Anal fistula can be explained as an abnormal connection between the inner surface of the anus and the skin outside the anus. Anal fistula, which can only be in the form of a single channel, can sometimes appear in the form of several different channels. It should be noted that the places where the channels pass and the regions where they occur are extremely important in anal fistula. There are vitally important muscles in this region. Therefore, it is extremely important to what extent these muscles are affected by the fistula.

In case of fistula formation, a continuous discharge of inflammation may occur. Although it is expected that this problem will resolve on its own in most cases, it should be noted that it is an extremely low possibility of self-resolving. For this reason, it is absolutely necessary to diagnose and treat as soon as possible. We will explain in detail how the treatment is done, how it is diagnosed and the symptoms of this ailment. But first, let’s give the answer to the question of what fissure and fistula are.

What is Fissure and Fistula?

Fissure and fistula are diseases that are often confused because their pronunciations are similar. Although these two disorders occur in the same region, they are very different diseases. Anal fissure, with its most general definition, is cracks that occur due to the strain of the anal canal (torn in the breech). Due to deep cracks in the skin, the muscles in the last part of the large intestine may also be exposed. This discomfort is more common in those with hemorrhoids or long-term constipation problems. Symptoms can be listed as pain, bleeding, itching and swelling. The most common of these symptoms is pain during defecation. This pain is caused by muscle contraction. The ailment in question is considered in two different groups as acute and chronic.

On the other hand, anal fistula occurs due to inflammation in the breech region, as we mentioned before, and the patient experiences pain as a result of an abscess in the breech region. In time, this abscess is emptied and the patient is relieved, but it is the first symptom of fistula in the future. It manifests itself in the form of channels or holes that occur just outside the breech area. Cracks may also occur in this area and infection may develop. This can lead to abscess. It can often be diagnosed with a simple examination. Therefore, it would be beneficial for patients to consult their doctor immediately if they notice some abnormal conditions.

Anal fissure and fistula are different diseases. Therefore, their treatments are applied with different procedures. There is only one connection between them, which is that they both have breech region disease.

Anal Fistula Causes

Patients also wonder why they have such a problem. We can say that the most common cause of anal fistula is inflammation of the glands located in the anus, under the skin and between the muscles. In general, the causes of anal fistula can be listed as follows:

  • Presence of acute diarrheal attacks
  • Traumas caused by reasons such as foreign body or hard defecation
  • Inflamed anal fissures
  • Inflamed anal hematomas
  • Intestinal parasites
  • Pinworms in the anus
  • Ulcerative colitis problem
  • Tuberculosis
  • Intestinal fungi
  • Cancer
  • Inflammation of the lower abdominal region
  • Infections in the genital area
  • Crohn’s inflammation
  • Diverticulitis is inflammation of the small pouches in the intestine
  • Tuberculosis
  • Surgery should not be performed in chron and ulcerative colitis, which are intestinal inflammations, because the fistula reoccurs even if the underlying disease is not cured.

Anal Fistula Symptoms

The symptoms that occur in the case of anal fistula may not be the same in every patient. We can list these symptoms as follows:

  • Swelling in and around the breech
  • Pain in the anus
  • Itching and burning in the anus
  • Difficulty in sitting
  • Redness in and around the anus
  • A feeling of fullness from the anus
  • Having a foul-smelling and sometimes bloody discharge around the breech
  • High fever
  • Pain when urinating
  • Constipation
  • Yellow stains on underwear

If any of these symptoms occur, it is necessary to consult a doctor. Because the situations listed above are not considered medically normal. Therefore, patients should consult a doctor with the thought that they have a health problem. In this way, the necessary research can be done as soon as possible, the diagnosis is made and the treatment is started.

How Is It Diagnosed?

Further investigations are not required to diagnose this health problem. We can say that it is a disease that can often be diagnosed with an examination. Some imaging studies are also needed to make a diagnosis only in cases where the flow is stopped or the fistula hole remains in the anus. In this way, a much healthier diagnosis can be made.

Preferred tests for diagnosis are mostly MRI and colonoscopy. With the help of MRI and colonoscopy, the extent of the spread of the patient can be determined. In addition, it is possible to determine where the path of the fistula goes and whether there is an abscess focus. We can say that MRI and colonoscopy are imaging tests that can determine whether the fistula has developed due to a different disease. However, not every patient necessarily needs a colonoscopy. In the case of a simple fistula, only the examination may be sufficient for the diagnosis. However, it should be noted that more reliable data can be obtained with colonoscopy in case of recurrence of this problem or when there is a suspicion of a different underlying disease.

Types of Anal Fistula

In fact, fistula types are very important only for the doctor who will operate.

  1.  Transsphenteric Fistula
  2.  Suprasphenteric Fistula
  3.  Estrasphenteric Fistula
  4.  Intersphenteric Fistula

How Is It Treated?

First of all, we can say that most of the patients expect the anal fistula to go away on its own. However, this happens extremely rarely. As there is often no self-healing, treatment is definitely needed as soon as possible. Waiting for it to pass on its own is a futile wait. It both wastes time for the patient and leads to further progression of the disease. Even more important is the risk of triggering skin cancer in this area if the fistula progresses.

The treatment can be done by compulsory surgical intervention. Antibiotic therapy can also be applied to support surgical intervention. However, it should be noted that treatment is not possible with the use of drugs alone. In surgical intervention, long channels called “fistula tract” with inflammation in them should be opened. Then these channels need to be cleaned by scraping. Of course, anal sphincters can also be affected by this surgical intervention. For this reason, an experienced surgeon should be preferred.

In some patients, we can say that the fistula is very long. In such cases, a complicated surgical intervention is required. Mostly, techniques such as mucosal advancement flaps, late fistulotomy and seton application are preferred.

Let us also convey the information that the operation is performed under general anesthesia. Therefore, pain is never felt during anal fistula surgery. Only a slight pain may be felt after the procedure. In this case, you can use the painkillers prescribed by your doctor for you. In this way, it will be very easy to control the pain and the recovery period of the patient will be completed in a more comfortable way.

Anal Fistula Surgical Treatment

Medical treatment of perianal fistula with medication is currently not possible.


If the fistula contains a small part of the breech-squeezing muscles, it is surgery.

This surgery is cut wide from the hole outside the breech and removed as a hole up to the inner mouth in the breech (anal canal). As a result, a new tunnel is created and the tunnel heals and closes on its own.

2- Fistulectomy

It is done in simpler fistulas. The breech (anal canal) and the fistula canal outside the breech are opened from the top and the wound is left open. The success rate is high.

3- Fibrin adhesives

The fistula tract (fistula tube) is put into it with a special adhesive and the fistula tract is closed. The success rate is low.

4- Laser treatment

The tip of the laser tool is taken to the end of the fistula tract, burned with the help of laser, and the fistula is closed with the help of laser.

5-What is the Seton Technique? What Does It Do?

This technique is applied in the form of passing a medical rope between the mouths of the fistula in the intestine and the skin and tying it. Over time, this rope is narrowed and it is aimed to gradually cut the external breech muscle. We can say that the success rate of the method in question varies between 80% and 100%. You can write your questions about the subject in the comment section.

The chance of recurrence is high in all surgical treatments.

Why does it recur after anal fistula surgeries?

The biggest reason for this is the experience of the surgeon. Recurrence rates are very high in fistula surgeries. If they do not have a good surgery, they will face bigger problems than recurrence. If the muscles that contract the anus are cut during the surgery, the patient cannot hold the toilet. For this reason, it should be thoroughly investigated before performing fistula surgery.