Anal Fistula (Bhagandar): Symptoms, Causes and Surgical Treatment

Anal fistula, or bhagandar, is a small tunnel that forms between the inside of the anus and the skin around it. Many people live with discharge and pain for months because they are too embarrassed to see a doctor. The problem usually doesn't go away by itself, but it can be treated.

What is an anal fistula?

Inside the anus there are tiny glands. If one gets blocked and infected, it can form a pocket of pus called an abscess. When the abscess bursts or is drained, a tunnel may remain, connecting the gland to the skin. That tunnel is the fistula. It keeps leaking because the infection never fully clears.

What does it look like?

Often you will see a small opening, like a pimple or a boil, on the skin near the anus. It may leak pus, blood or fluid, and then seem to heal for a while before coming back. The skin around it may be red, swollen and tender. A doctor can find the inner opening only by examination, and sometimes by scans.

Symptoms

• A boil or opening near the anus that keeps draining pus or blood

• Pain and swelling that get worse when you sit, move or pass stool, then ease when it drains

• Skin irritation and itching around the anus

• Bad-smelling discharge

• Fever and chills when an abscess forms

• Repeated "boils" in the same area

Causes

• An infected anal gland that forms an abscess (the most common cause)

• Crohn's disease and other bowel conditions

• Tuberculosis, in some cases

• Injury, earlier anal surgery or childbirth tears

• Long-term infection or, rarely, a tumour

It is not caused by spicy food, sitting too long or poor hygiene alone.

Types of anal fistula

Fistulas are described by how they run in relation to the anal muscles (the sphincter). Simple, low fistulas pass through a small part of the muscle. Complex or high fistulas pass through more of it, can have several tunnels, and need careful planning because the muscle controls bowel control.

How it is diagnosed

The surgeon examines the area and may use a probe or small scope. An MRI of the pelvis (fistulogram or MRI fistula) is often used to map complex fistulas. Sometimes a colonoscopy is done to rule out bowel disease.

Treatment

A fistula needs a procedure. Medicines, ointments and antibiotics can ease the pain and treat an abscess, but they can't close the tunnel. The type of surgery depends on where the tunnel runs.

• Fistulotomy: the tunnel is opened and left to heal from the inside out. It works well for simple, low fistulas.

• Seton: a thin thread or band is placed through the tunnel to drain it and slowly guide healing. It is often used in high or complex fistulas to protect the muscle.

• LIFT: the tunnel is tied off between the muscles and removed, so the muscle stays intact

• Advancement flap: the inner opening is closed with a flap of healthy tissue

• Laser, glue or plug: newer options for selected fistulas, with varying success rates

The surgeon picks the method after examining you. The goal is to heal the fistula and protect bowel control.

Recovery

• Many operations are done as day care, or with a short stay

• Pain, some bleeding and discharge for a few weeks are expected

• Sit in warm water for 10 to 15 minutes, a few times a day

• Keep stool soft with fibre and water. Don't strain.

• Wound dressing may be needed for a few weeks

• Desk work often resumes in about 1 to 2 weeks. Complete healing may take 4 to 8 weeks or longer for complex fistulas.

Fistulas can come back, more so in complex cases or Crohn's disease. Follow-up visits matter.

Risks

Risks include infection, bleeding, the fistula coming back, and slight leakage of gas or stool. The chance of this is higher with high fistulas. Your surgeon will explain the risks for your type before surgery.

Get help now: Get help the same day if you have severe pain, swelling that is hot and tender near the anus, fever, or you can't pass urine. An abscess needs to be drained quickly.

When to see a doctor

Don't wait if a boil near the anus keeps coming back, you have discharge that never fully stops, or you've had an abscess drained before and still have a leak. Early treatment is easier than treating a fistula that has branched.

Common questions

Can anal fistula heal on its own? Rarely. The opening may seem to close for a while, but the tunnel usually stays and the infection returns.

Is fistula surgery painful? You are under anaesthesia during surgery. Some pain afterwards is expected and is managed with medicines.

Will I lose bowel control after surgery? Most people don't, especially with simple fistulas. The risk is higher with high or complex fistulas, which is why the choice of surgery is careful.

Is a fistula dangerous? It is rarely life-threatening, but untreated it can cause repeated abscesses, long-term pain and, very rarely, cancer in a fistula that has been present for many years.

Have questions or want to see a specialist? For appointment and queries, call 8156929292. AXTEN HOSPITALS - HONEST SURGERY, HONEST CARE.