Anal fistula is a common disease and a frequent occurrence, commonly known as “fistula”. China is one of the earliest countries to recognize fistula, especially in Chinese medicine, which has a very good treatment method in the cause and treatment of fistula. Ancient India included anal fistula as one of the 8 types of diseases with poor prognosis before 1000 BC. The treatment of anal fistula by astringent and ligature has been recorded in the medical treatises of ancient Greek scholars in 460 BC. In the last hundred years, there has been a breakthrough in the understanding of anal fistula, and the treatment of anal fistula has also made great progress.
1. What is an anal fistula?
The full name of the fistula is anorectal fistula, and as the name implies, there is a fistula outside the anus that connects to the anorectum. The actual fistula is the most important thing.
To answer this question, we need to give you a brief introduction to the basic structure of the anus. In the human anus there is a junction between mucous membrane and skin at 1.5cm from the anal edge, medically known as the dentate line, which is where the endoderm of the body meets, and there are corresponding glands below the dentate line, clinically known as anal glands, which normally secrete glandular fluid to moisten the intestinal cavity. When the human body is fatigued or drinks a lot of alcohol, eats spicy food or has diarrhea, it may cause infection of the anal glands, forming anal canalitis or perianorectal abscess, in which the patient will feel abnormal pain in the anus, which will not be relieved for a while, and some patients have fever and elevated blood picture, and in serious cases, it may lead to poor urination.
Generally, patients with abscesses will often experience two conditions.
(1) Self-rupture of the abscess, i.e., the skin is pierced from the top of the abscess and the thick juice overflows.
(2) A local incision is made by the doctor to drain the abscess, and the thick juice is drained out.
In either case, the patient immediately feels relaxed in the anus because of the sudden reduction in local pressure after the abscess is drained, but because the original infected cavity still exists after the drainage of the thick juice, the cavity will gradually shrink and harden in the later stages of drainage, and then a fistula will gradually form, which is often referred to as an anal fistula. The fistula is connected to the rectum at one end, and there is often a secretion from the fistula’s external mouth, which makes it difficult to heal in the long run. Therefore, we say that the only way to cure an anal fistula is surgery, which is the only way to completely open the internal and external openings of the fistula as well as the tube, so that the trauma can be drained and cured.
In clinical practice, we advocate that the sooner the fistula is diagnosed, the better the surgery, because according to domestic literature, the cancer rate of fistulas older than 10 years is higher. As for what kind of surgery to take, I suggest that patients should go to the appropriate brand specialist hospital or a more reliable specialist to prevent physical and mental pain and unnecessary economic burden due to improper surgery.
Modern medicine believes that anal fistula is a sequel of perianal abscess, which is formed by the gradual atrophy of the pus cavity after breaking down by oneself or artificially cutting open the pus and forming a fistula inside and outside the anus. As the fistula is connected to the inside of the anus, secretions often enter the fistula, causing repeated infections and making it difficult to heal. The longer the fistula, the more complicated it may become, mainly because the outer mouth will be temporarily closed, when re-infected, may produce branches from the vicinity of the fistula, that is, the formation of a complex anal fistula.
3, what are the symptoms of anal fistula?
The fistula can occur in all ages and different sexes, but is common in adults, generally have a history of repeated episodes of perianal abscess, and a history of incision and drainage of pus or self-rupture, patients often feel that there are hard strips of material outside the anus to the anus, sometimes local pain, especially during the infection increased pain, if the pain will be quickly relieved after breaking. Secondly, pus is also a common symptom of anal fistula, usually more pus is formed at the beginning of the fistula, and it is accompanied by fecal odor, after a long time, the pus is sparse, or sometimes not, if too fatigue and re-infection can cause a sudden increase in pus and increased pain. In addition, due to the stimulation of anal fistula secretions, patients often feel damp, itchy skin outside the anus, thus forming secondary perianal eczema.
4, anal fistula is often divided into several categories?
