How is anal fistula treated in Singapore?

Doctor's Answers 3

What is an anal fistula?

Anal fistula is a chronic abnormal communication between the anal canal and the skin around the anus. There is usually an internal opening in the anus, and an external opening in the perianal skin, and a "tunnel" which connects these two openings. Because this tunnel has an epithelialised wall, it does not heal by itself and can cause persistent perianal discharge, recurrent perianal abscesses and even perianal cancer in the longer term.

Treatment of anal fistula

The most common treatment for anal fistula is surgery. Your surgeon can perform a Fistulotomy -- surgery to open up the tunnel tract to allow it to heal by itself, or a Fistulectomy -- which is surgery to remove the fistula tract. These wounds may take a few weeks to heal completely but are usually quite comfortable with only minimal perianal discomfort in the healing period.

Other treatments include

  1. Insertion of Seton
  2. Advancement flap surgery
  3. LIFT (Ligation of Intersphincteric Fistula Tract)
  4. Fibrin glue treatment
  5. Video-assisted Anal Fistula Treatment

The appropriate treatment can be advised by your surgeon, and also depends on how deep the internal opening of the fistula tract is, and how much of the anal muscles are involved.

An anal fistula is an abnormal tunnel connecting the anal canal with the skin in your buttock beside the anus. It usually arises from an infection of an anal gland that burst into your buttock skin. If someone has an anal abscess, antibiotics may help to prevent it from becoming an anal fistula. However, once an anal fistula is formed, surgery will be required to cure the patient.

There are many surgical techniques available and an overview can be found in the link below [1]. The aim of surgery is to remove the infection but maintain anal continence at the same time while trying to cure the patient. I usually discuss all the various options of treatment with the patient and explain the process, success rate and complication rate of each approach. That is individualised to each patient as the fistula tract can be different between patients.

In my experience, about 90% of anal fistulas are the simple types which can be treated with a single surgery and has a low risk of recurrence and negligible risk of anal incontinence. I tend to use a combination of different surgical techniques for complex fistula as each surgical technique has its strength and weakness. The surgeon must have a good grasp of all the techniques to find the best solution for each patient. In my experience, patients with complex fistulas can be cured but may need more than one surgery or longer time for recovery.


References:

1. Dr Lim Jit Fong. Perianal abscess and Anal Fistula, Singapore - Lim Jit Fong Colorectal Centre. Colorectal-surgery.com.sg. http://www.colorectal-surgery.com.sg/medi_page/site_web_ljf/common_page.asp?pg=12. Published 2011. Accessed January 17, 2020. ‌

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Dr Chong Choon Seng

Colorectal Surgeon

Hi there,

There are many ways to deal with anal fistula and it depends on the type of fistula and the cause as well. In short, most fistulas are able to be adequately treated by a simple surgery called fistulotomy. However, there is a need to see a doctor for an accurate diagnosis and pre-operative investigations before the treatment can be individualised.

Similar Questions

Do I need a colonoscopy for tailbone and anal pain to rule out cancer?

Hi, The description of your symptoms appear to be proctalgia ani. While it literally translate to "pain in your anus", the persistence of your symptoms warrants a physical examination by a doctor. The causes can range anywhere from an anal fissure (tear in your anus), to deep anal infections, to referred pain from somewhere else e. g. coccydynia / pelvic floor strain (from your weight lifting), and stress.

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Dr Jason Lim

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What tests can help to distinguish between a pile, abscess or fistula?

A painful lump in the anus can be due to piles, abscess or even anal fissure. The most important assessment is by examination of the anus and rectum. This is performed in the clinic with digital rectal exam (using a finger) as well as inserting a short anal probe (less than 7cm deep) to see the inside of the anus. This should be sufficient to confirm the diagnosis. In rare circumstances, if the clinical exam is not able to confirm the diagnosis, your doctor may request for an ultrasound or MRI.

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