Anorectal Fistula (Fistula in Ano)
Dr. Weyrich's Naturopathic Proctology Notebook
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A fistula is an abnormal tract or passage connecting two parts of the body
or the inside to the surface of the skin. In the case of an anorectal fistula,
the tract usually connects the inside of the anorectal canal to a drain
in the skin.
Signs and Symptoms
- Discharge of pus, feces, or flatulence through
an opening in the skin near the anus or into the vagina.
- Pain or itching around the anus.
- Secondary to a ruptured or drained abscess (most common).
- Inflammatory bowel disease.
A fistula is diagnosed by locating the external opening and tracing the
tract to its internal opening (or vice versa) using a fistula probe
(a soft piece of wire).
Once the course of the fistula has been traced with a fistula probe,
outward traction of the probe will reveal the course and depth of the fistula
Superficial fistulas can be treated using minor surgical techniques, involving
careful incision along the course of the tract to open the
fistula. An electric cutting current is useful for this purpose. The
edges of the fistula are then shaved off using electrodessication in order
to promote healing from the inside out and to discourage premature healing
of the outer surface.
Care must be taken to avoid cutting too much of the anal sphincter muscle,
in order to prevent post-operative anal incontinence.
Anorectal fistulas seldom resolve without surgical treatment.
Untreated fistulas may revert to abscesses.
Recurrence after surgery is common (20% or more). Surgical removal of too
much muscle, especially high in the anal canal or with repeated surgery,
is associated with the risk of anal incontinence.
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Unless specifically noted above, references used in the construction of this web
page include the following:
Lecture notes from Functional Medicine University.
Lecture notes from Southwest College of Naturopathic Medicine.
Lecture notes from the University of Tennessee graduate programs in
Chemistry and Biochemistry.
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(Naturopathic Medical license number 07-1008).
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