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Anal fistula and Anorectal Sepsis
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Anal fistula is a recurrent infection affecting the anus and occasionally the lower rectum. It causes considerable discomfort and disability to the sufferer of this chronic condition.
In Singapore, this condition is also known as the 'rat hole' (Lao Shudong) amongst the Chinese community and traditional Chinese medical practitioners. It commonly affects economically active adults in the 3rd to 5th decades of life.
Although, anal fistula has been recognized for thousands of years, the treatment of the complex or recurrent anal fistula continues to challenge surgeons till today.
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A fistula is a medical term describing an abnormal tract with two openings (internal and external) communicating between any two epithelium-lined surfaces.
Therefore, an anal fistula is an abnormal tract communicating between the perianal area to the anal canal and occasionally to the lower rectum.
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Infection of the anal gland gives rise to anal abscess and unresolved prolonged infection of these anal glands results in the formation of anal fistula (crytoglandular hypothesis).
90% of all anal abscesses result from non-specific infection of the anal glands. We do not know why certain individuals are prone to this infection but approximately 25% to 30% of these patients with anal abscesses will eventually end up with an anal fistula [1].
Only people with susceptible anal glands can develop anal abscess and eventually anal fistula.
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