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Fistulas are abnormal connections between two structures. Most commonly, they involve an area of the rectum or anus to the skin surrounding the anus. This is called fistula-in-ano. Alternatively, they can involve connection between two segments of the small or large intestine, which is typically seen in disease states such as Crohn’s Disease
Fistulas often present as an abscess in or around the anus. The fistula allows bacteria to escape from within the bowel and cause an infection in the subcutaneous tissues of the skin. While approximately half of individuals who develop this type of abscess will completely heal without further intervention, half will go on to develop a chronic fistula, where the connection between the rectum and skin remains open and can create ongoing problems.
The most common symptoms of a fistula in ano or abscess include: anal pain, a mass or lump in the skin by the anus, drainage of pus from the skin around the anus.
Treatment for Fistulas:
As stated above, some acute fistulas resolve spontaneously after drainage of the associated abscess. Chronic fistulas, however, often require surgical treatment which may involve an incision in the skin or muscle to open the fistula tract. Alternatively, a drain or “seton” may be placed to allow the area to heal and prevent further problems. Your doctor will decide which is most appropriate for you. It is not uncommon for people with fistula disease to need several operations before the problem is completely cured. Although annoying, your surgeon wants to maintain your ability to control your bowels as incontinence is one of the risks of fistula surgery.
For more information on fistulas, visit the American Society of Colon and Rectal Surgeons website at:
Related video: https://www.fascrs.org/video/abscess-and-fistula