Which doctor treats an anal fistula?
The first point of contact for patients with anal fistula is usually the general practitioner. However, general practitioners then refer affected patients to a proctologist or a specialized colorectal center. A proctologist is a specialist for the rectum and thus also for complaints in the anal region. Furthermore, in the case of treatment and surgery of an anal fistula, general and visceral surgery is often involved, especially when it comes to the surgical therapy or treatment of the anal fistula.
When should you see a doctor for an anal fistula?
If you have a fistula at the anus or symptoms of an anal fistula, a visit to the doctor is strongly recommended. If the following symptoms of an anal fistula occur, you should see a doctor promptly. In most cases, anal fistulas do not heal on their own and can lead to further problems and secondary diseases if left untreated. An anal fistula is often also the result of a chronic anal abscess. The earlier you see a doctor for complaints in the anal area, the better the therapy and treatment of the anal fistula will be. A doctor should definitely be consulted if the following symptoms of an anal fistula occur:
- Persistent pain in the anal area, especially when sitting or during bowel movements.
- Chronic discharge of secretions, pus, or blood from the anal region.
- Recurring swellings or abscesses forming in the anal area.
- Fever or malaise, which could indicate an infection.
An early visit to the doctor can prevent complications and facilitate rapid therapy and treatment of an anal fistula.
How is the diagnosis of an anal fistula made by the doctor?
The diagnosis of an anal fistula begins with a thorough medical history interview, the anamnesis. The doctor will ask you about your symptoms of the anal fistula, such as pain, secretion in the anal region, bleeding, or other complaints. The timing of symptom onset, their intensity, and whether they are continuous or improve intermittently are also important information. Additionally, the doctor will inquire about known diseases, your lifestyle, diet, physical activity, consumption of cigarettes and alcohol, as well as previous surgeries or diseases in the anal area.
How is the examination of an anal fistula conducted by the doctor?
Subsequently, the doctor will examine the affected anal region more closely. The doctor will inspect the rectum and use proctoscopy to look for signs of an anal abscess and also the fistula openings in the anal canal. During this examination, anal fistulas and anal abscesses, as well as anal fissures, hemorrhoids and other changes can be gently and painlessly detected and identified. The location of the anal fistula canal in relation to the anal sphincter is of great importance for the prognosis and the later treatment of the anal fistula.
Endoscopic procedures such as colonoscopy to exclude inflammatory or tumorous bowel disease are also part of the standard diagnostic methods for anal fistulas. Sometimes additional examinations such as an ultrasound examination via the rectum, called transanal endosonography, are performed. This allows the doctor to detect deeper abscesses and anal fistulas. Using fistula probes and dyes, the course of the fistula tract and its relation to the sphincter muscles can be well visualized. These examinations are usually performed under short anesthesia. In complicated cases, for example in patients with Crohn's disease, magnetic resonance imaging can provide information about the exact course of the anal fistula. Especially in recurring anal fistulas, your doctor can also inform you about prevention of anal fistulas.
Which examinations and tests will the doctor perform to diagnose the anal fistula?
There are several examinations and tests that are performed when an anal fistula is suspected to establish a diagnosis and to better assess the course of the fistula. Usually, a proctological examination is first performed, during which the anal region is visually inspected and the anal canal is palpated to detect any changes such as fistula openings, anal abscesses, or swellings.
Ultrasound examination for anal fistulas
If the findings are unclear, an ultrasound examination (endosonography) can be performed. An ultrasound device is inserted into the rectum to examine the fistula and its course in the area of the sphincter muscles more closely.
Colonoscopy if chronic inflammatory bowel disease is suspected
If there is suspicion of an underlying chronic inflammatory bowel disease, a colonoscopy can be performed. This examination allows direct assessment of the condition of the bowel and detection of inflammatory processes or other diseases that may be the cause of fistula formation.
Fistula probes to explore the course of the fistula tract
To assess the exact course of the fistula tract and its relationship to the sphincter muscle, probing under anesthesia can be performed. A thin probe is inserted into the fistula opening to explore the tract. This examination is often already an integral part of the treatment of an anal fistula and can be done during surgery.
Magnetic resonance imaging for complicated fistulas
In complicated anal fistulas or in patients with Crohn's disease, magnetic resonance imaging (MRI) can be helpful to visualize the exact anatomy of the fistula and its relationship to surrounding structures such as muscles and organs. MRI provides detailed images and can help support the planning of possible surgical treatment of the anal fistula.
