to a collection of pus in the anal gland as a result of perianal abscess.

What causes an anal fistula?

An anal fistula typically forms as a result of an infection or inflammation in the anal or rectal area. The most common cause of an anal fistula is an anal abscess, which is a collection of pus that forms in the anal or rectal region due to infection. It occurs when an infection develops in one of the small glands lining the anal canal, leading to the formation of a pocket of pus. 

If the abscess is not treated promptly, the pus may accumulate and create pressure, causing the abscess to rupture spontaneously or require surgical drainage. When the abscess drains, it may leave behind a non healing small tunnel or tract, resulting in an anal fistula.

What are the signs of an anal fistula?

Some of the common signs of an anal fistula include:

  • Fever or chills due to pus collection
  • Itching or irritation in the anal region
  • Pain or discomfort around the anus, especially when passing motion
  • Pus drainage or foul-smelling discharge from the small opening near the anus
  • Recurrent anal abscesses
  • Swelling and redness around the anus

If you are experiencing any of these symptoms, contact Lee Surgery & Endoscopy today to schedule an appointment.

Who is at risk of an anal fistula in Singapore?

Several factors can increase the risk of developing an anal fistula. While anal fistula can affect individuals of any age, gender, or background in Singapore, certain groups may be at higher risk due to specific predisposing factors, including.

  • Inflammatory bowel diseases (IBD): conditions such as Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease (IBD) that can increase the risk of developing anal fistulas. In IBD, chronic inflammation in the digestive tract can extend to the anal region, leading to the formation of ulcers, abscesses, and fistulas.
  • History of anal trauma or injury: trauma or injury to the anorectal region, such as during childbirth, anal intercourse, or anal surgery, can increase the risk of developing anal fistulas. Traumatic injuries may create openings or tears in the anal mucosa, allowing bacteria to enter and form abscesses that may evolve into fistulas.
  • Sexually transmitted infections (STIs): individuals with STIs such as gonorrhoea, chlamydia, and herpes simplex virus (HSV) are at an increased risk of developing anal fistulas. These infections can cause inflammation and tissue damage in the anal region, increasing the risk of abscess formation and subsequent fistula development.
  • Compromised immune system: individuals with a compromised immune system are at an increased risk of developing infections which lead to anal abscesses, thus increasing the risk of developing anal fistulas.

How is anal fistula diagnosed in Singapore?

If you have a suspected anal fistula, your gastro specialist in Singapore will first evaluate your medical history and perform a physical examination. Afterwards, they may proceed with one or a combination of the following diagnostic procedures:

  • Fistulography: a fistulography may be performed to visualise the anatomy of the anal fistula. During a fistulogram, a contrast dye is injected into the fistula tract, and X-ray images are taken to identify the course and location of the fistula.
  • Imaging tests: imaging tests such as an endoscopic ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT) scans may be conducted to evaluate the anatomy of the anal fistula and assess its extent and complexity. 
  • Proctoscopy or anoscopy: a proctoscopy or anoscopy involves using a thin and flexible tube with a camera to visually inspect the inside of the rectum and anal canal for signs of inflammation, fistula openings, or other abnormalities.
fistulography singapore
A fistulography is used to identify the presence of an anal fistula.

What are the treatment options for anal fistulas in Singapore?

Once your doctor has confirmed the anal fistula diagnosis, the treatment options will depend on various factors, like the severity, location, and complexity of the fistulas. Treatment options for an anal fistula include:

  • Fistulotomy: a fistulotomy is a surgical procedure that involves cutting open the entire length of the fistula tract. This will allow it to heal from the inside out. 
  • Endorectal advancement flap: an endorectal advancement flap is when the surgeon creates a flap from the rectal wall to cover the repair of removing the fistula’s internal opening. 
  • Fistula plug: a fistula plug is a biologic or synthetic plug that can be inserted into the fistula tract to close it off and promote healing.
  • LIFT Procedure: a Ligation of The Intersphincteric Fistula Tract (LIFT) is a surgical technique that involves identifying and ligating the internal opening of the fistula tract, thereby allowing it to heal without cutting through the sphincter muscles.
  • Seton Placement: a seton is a piece of surgical thread that is placed through the fistula tract to help keep it open and draining.

Frequently asked questions

Are anal fistulas painful?

Yes, an anal fistula can have mild discomfort. Pain will be worse with concurrent abscess. Most patient will present with a small nodule near the anus with discharge.

Are anal fistulas life-threatening?

Without immediate medical attention and with recurrent abscess formation can lead to systemic infections.

Can anal fistulas recur?

Yes, anal fistulas have a tendency to recur, particularly if the underlying cause is not adequately addressed or if the initial treatment is unsuccessful. Recurrence rates for anal fistulas vary depending on various factors, including the type of fistula, the complexity of the tract, the presence of underlying conditions such as inflammatory bowel disease, and the effectiveness of the treatment approach.

Can anal fistulas go away on their own?

No, anal fistulas cannot go away without medical treatment.

Any other questions?

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