How to Detect Fistulas - Understanding Diagnosis

What are the Best Methods for Fistula Detection?

Fistula detection involves identifying abnormal connections between organs or tissues, often requiring a combination of clinical evaluation, imaging techniques, and diagnostic tests. Early diagnosis of anal fistulas  is crucial for effective treatment and to prevent complications.

Introduction

Fistulas are extremely common in India and are usually curable with proper surgeries and medication. Understanding how to diagnose a fistula can help patients seek the correct treatment to regain health and comfort. This article will guide you with clear and accurate information regarding the symptoms, causes, diagnosis and treatments of anal fistula.  

What is a Fistula?

An anal fistula is the formation of an abnormal anal passageway inside your anus to the outer area of the skin. Most of the fistula arise due to infection in the perianal region, where the anal glands accumulate pus (an abscess) in these nearby tissues. When this abscess is drained completely, it creates a tunnel-like opening leading to the actual term fistula.

What are the Diagnostic Tests for Anal Fistula?

Doctors generally detect the fistula or abscess during a physical examination or a routine check-up. For further detailed diagnosis, they usually conduct these tests as follows:

Proctoscopy

Healthcare providers use a lighted scope (or proctoscope) to visualise the inner cavity of the anal fistula. It helps them identify or detect any infection or pus in the internal region of the anal gland. Some experts use hydrogen peroxide or a fistula probe to trace the fistula's path and identify any internal openings.  

Magnetic Resonance Imaging (MRI)

Healthcare providers can obtain detailed images of the sphincter muscles, the fistula tract, and the pelvic floor. This clear and detailed image helps them identify and map the fistula canal and allows them to treat further complications. It is affordable and can be done through routine check-ups.

Ultrasound

Doctors use high-frequency sound waves to visualise the surrounding tissues of the fistula. It is done for the initial clinical assessment of the anal fistula.

Doctors can easily map the tissues near the anal canal to check for any risk of underlying infection. Ultrasound is a cheap diagnostic test to check the anal canal properly.  

CT Fistulogram

A CT fistulogram is a medical imaging procedure to visualise fistulas near the anal area. This method helps medical experts determine the location, shape, size and complexity of fistula disease. In addition, it aids in diagnosis and treatment to prevent further complications.

Ultrasound Endoscopy

It is a combination of endoscopy and ultrasonography to visualise the anal fistula and surrounding tissues. This method is useful for assessing the depth and extent of the fistula. Surgeons use this procedure to guide surgery methods to treat fistula complications.

What are the Treatments For Fistula?

There are various procedures to treat fistula, but the best option depends on the position of the fistula, that is, whether it is single or has formed multiple branches within the perianal area.

Let us discuss some of the treatment procedures for anal fistula:

Fistulotomy

It is one of the most common types of anal fistula surgery. Doctors cut the entire length of the fistula to open it up completely. The treatment will gradually heal in the form of a flat scar.

Seton Techniques

Surgeons insert these setons or surgical threads through the canal or anal sphincter muscle for several weeks to keep it open. It enables the draining out of the pus and leads to a healing process without any surgery of the anal area. It does not provide permanent solutions but is used when fistulotomy is not required to treat the fistula disease.

Flap Procedure

Doctors consider this if the fistula passes through the anal sphincter muscle, as undergoing a fistulotomy can cause a higher risk of incontinence. In this method, doctors take a small portion of the flap tissue from the inner cavity and cover the hole after dissecting the fistula opening. It has a lower success rate than fistulotomy but does not require the cutting of the sphincter muscle.   

LIFT

Litigation of the intersphincteric fistula tract (LIFT) procedure is a treatment for fistulas that passes through the anal sphincter muscles, where it is too risky to perform a fistulotomy. A surgeon cuts the fistula to remove the sphincter muscles. The fistula is sealed from both ends and cut open to lie flat on the surface. It shows prominent results, but the solution is temporary and requires further investigation.

Endoscopic Ablation

A doctor inserts an endoscope, a small tube with a camera, into the fistula. The doctor then seals the fistula tube with an electrode. It is a convenient practice and shows positive results.

Laser Surgery

This method is also known as radially emitting laser fibre treatment. In this method, healthcare providers use a small laser beam to seal the entire fistula. This procedure is uncertain and does not have any safety concerns. Laser ablation uses targeted heat to seal fistula tracts. While minimally invasive, success rates vary (50-80%) based on complexity.

What are the Risks of Anal Fistula Surgery?

Like any type of surgical treatment, anal fistula surgery have certain risks including:

• Infection in immunocompromised patients.
• Recurrence of the fistula even after undergoing the surgery.
• Bowel incontinence is one of the most common potential risks after a fistula surgery.

Final Takeaway

If you are suffering from severe anal pain, it is crucial to consult a healthcare provider. They will guide you on how to treat and prevent anal fistula to prevent any future complications.

Fistulas can be common and familiar, but are not always painful. If the pain continues for a while, it is better to consult a specialist for further treatment methods.