How Fistula-in-ano is diagnosed?
Fistula-in-ano are usually diagnosed by the sign and symptom told by the patientand by examining the area around the anus.. The physician may do a physical examination, digital examination of the anal area and often it needs a proctoscopic examination. The digital examination of back passage is done with the use of lubricant by wearing gloves. The Physician will look for an opening (the fistula tract) on the skin. Then try to determine how deep the tract is, and the direction in which it is going. In many cases, there will be discharge from the external opening.Some fistulas may not be visible on the skin’s surface. In that case, there may be need to perform additional tests, like x-ray or MRI fistulogram of the anal area to get a better view of the fistula tract.
Sometimes, in doubtful cases or in the presence of multiple fistula further tests may be required to see whether the condition is related to Crohn’s disease, tuberculosis or any other alarming pathology. Among these studies are blood tests, X-rays and colonoscopy.
What is the difference between low anal and High anal Fistula-in-Ano?
Low anal and High anal Fistula-in-ano is named according to the relation of internal opening with the dentate line. Dentate line is the junction of lower part of rectum (the end part of Gastrointestinal tract or the hind gut) and the proctoderm (the skin of anus). That is the junction of skin and mucus membrane. High anal Fistula-in-ano are those which opens above the dentate line while low analopens below the dentate line.
What are the other types of Fistula-in-Ano?
Other clinical Classification is also there as per the relation of the course of the tract.
- Intersphincteric fistula. The tract begins in the space between the internal and external sphincter muscles and opens very close to the anal opening.
- Transphincteric fistula. The tract begins in the space between the internal and external sphincter muscles or in the space behind the anus. It then crosses the external sphincter and opens an inch or two outside the anal opening. These can wrap around the body in a U shape, with external openings on both sides of the anus (called a horseshoe fistula).
- Suprasphincteric fistula. The tract begins in the space between the internal and external sphincter muscles and turns upward to a point above the puborectal muscle, crosses this muscle, then extends downward between the puborectal and levator ani muscle and opens an inch or two outside the anus.
- Extrasphincteric fistula. The tract begins at the rectum or sigmoid colon and extends downward, passes through the levator ani muscle and opens around the anus. These fistulas are usually caused by an appendiceal abscess, diverticular abscess or Crohn’s disease.
Radiological(MRI) classification
- Grade I: Simple linear intersphincteric.
- Grade II: Intersphincteric with abscess or secondary tract.
- Grade III: Transsphincteric.
- Grade IV: Transsphincteric with abscess or secondary tract within the ischiorectal fossa.
Written by:
Prof. Dr. R N Tripathy
(Ayurveda Surgeon)
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