Anal Fistula

What it is

An anal fistula is a tunnel that forms between the inside of the anal canal and the skin around the anus, most often as a consequence of an anorectal abscess that drained but did not close completely. It shows up as discharge or pus coming from a small opening near the anus, skin irritation, intermittent pain and repeated abscess episodes. It rarely heals without treatment, and management is almost always surgical. At Femi Saúde, the coloproctology team maps the fistula's tract with a physical exam and imaging tests when necessary, and chooses between fistulotomy, seton placement and sphincter-sparing techniques, prioritizing a cure while preserving continence, a central concern in women's health.

Most common symptoms

• Discharge or pus from an opening near the anus
• Constant skin irritation and moisture
• Pain that increases when sitting or having a bowel movement
• Recurring anal abscesses
• Itching around the anus
• Slight bleeding from the opening

Causes and risk factors

• A previous anorectal abscess
• Infection of the anal glands
• Crohn's disease
• Previous anal trauma or surgery
• Tuberculosis and other rare infections

How it is diagnosed

The coloproctologist identifies the external opening on inspection and, with a digital rectal exam and anoscopy, looks for the internal opening and the tunnel's path. For complex or recurrent fistulas, or when multiple tracts are suspected, pelvic MRI or endoanal ultrasound precisely shows the fistula's relationship to the sphincter muscles, information that is decisive for choosing the surgical technique. When there are signs of inflammatory bowel disease, colonoscopy complements the investigation.

How we treat it at Femi Saúde

Treatment is surgical. For superficial fistulas, fistulotomy opens the tract so it can heal from the inside out, with a high cure rate. For fistulas that cross a significant portion of the sphincter, the coloproctology team at Femi Saúde prefers to place a seton to drain and prepare the tract, and later use muscle-sparing techniques such as LIFT or the advancement flap. When Crohn's disease is present, clinical treatment of the disease is carried out alongside it. Recovery involves simple dressings, careful hygiene and follow-up visits to monitor healing.

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