Anal fistula

What is an anal fistula?

Inside the anus glands are located ( proctodeal glands ), which may inflame spontaneously without external reasons , by no means plays a lack of or improper hygiene a role. If there is an inflammation of this gland a passage develops to the outside (fistula). An abscess develops in the process which is a painful swelling. . Bursts this abscess, a connection from the inside to the outside is completed, and a anal fistula has developed.

How is an anal fistula diagnosed?
The patient often notices the appearance of pimples in the anal region which become more noticeable due to repeated swelling, purulent discharge and intermittent pain. The doctor asks for relevant symptoms and then examined in lithotomy position (such as at a gynecologist) on external signs of an anal fistula  This opening may be examined under circumstances with a very fine tube.

The sphincter is examined on inflammation digitally (with a finger ). Then a proctoscopy is done (mirroring the inner anus), which is not more unpleasant than the examination with the finger. After completing the short inspection which is far less unpleasant than assumed by the patient ,a definite diagnosis can usually be made .  A therapy plan is developed and discussed with the patient  Very rarely elaborate instrumental tests such as an ultrasound or an MRI are required.

What kind of anal fistulas exist?


Most anal fistulas pass through the sphincter and can damage it. Luckily take 80 % of these fistulas a more superficial course. The course of the fistula tracts in relation to the sphincter is decisive for the classification and therapy planning of an anal fistula..

A distinction is made in :

sub mucosal fistulas ( the paths run under the skin)
inter sphincter  anal fistulas ( the paths run between the inner and outer sphincter )
trans sphincter anal fistulas ( the corridors traverse both sphincter shares )
supra sphincter anal fistulas ( the paths run between sphincter and pelvic floor muscles )
extern sphincter anal fistulas ( the paths run outside of the sphincters , and have their
origin only exceptionally in a proctodeal gland )