How Are Anal Fistulas Diagnosed?
DiagnosisYour doctor begins your care with a personal conversation about your medical history, your symptoms, and how they are affecting your quality of life. Fistulas must be carefully assessed to determine their exact location inside the anus and their relationship to the surrounding musculature.
To do this, our physicians will examine the anorectal area and may use an anoscope—a small instrument to view the inside of the anal canal. If your doctor suspects Crohn’s disease or ulcerative colitis, they may recommend further evaluation with a colonoscopy or sigmoidoscopy to examine your colon. Based on the results of your assessment and testing, your doctors will decide what anal fistula treatment is best for you.
Your doctor may decide to use one of the following tests to diagnose your anal fistula:
- MRIs provide images of the fistula, anal sphincter muscles, and pelvic floor
- Endoscopic ultrasound uses high-frequency sound waves to visualize the anal fistula and anal sphincter muscles
- Fistula probes can be inserted into the anal fistula to help identify the tract
- Anoscope, or a small endoscope, can examine the anal canal
- Colonoscopy examines the entire colon or large intestine
- Sigmoidoscopy examines the portion of the colon (the sigmoid colon) that leads to the rectum and anus
How is Anal Fistula Treated?
TreatmentOur colorectal surgeons have extensive experience treating anorectal fistulas, from the simplest to the most complex. Fistula care is complicated and requires knowledge of the special anatomy in this area to drain the infection and treat the fistula while maintaining bowel control. There are many different approaches to treating anorectal fistulas, and more treatment options are being developed.
Your doctor will choose the surgical technique that is most appropriate for your care.
- Fistulotomy. The fistula is surgically opened, flushed out, and stitched open or left as is to heal from the bottom up.
- Seton placement. The surgeon places a silk or latex string in the fistula tract to help drain the infection. Over time, the seton may be tightened to slowly cut through the overlying skin and soft tissue and open up the fistula.
- Endorectal Advancement Flap. For anal fistulas that significantly involve the anal sphincter muscles, the surgeon may excise the internal opening of the fistula tract and create a flap of healthy anorectal tissue to cover the internal defect.
- LIFT procedure. For high transphincteric fistulas, the surgeon accesses the fistula tract between the sphincter muscles and ligates the tract in the intersphincteric plane. The external opening is widely drained. The internal opening may be closed with an endorectal advancement flap.
- Fibrin glue. The fistula tract is debrided and then surgeon injects fibrin glue into the fistula to seal it.
- Anal fistula plug. The plug is pulled into the fistula tract.
- Laser surgery. This treatment involves introducing a device into the fistula tract that will emit a laser beam to promote healing of the fistula tract.
- Additional techniques and clinical trials are in development
Trust NewYork-Presbyterian for Anal Fistula Treatment
If you are suffering from an anal fistula, the experts at NewYork-Presbyterian are here to help. NewYork-Presbyterian’s colorectal surgeons have extensive experience in diagnosing and treating anal fistula symptoms to prevent serious complications. Call us to make an appointment for a consultation.