Rectal Fistula: Symptoms, Diagnosis and Treatment

A rectal fistula occurs when an infected tunnel appears between the skin and the anus. Most rectal fistulas occur after an infection in an anal gland. This forms an abscess, and then it drains through the skin and creates the tunnel. Some diseases can also cause rectal fistulas. They can be painful and often require surgery.

Causes of Rectal Fistula

Infections and abscesses usually cause rectal fistulas. They can sometimes form after surgeries and are often linked to Crohn’s disease and inflammatory bowel disease. Rectal cancer and diverticulitis can also lead to rectal fistulas.

Symptoms of Rectal Fistula

The symptoms of rectal fistulas can vary from person to person. Some people experience severe symptoms, and others don’t even know they have them until they are accidentally found during an exam or procedure. Some of the most common symptoms experienced include:

• Rectal pain
• Pain when sitting down
• Throbbing feeling in the anus
• Skin irritation around the anus
• Swelling, redness, and tenderness around the anus
• Blood
• Discharge
• Fever
• Constipation
• Painful bowel movements
• Pressure around the anus

Diagnosis of Rectal Fistula

A doctor diagnoses rectal fistulas, usually after a patient complains of symptoms. Sometimes, doctors might find fistulas while they are checking for STDs or conducting colonoscopies to check for cancer. Doctors can diagnose rectal fistulas with a simple digital examination and might order a colonoscopy if they believe there might be other issues, as well. Doctors might also use MRIs, ultrasounds, and CT scans to find or diagnose fistulas.

Treatment of Rectal Fistula

There are several treatment options that can be used to treat rectal fistulas. The type of treatment depends on the location of the fistula and the patient’s overall health. Some of the most common treatment options include,

• Fistulotomy: This is the most common procedure used to treat rectal fistulas. The doctor makes a cut along the entire fistula and drains the abscess.
• Seton Techniques: This involves leaving a piece of string in the fissure to keep it from closing or growing larger. It also helps with incontinence associated with the fistula.
• Flap Procedure: When the rectal fistula is complex, a flap procedure can be done. The flap is cut open, the fistula is drained, and the flap is reattached over the cut.
• Fibrin Glue: This is a nonsurgical option that involves filling the fistula with glue and then sealing the opening. This prevents the fistula from filling with infection.
• Plugs: Small plugs made from human tissue are inserted into the opening of the fistula and are stitched into place. This helps seal it and prevents it from filling with fluid or becoming infected.
• Preventative Care: Doctors will work with patients to determine the cause of their rectal fistulas and try to prevent more from occurring. Doctors also work to find underlying causes and treat them to help prevent fistulas from reforming.

Prognosis of Rectal Fistula

Prognosis is good for patients who find a suitable treatment method. Most people who suffer from a rectal fistula will experience more, even after the first one has been treated. Sometimes, the same fistula can reopen and will need to be sealed again.

Additional Resources:

• https://www.fascrs.org
• https://gi.org/