Symptoms such as pain, blood, and discomfort around the anus will create difficulties in performing daily tasks. These two diseases can be responsible for the above symptoms, which include anal fissure and anal fistula. Though they occur in the same place, their causes, complications, and mode of treatment differ.
Some anal fissures respond to dietary and drug treatment, while anal fistulas need surgical intervention for recovery. The above information enables patients to determine when professional help is needed.
Patients should seek advice from a colorectal surgeon when the symptoms do not go away or there are infections that keep recurring.
This guide provides information on the causes, early symptoms, mode of detection and possible treatments of anal fissure and fistulas. It also includes some questions that patients can ask Dr. Rajeev Singh at the time of a medical appointment.
Understanding Anal Fissures and Anal Fistulas
An anal fissure and fistula are different medical problems, although both involve the skin around the anus.
What is an Anal Fissure?
An anal fissure is a tear in the membrane lining the anus. It results from passing hard or large stool, leading to stretching of the delicate tissues.
Common causes of this condition include:
- Constipation and straining.
- Hard or large stool.
- Diarrhoea.
- Damage during child birth.
- Inflammatory bowel diseases.
Common symptoms associated with this problem include:
- Sharp pain while defecating.
- Burning sensation after defecation.
- Small amount of fresh blood in the stool.
- Any fissure lasting more than six weeks is classified as chronic.
What Is an Anal Fistula?
An anal fistula refers to an abnormal connection between the lining of the anal canal and the skin around the anus.
The condition is caused by an infection, forming an abscess, which is basically a pocket containing pus. Even after the abscess bursts and pus comes out, there can be tunnels remaining.
Symptoms include:
- Inflammation around the anus.
- Discharge of pus from the skin opening.
- Continuous irritation or pain.
- Pain during seating and passing of stools.
- Formation of abscesses.
Anal fistulas, unlike most fissures, do not heal without a procedure.
When Does an Anal Fissure Need Specialist Treatment?
Conservative methods of treatment work well in many cases of newly developed anal fissures, especially when constipation issues are considered.
Treatment for new anal fissures includes:
- Diet high in fiber intake.
- Consuming enough fluids.
- Administration of stool softeners as prescribed by a physician.
- Sitz baths with warm water.
- Topical medications prescribed by the doctor.
When Is Surgery Considered?
Surgical or procedural therapy is considered by a physician when:
- The fissure fails to heal even after receiving proper medications.
- Pain persists or keeps coming back.
- The fissure becomes chronic.
- Tension within the sphincter muscle causes problems with healing.
- Symptoms impact daily routines.
Lateral internal sphincterotomy is one such surgery in which a small part of the sphincter muscle is cut to reduce pressure.
Though this is an effective therapy for certain chronic fissures, there are complications associated with this, too.
When Does an Anal Fistula Require Surgery?
For most patients, surgical intervention is necessary since the abnormal channel does not heal with medications alone.
Antibiotics can be used to manage infections that occur, but will not close the fistula.
The type of fistula treatment to be used depends on the location, complexity, and association of the fistula with the muscles responsible for controlling the passage of stool from the bowels.
Surgical Treatments for Fistula
Fistulotomy: The surgeon cuts the fistula tract in order to promote healing. Suitable for some simple fistulas where little sphincter muscle is involved.
Seton procedure: Insertion of a surgical thread into the fistula in order to promote drainage or staged treatment.
LIFT procedure: Closing of the fistula tract between the sphincters while trying to preserve muscle function.
Flap advancement: Advancement of healthy tissue to cover the internal opening of the fistula.
Some centers offer laser treatments for the fistula, depending on patient suitability.
Bowel control needs to be protected when considering fistula surgery.
How Does a Colorectal Surgeon Diagnose These Conditions?
The colorectal surgeon looks at the symptoms, history and physical findings to differentiate between fissures, fistulas, abscesses and other anorectal diseases.
The diagnostic process will involve:
- Physical examination: To look for a fissure or opening of external fistula.
- Digital rectal examination: If required and feasible.
- Anoscopy: To investigate the anus canal with an instrument.
- MRI scanning: To study the complex tract of the fistula and also any accompanying abscess.
- Investigation under general anesthesia: When thorough examination is not possible comfortably.
All patients don’t need tests or invasive examination.
Those who visit Dr. Rajeev Singh can discuss their need for investigations and treatment options.
Recovery After Fissure and Fistula Treatment
The recovery time will depend on each individual situation.
Post-surgical recovery for fissure can be relatively quick, with relief from pain, but it could take weeks for total healing of the wound.
Fistula recovery will be slow and, in most cases, more than just one surgery may be required.
Preventive Measures During Recovery Period
Patients should be instructed to:
- Ensure soft stools by fibre, water and prescribed medications.
- Maintain hygiene of the anus.
- Take sitz bath as per recommendations.
- Have pain killers as per doctors’ instructions.
- Strain less while passing stools.
- Visit their doctors for further checkup.
Some amount of wound drainage is expected after fistula surgery. But pain, fever, bleeding and increased swelling must be evaluated by a doctor.
Can Anal Fissures and Fistulas Be Prevented?
Though not all cases can be prevented, maintaining good bowel practices could help lessen some risk factors.
The following are recommended methods:
- Eat more vegetables, fruits, and whole grain products.
- Ensure adequate water intake.
- Avoid straining for long periods of time.
- Act on the need to defecate.
- Handle chronic constipation and diarrhoea effectively.
- Consult a doctor regarding painful swellings in the anus or possible infection.
They are especially effective in preventing fissures from constipation.
Nonetheless, fistulas could arise due to infections and inflammation despite proper hygiene practices.
When Should You Consult a Doctor?
Consultation with a doctor is advised in case any of the above mentioned problems continue to occur or keep coming back.
In the following cases one should consult a professional:
- Pain while defecating.
- Bleeding around the anus.
- Pus or other discharge.
- Painful swelling in the area.
- No improvement of symptoms after initial treatment.
- Difficulty in sitting and performing daily activities.
In case of increased fever, severe swelling, rapidly spreading redness, or significant bleeding – seek immediate medical help.
Frequently Asked Questions
1. Is an anal fissure operable?
Yes. Some anal fissures heal spontaneously due to improved bowel practices, prescribed medicine, and methods of minimizing constipation.
2. Is an anal fistula curable by just using antibiotics?
Normally not. Antibiotics may be used in some cases for treating infections associated with it, but still, a surgical procedure is needed.
3. Is a fistula operation painful?
A procedure of anaesthetization is helpful in minimizing pain at the time of the operation.
4. Does anal fistula recur after surgery?
Yes. Fistula recurrence is always a possibility due to various factors such as presence of infections or complex tract.
5. Are anal fissures and piles the same thing?
No. Anal fissure refers to a tear while piles refer to inflamed blood vessels.
Conclusion
The signs and symptoms of anal fissures and anal fistulas can be similar, although the approach to treatment is quite different in these two conditions. While most fissures will resolve through conservative treatment, many fistulas usually need procedure or surgical treatment.
A colon rectal specialist can help diagnose the symptoms, determine the nature of the problem, and recommend a proper way forward regarding the treatment.
Those interested in having anal fissure surgery or fistula surgery can contact Dr. Rajeev Singh for further information on their available options.
