Perianal Fistula

Fistulas are channels formed between two independent structures. Perianal fistulas formed around the anus are channels that should not actually exist between the skin around the anus and the intestine inside the anus. There are tiny glands in the anus that make it slippery, especially during defecation. The mouths of these glands that secrete can sometimes become blocked, where infection and abscess occur. Sometimes, in cases such as obesity, sitting for a long time, insufficient cleaning after toilet, the hair follicles around the anus become inflamed and form abscesses. When these abscesses are not evacuated in the early period, they grow by including the surrounding tissues or drain by opening into or out of the anus. When this abscess focus heals, it leaves a channel between the inside of the anus and the surrounding skin tissue.

What are the Symptoms of Perianal (Rectal Circumference) Fistula?

When abscess occurs, severe pain and discharge occurs in this area. However, sometimes without creating such a noisy picture, it shows itself like a pimple around the anus. When it is plastered, stool or a bloody inflamed fluid may come from this canal opening. These fistulas cannot heal spontaneously, they must be treated surgically. In particular, it is necessary to investigate the reasons for its occurrence. Usually they tend to recur when seen with intestinal diseases such as Crohn’s disease.

How is the Diagnosis Made in Perianal (Rectal Circumference) Fistulas?

In perianal fistulas, there are a number of diagnostic steps that must be done after the outer mouth is detected. Finding the inner mouth of these fistulas and the route they follow in the anus wall is very important and determines the treatment method to be applied. First of all, it is tried to determine the location of the inner mouth with a device that shows an area of 10 cm inside the anus, which we call a finger examination and anoscope, because 20% of these fistulas are simple fistulas and can be easily treated. Fistulography, which used to be a method used to shoot films by giving drugs from the outer mouth of the canal, is now being gradually abandoned due to the fact that the fistula does not determine the path followed by it and the margin of error is high. The safest method for today is to determine the path of the fistula and the location of the inner mouth by MRI and to plan the treatment accordingly.

How is the Treatment Done in Perianal (Rectal Circumference) Fistulas?

If the perianal fistula is detected as a simple fistula in the MRI examination, it is easy to treat and the fistula canal is opened by surgery. In up to 60% of patients, the fistula passes through or between the muscles that allow us to hold our stool, in which case an additional process called seton should be added to the disruption of the fistula canal. In 20% of the patients, the inner mouth of the fistula has extended up to the large intestine. In this patient group, treatment is much more difficult and larger surgical procedures may be required.

Recently, laser treatment models have been used in perianal fistula patients. These treatment models are based on the principle of burning the inside of the canal with laser after the patient has had the infection in the fistula. Although it is much more comfortable for the patient compared to surgical treatment, its use is limited. Since the burned fistula passes through the intra-anus muscles, serious strictures in the anal exit and revision operations may be required after recovery.

How is Postoperative Recovery in Perianal (Rectal Circumference) Fistulas?

Fistula surgery is one of the most unpleasant topics of general surgery. Postoperative 4-6 weeks of follow-up and recovery period are required. During this period, attention should be paid to the hygiene of the anus area, and attention should be paid to prevent recurrence of the infection with applications such as shower and sit-bath during the day.