Fissures in Ano and Anal Fistulas difference and Treatment

What is An Anal Fistula?

Unlike a fissure which affects only the superficial lining, an anal fistula refers to an abnormal narrow tunnel underneath the skin’s surface. Fistulas form from infections in the anus or rectum that spread inwards to create pus-filled pockets.

Causes of Anal Fistula:

1. Infection from anal abscesses or glands
2. Repeated bouts of infections like tuberculosis
3. Inflammatory bowel diseases like Crohn’s or ulcerative colitis
4. Prior surgery around the anal or rectal region

When these infectious pockets eventually drain, a small passageway connects the infected glands from the inside to the skin of the anal opening. Over time, this forms an abnormal communication that won’t heal on its own without treatment.

Symptoms of an Anal Fistula:

1. Intense pain around the anus, especially during bowel movements
2. Blood or pus leaking from the fistula opening
3. Swelling, redness and irritation surrounding the infected area
4. Difficulty sitting or passing stool due to discomfort

Diagnosing Fissures vs. Fistulas

While certain symptoms may seem comparable at first, we analyze each patient to differentiate between an anal fissure or fistula.

To correctly diagnose the problem, we take the patient’s full medical history before a physical exam of the area. Diagnostics like an anoscopy, to confirm the findings. Treatment completely differs based on identifying whether tissues inside or out have been affected from an infection spreading inwards or trauma from the surface.

Treating Anal Fissures:

The main treatments for anal fissures aim to keep the area relaxed and promote healing.

Initial therapies often focus on lifestyle changes like:

1. Increasing fiber and water intake to prevent constipation
2. Avoiding straining during bowel movements
3. Sitting in warm water baths to encourage blood flow

We also often suggest Conservative method of Sitz bath and prescribe topical ointments or medications to relax the muscles around the anus. This increases blood flow and allows any tears to heal faster.

As a last resort, surgery might be required for chronic fissures that won’t heal. This cuts a portion of the anal muscle to reduce spasms and tension.

Treating Anal Fistulas:

To treat troubling fistulas, my goal is to first drain any infections entirely. Antibiotics or anti-inflammatory drugs help calm swelling in the initial stages.

Depending on the fistula’s location and complexity, surgical intervention is often necessary. It’s a procedure where surgeon carefully thread a tiny rubber band through the fistula passageway until it emerges out the internal opening. Tightening this seton drainage allows pus to release while the unhealthy tract heals from inside out.

For more superficial low fistulas, opening the passageway fully or stitching closed the internal opening could suffice. Unfortunately, complex high fistulas with multiple tracts reoccur commonly, occasionally requiring a diverting colostomy or muscle flap procedures.

Preventing Anal Fissures and Fistulas:

While anal disorders rarely can be fully prevented, focusing on overall health, diet, and bowel habits aid as a precaution.

Tips to lower your risks include:

1. Eating high-fiber foods and staying hydrated for easy bowel movements
2. Maintaining appropriate toilet posture and hygiene
3. Avoiding prolonged straining but letting defecation flow naturally
4. Using warm water compresses to increase blood circulation
5. Not ignoring symptoms and seeking prompt specialist care