Medical expert of the article
New publications
Anorectal fistula (fistula of the rectum)
Last reviewed: 23.04.2024
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Anorectal fistula is a tubular passage opening on one side in the anal canal, and the other opening on the skin in the perianal zone. Symptoms of anorectal fistulas are manifested by discharge from the fistula and sometimes by pain. Diagnosis is established by examination and sigmoidoscopy. Treatment of anorectal fistulas often requires surgery.
[What causes anorectal fistulas?
Anorectal fistulas develop spontaneously or develop secondarily after drainage of the pararectal abscess. Predisposing factors include Crohn's disease and tuberculosis. In most fistulas, the anorectal crypt is affected; others may be a consequence of diverticulitis, a tumor or an injury. In infants, fistulas are congenital and more characteristic of boys. Rectovaginal fistulas may be secondary to Crohn's disease, resulting from injuries in obstetric care, radiotherapy, or malignancy.
Symptoms of anorectal fistulas
Characteristic relapses of an abscess in the anamnesis, accompanied by periodic or constant discharge from the fistula. Detachable, as a rule, puffy, serous-hemorrhagic or mixed. If there is infection, there may be pain.
Diagnosis of anorectal fistulas
On examination, one or more secondary fistula orifices can be found. Often palpable fistula in the form of a tourniquet. The examination with a probe inserted into the fistulous course allows one to determine the depth, direction and often the primary opening of the fistula. You can use sigmoidoscopy. From cryptogenic fistulas, purulent hydradenitis, epithelial coccygeal fistula, pustular skin lesions and urethral perianal fistulas should be differentiated.
What do need to examine?
How to examine?
Treatment of anorectal fistulas
Previously, the only effective method of treating anorectal fistulas was surgical, consisting in the initial opening of the entire fistula, excision with the formation of a "groove". A partial sphincterotomy is necessary. In the case of dissection of a significant part of the sphincter, some stool incontinence may develop. In the presence of diarrhea or Crohn's disease, fistulotomy is not advisable because of the long healing of the wound. In Crohn's disease, patients should be prescribed metronidazole and other appropriate antibiotics, as well as suppressive therapy. In fistula due to Crohn's disease, infliximab is very effective. Moving flaps or instillation of fibrin glue into the fistulous course is an alternative to conventional surgery.