What is the Rectal Fistula?

Medically reviewed by: Gary H. Hoffman, MD

The Perirectal Fistula.  A Complicated Problem.

The Rectal Fistula. What Is ItA perirectal fistula.  A perianal fistula.  A fistula.  All terms that refer to the same thing. What is it?

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A fistula begins as an infection.  There are many theories as to why the infection begins. However, nobody knows for sure why the process starts.  Inside the anus and rectum are areas called crypts.  They are small pockets that surround the area where the rectum joins the anus.  These crypts run all the way around the anorectal junction.

The Fistula Begins.  Why?

For whatever reason, these crypts can become inflamed and begin to suppurate (smolder). Pus is formed.  Often they empty and drain into the anal canal and nothing further comes of them.  Occasionally, they begin to burrow outward toward the skin of the buttocks.  The patient feels this burrowing as an ache, a pain, pressure or stinging.  While this burrowing is confined, it remains a collection of pus, also known as an abscess.   Most often, patients have no idea what is happening.  If the patient is lucky, the burrowing will erupt through the skin and drain.  But, if it does not erupt, an abscess, or collection of pus, is formed.  This is intensely painful and may be associated with fevers, chills or an inability to urinate.

You Have A Fistula.  What Next?

This is what often starts a trip to the proctologist, also known as a colon and rectal surgeon or coloproctologist.  The surgeon will usually open and drain the abscess, giving instant relief.  The drainage may be done in the office, or in a surgical center under anesthesia, depending on how extensive the problem is.

Fifty percent of the time, the surgeon’s incision closes and heals.  Fifty percent of the time, it remains open and drains constantly.  This is called a fistula.  Fistulas are a common problem in Los Angeles, Beverly Hills and in all cities across the United States.

The treatment of a perirectal or perianal fistula is complex and best left to the proctologist who is well trained in the diagnosis and treatment of these problems.

The Fistula May Have An Underlying Cause.

The fistula may be a sign of other disease such as the inflammatory bowel disease called Crohn’s disease.  Or, the fistula may be a disease unto itself.  Either way, neglect is the wrong approach.  The sooner you are seen and evaluated, the easier may be the treatment, In its very earliest stages, antibiotic treatment may be all that is required.  In the late stages, a major operation may be needed.

Abscesses and fistulas can be extremely problematic in those with diabetes and in those who are immunocompromised.  Again, early diagnosis may be life saving.

Los Angeles Colon and Rectal Surgical Associates

Do not neglect anorectal disease.  The surgeons of Los Angeles Colon and Rectal Surgical Associates are trained to diagnose your problem and help with complete treatment.  They will patiently answer all of your questions.  But, you must take the first step and seek treatment for your problem.  (310)273-2310.

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