What Is a Perianal Fistula? Symptoms and Effective Treatment Methods

A perianal fistula is a chronic and distressing health condition that occurs around the anus. It usually develops as a result of a previously formed anal abscess and is characterized by the formation of an abnormal tunnel (tract) between the anal canal and the surface of the skin. This tunnel allows infected material to drain externally. However, if left untreated, the condition can lead to recurring infections, inflammation, and a significant decline in quality of life.

What Causes a Perianal Fistula?

Perianal fistulas most commonly occur following anal abscesses that develop due to inflammation or blockage of the anal glands. When an abscess is not treated promptly or properly, the infection may spread to deeper tissues, creating a path to the skin’s surface and resulting in fistula formation.

In some cases, perianal fistulas may also be associated with inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis, as well as other conditions that affect the immune system. Rarely, tuberculosis, trauma, tissue damage following radiotherapy, or certain types of cancer in the anal region may also contribute to the development of a fistula.

What Are the Symptoms of a Perianal Fistula?

Perianal fistulas often present with specific clinical symptoms, although they may sometimes be confused with conditions such as hemorrhoids, anal fissures, or anal abscesses. Therefore, early diagnosis and proper evaluation by a general surgery specialist are essential.

Common symptoms include:

• Recurrent pain and tenderness around the anus
• Visible opening or hole on the skin surface
• Persistent or intermittent foul-smelling discharge
• Swelling and discomfort, especially when sitting
• Pain, burning, or bleeding during bowel movements
• Redness, irritation, or itching around the fistula
• Signs of infection such as fever, fatigue, and loss of appetite

These symptoms may worsen over time, and if not treated, the fistula can become chronic. Chronic fistulas can severely affect a person’s daily life and activities.

How Is a Perianal Fistula Diagnosed?

The diagnostic process begins with listening to the patient’s complaints and performing a physical examination. Visible fistula openings or drainage are often sufficient for diagnosis. However, to clearly determine the structure, direction, and depth of the fistula, the following imaging methods may be used:

• Rectal ultrasonography (Endoanal USG)
• Pelvic MRI imaging
• Fistulography
• Anal endoscopy

These methods help reveal the internal opening of the fistula, its course, and its relationship with surrounding tissues. Such detailed information is crucial for planning the correct treatment.

Treatment Methods for Perianal Fistulas

Perianal fistulas rarely heal on their own. Surgical intervention is usually required for a permanent solution. The treatment method depends on the type of fistula (simple or complex), its course, and the patient’s overall health condition.

1. Fistulotomy (Opening and Cleaning the Fistula)

An incision is made along the fistula tract to expose and clean out infected tissues. This method is highly effective for simple and superficial fistulas, with a relatively fast healing period.

2. LIFT Procedure (Ligation of Intersphincteric Fistula Tract)

The tract located between the internal and external anal sphincters is tied off and divided. This method is especially preferred as it protects the anal sphincter, reducing the risk of complications such as gas or fecal incontinence.

3. Fibrin Glue Injection

A special biological adhesive is injected into the fistula tract. This is a non-invasive option for patients who prefer to avoid surgery, but its success rate is lower compared to surgical methods.

4. Fistula Plugs (Seton Technique)

A plug is placed into the fistula canal. This method is preferred to preserve muscle tissues and typically requires long-term follow-up.

5. Laser Treatment for Fistulas (FiLaC)

Laser energy is used to cauterize and seal the fistula tract from the inside. It is a minimally invasive technique that does not require surgical incisions.

Why Is Early Intervention Important in Perianal Fistulas?

Early diagnosis and timely treatment are crucial in preventing the fistula from becoming chronic or recurring. Especially when treated before damage occurs to the internal sphincter muscles, patients have a much better chance of maintaining their quality of life.

After treatment, it is extremely important for patients to:

• Follow all medical advice and instructions precisely
• Maintain proper hygiene
• Attend all scheduled wound care and follow-up appointments

Conclusion: Perianal Fistulas Should Not Be Ignored

Perianal fistulas can lead to serious health issues if not treated in time. Due to symptoms like persistent discharge and pain that reduce quality of life, early medical intervention is essential. With today’s advanced surgical and laser-assisted treatment options, perianal fistulas can be treated with high success rates.

If you are experiencing symptoms such as discharge, swelling, or pain around the anus, you are strongly advised to consult a general surgery specialist for a thorough evaluation.

Disclaimer: All content on this site is intended for informational purposes only and is based on scientific sources available at the time of writing. For any health concerns, symptoms, diagnosis, or treatment needs, please consult your doctor or a qualified healthcare professional.