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An anal fistula is a small passage that connects the inside of the anal canal or lower part of the rectum to the skin surrounding the anus.
The anus is the final part of the digestive tract through which the faeces are removed from the body. Inside the anus, there are special glands that secrete mucus. Sometimes, these glands may get clogged and infected forming an abscess which in turn, may transform into an anal fistula over time.
Common signs and symptoms of an anal fistula are:
Dr. Sim Hsien Lin’s main sub-specialty is in colorectal surgery. In addition, her sub interests include laparoscopic colorectal surgery, transanal endoscopic microsurgery, management of piles, inflammatory bowel diseases, complex anal fistulas as well as diagnostic and therapeutic endoscopic procedures.
Dr. Sim Hsien Lin is a specialist colorectal surgeon in Singapore with over 10 years of experience in colorectal surgery. Her sub interests include laparoscopic colorectal surgery, transanal endoscopic microsurgery (TEMS), surgical management of piles, inflammatory bowel diseases and complex anal fistulas.
To diagnose an anal fistula, your specialist doctor will need to examine the area around the anus. They will search for an opening or hole on the skin. Then, the specialist will evaluate how deep the canal is and identify in which direction it is going.
In some cases, anal fistulas are not detectable on the skin surface. In this instance, your specialist may need to conduct additional tests, such as:
A procedure where a scope is used to check the interior of the anus and rectum.
These usually include an ultrasound, computer tomography (CT scan) or magnetic resonance imaging (MRI) to create images of the anal tract for better visualisation.
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Dr. Sim became a Fellow of the Royal College of Surgeons (Edinburgh) in 2011, winning the Gold Medal award at the FRCS Exit Examination that year.
Dr. Sim firmly believes that transdisciplinary care is the key to supporting both the elderly and complex patients through their perioperative and recovery journey.
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Most anal fistulas require surgery that is performed by a colorectal surgeon. Depending on your particular condition, Dr Sim may offer you the following surgical options:
An operation where your surgeon will open up the abnormal connection, transforming it into an open groove. This will allow a fistula to heal from the inside out.
This advanced procedure involves filling the fistula tract with a special tissue that will naturally dissolve over time.
During this procedure, your colorectal surgeon will “seal” the fistula canal with special glue.
This technique involves making an incision around the anus, locating the fistula tract between sphincter muscles and tying off the two openings of the tract.
If your fistula is complex and passes through a large portion of the anal sphincter, your surgeon may recommend inserting a seton. A seton is a non-absorbable suture that is inserted in the fistula for at least a few weeks. It allows the pus to drain and facilitates some healing without the need to cut the sphincter muscles. Often a subsequent procedure is required if a patient wishes to have the seton removed in the future.
During this surgical treatment, the fistula is scrapped out and an internal opening is covered using a flap created in the rectum.
This surgery involves utilising a small laser beam to seal the fistula.
This advanced surgical technique is applied to treat complex fistulas. During this procedure, the surgeon will insert a video scope into the external opening of the fistula going all the way through the tract and follow it to the internal opening. This allows the surgeon to potentially locate the internal opening and clean out and ablate the canal with a brush and a probe respectively through the video scope. The internal opening will be closed via various methods if it can be located.
Typically, fistula surgeries are performed on an outpatient basis, meaning that you do not have to stay at the hospital overnight. However, patients with complex or infected fistulas may need to stay at the hospital for a short period of time. Some cases require more than one surgical treatment.
The level of discomfort and pain after surgery varies from mild to moderate. Your surgeon may inject a local anaesthetic (lidocaine) or prescribe pain pills. Patients are usually recommended to take stool softeners post-surgery in the first few weeks after surgery.
After-care differs depending on the type of surgery performed. Patients with open wounds would require shower spray to clean the wound. while VAAFT cases would require daily flushing of wounds for a couple of weeks.
Just like any surgical procedure, treatment of anal fistula has a potential risk of complications which mainly include:
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Please fill up this form and we’ll get back to you shortly!
For quicker response, call us at+65 6261 9227
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