From a professional point of view, anal fistulas are divided into simple fistulas and complex fistulas. A simple fistula means that there is only one internal port, one external port and one tube; a complex fistula has more than two internal ports, external ports and tube walls. Generally speaking, simple fistulas have mild symptoms and relatively little surgical damage, while complex fistulas are more symptomatic, have a longer onset time, are complicated to operate on, and have a relatively slow recovery. The procedure can be performed by a professional physician to determine if it is simple or complex.
5.What are the treatment methods for anal fistula?
The conservative treatment can only relieve the symptoms, not to achieve the purpose of the root cause, mostly for the old and infirm or for various reasons temporarily not suitable for surgery; surgical treatment can achieve the purpose of complete eradication of fistula.
Some people with common sense may have heard of the “hanging thread” method, which was adopted as early as the Ming Dynasty and is a patented invention of Chinese medicine in China, and the method has now spread overseas and is effective. In fact, the purpose of the hanging wire is to slowly cut the anal sphincter, and its mechanism is mainly to use the mechanical action of the leather band to slowly cut the fistula with its tight binding pressure or contraction force, and at the same time to slowly cut while the broken end and the surrounding tissues produce adhesions, thus preventing the risk of anal incontinence. Its main drawbacks are high postoperative pain, long response time, and the tendency to recur. Surgical treatment is the most thorough method, and its aim is to open the fistula from the external to the internal orifice in a single incision so that the fistula drains freely, creating a completely open wound, and then using the opportunity for the granulation to grow from the bottom of the wound to achieve a cure. The key to successful surgery is to find the right internal opening and to open and drain all fistulas, otherwise there is a risk of recurrence. In addition, once a fistula is diagnosed, surgery should be done early to prevent aggravation or cancer.
There are also some so-called experts and medical professionals in the society who tempt patients to pursue refined benefits under the guise of high technology, such as patch treatment method, coating treatment method, laser therapy, etc. It is recommended that patients should act with caution, ask more questions and look more, otherwise it leads to lifelong regrets. Therefore, choosing a professional brand hospital or brand department can make you feel more at ease, while also reducing costs and pain, and the advertised ones should be chosen more carefully. People often say: do not believe in advertising blind medical treatment, believe in the advertising will be all blind to medical treatment.
The most advanced surgical method at home and abroad is what?
In the treatment of anal fistula, the current domestic level is higher than foreign countries. The most advanced surgical methods are the “small incision and less damage” approach for low-level complex anal fistulas and the “non-wire therapy and preservation of the sphincter” surgical approach for high-level complex fistulas.
The basic principles of these two procedures are.
(1) Full preservation of the anal sphincter.
(2) The incision can be drained freely to reduce the damage and ensure the recovery time and flat appearance.
The “An’s therapy”, which is now well-known at home and abroad, is to use the main focal incision and counter-oral drainage to treat various complex fistulas; the use of non-hanging wires to treat high complex fistulas has been clinically successful and has relieved patients of a lot of pain.
The most important thing is that you have to be able to get a good idea of what you are doing.
The biggest concern for many people suffering from anal fistula is whether there will be anal incontinence after surgery, whether incontinence mainly depends on the functional status of the anal sphincter, sphincter function is normal will not cause incontinence. In fact, if the surgery is done in accordance with the formal operation of the anal surgery demonstration, this problem will not occur.
8.Will the anal fistula recur?
If the surgery is accurate, the fistula will not recur in situ unless the infected internal opening is not treated properly. However, the clinic often encounters some patients who overeat and have an irregular life, and then have a fistula from another part of the body. The key is to take care of yourself and develop good eating habits and bowel habits so as to greatly reduce the recurrence rate.
9, what are the common drugs used for anal fistula?
If you’re a patient with an anal fistula that is not suitable for surgery, if the pain is repeatedly swollen, we advocate that patients take a Chinese herbal bath to relieve anal pain, commonly used drugs for anal fumigant, specifically: steep with hot water, wait for the water temperature of 35 to 40 degrees, warm water bath for 10 minutes, and then anus coated with Ma Yinglong cream to relieve inflammatory stimulation. In general, if there is no fever of infection, it is not necessary to use antibacterial agents. If you have been operated on, you need to use specific medication under the guidance of your doctor, but the principle of unobstructed drainage of the wound and the change of medication by your doctor to achieve the purpose of healing.