An anorectal fistula is an abnormal condition where a person develops a passageway from their anus to the skin surface surrounding the anus or other pelvic organs. It can be caused by conditions such as Crohn’s disease, diverticulitis, or tuberculosis, and can be treated with surgical or nonsurgical options. Pilonidal cysts share some symptoms but are unrelated.
An anorectal fistula, also called a fistula in the anus, is an abnormal condition in which a person develops a passageway from their anus to the skin surface surrounding the anus. Alternatively, an anorectal fistula can travel from the anal canal to the vagina, intestines, liver or other pelvic organs. The condition is more common in people with conditions such as Crohn’s disease, diverticulitis, or tuberculosis; it can also present as a birth defect in newborns or be caused by an injury to the anus. One of the main causes of an anorectal fistula is an anorectal abscess.
If an anorectal abscess is opened through surgery, an anorectal fistula can develop. Similarly, anorectal fistulas can occur if an anorectal abscess has drained spontaneously. In either case, the abscess is typically formed from blocked anal glands that are unable to drain properly into the anal canal.
Anorectal fistulas can be painful, but are not commonly life-threatening. They may be accompanied by symptoms of itching, pus secretion and a visible opening in the perianal skin. In some cases, stool may be diverted from the anus to the fistula opening. Anorectal fistulas are more common in people with cancer, Crohn’s disease, or diverticulitis.
Treatment for anorectal fistula typically includes surgical and nonsurgical options. Anorectal fistula repair surgery involves cutting the fistula open and either removing the entire fistula tract or removing only the tissue lining the fistula tract. A sharp seton, a long tube, may also be inserted to slowly cut the fistula over time. With surgical treatment, scarring is common. Bowel incontinence can occur if the sphincter muscle has been damaged sufficiently, and flatus incontinence can also develop.
Nonsurgical repair of anorectal fistula may include the use of biologic plugs or fibrin glue. These treatments try to heal the fistula from the inside out by plugging the passage with a sterile biodegradable substance. Alternatively, a drain can be used to drain the pus. This final option is unlikely to cure the fistula, but it may provide some relief.
Pilonidal cysts are unrelated to anorectal fistulas, but share some of the same symptoms. Pilonidal cysts can be caused when the area surrounding an ingrown hair in the cleft between the buttocks becomes infected. Pain, redness, and pus drainage may appear at the infected site. Several factors can contribute to the development of pilonidal cysts. Doctors advise people prone to developing this condition to remove excess hair from the area and maintain a healthy weight.
A doctor is able to diagnose whether a patient has a pilonidal cyst or anorectal fistula and prescribe the appropriate treatment. Doctors may prescribe pain medication or antibiotics for both conditions. While often not necessary, these medications can help relieve symptoms.
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