How do I get a perianal fistula?
Perianal fistulas arise from an inflamed gland in the anus, which develops into a pustule (abscess). The pus from the abscess has to go somewhere. It finds a way out and can break open spontaneously or be opened by the surgeon. When it empties itself, the corridor continues. This is the fistula. Because the perianal fistula has an open connection with the intestine, fluid or dirt can always come out. A very annoying ailment, which can happen to anyone.
Diagnosis and treatment of perianal fistulas
The diagnosis is simple. An experienced proctologist immediately recognizes the perianal fistula. It is more difficult to find the exact path of the fistula between the rectum and the skin around the anus. That can be a capricious journey. If necessary, an ultrasound or MRI is used to accurately record the trajectory of the fistula. There are several ways to treat the fistula, all of which involve opening and cleaning and closing properly. Interestingly, the treatment is different in men than in women. This has to do with the anatomy in the pelvic area. When treating a woman’s fistula, it is necessary to prevent damage to the sphincter muscle at all costs, because then there is a greater risk of incontinence. This risk is also present in men, but much less.
Simple fistula: surgical treatment
A simple perianal fistula that is a little further from the sphincter can be cut open (under anesthesia) to clean it. This leaves a ‘clean’ wound, which heals on its own in a few weeks.
Men: treatment of perianal fistula with seton
For complex fistulas near the sphincter, male patients were initially helped with a so-called ‘seton’. That is a thread or rubber band that is threaded through the fistula and the anus and tied in a loop. The seton keeps the fistula nicely open, so that any cavities with pus can drain properly. The fistula will shrink so that it can be treated definitively after a period of 6 weeks to 3 months.
Women: Perianal Fistula Treatment with Shifting Plastic
This is a fairly new but successful technique that requires considerable skill from the treating physician. Also now it starts with a seton. During the definitive operation of the fistula, it is not opened, but the opening is closed on the inside with a piece of mucous membrane of the rectum. So it is actually a small transplant. This way the sphincter can be spared to reduce the risk of incontinence.
What can we do for you?
Perianal fistulas come in so many forms that we cannot say in advance what the right approach is in your case. This should be apparent during the diagnosis. The first consultation, including a preliminary diagnosis, will in any case be reimbursed by your insurer, although a deductible may apply. During this intake, the specialist also discusses the treatment plan. If your treatment can take place under local anaesthetic, it will be scheduled with us immediately. If you need to be treated under anaesthetic, we will refer you to the hospital. In any case, the problem can be solved easily, so contact us quickly.
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