Fact: Crohn’s disease can affect the entire gastrointestinal tract from mouth to anus. Understandably, people don’t talk much about one of the most painful symptoms that can accompany Crohn’s: anal fistulas. For most people, these are very difficult and embarrassing to discuss, as they can result in bleeding, infections and the loss of control over one's bowels.
What are anal fistulas?
According to the Cleveland Clinic:
The anus is the external opening through which feces are expelled from the body. Just inside the anus are a number of small glands. If one of these glands become blocked, an abscess—an infected cavity—may form. An anal abscess is usually treated by surgical drainage, although some drain spontaneously. About 50 percent of these abscesses may develop into a fistula, in which a small tunnel connects the infected gland inside the anus to an opening on the skin around the anus.
These anal fistulas which normally start with an infection can cause:
- Night sweats
In layman's terms, the infection — which builds up and is normally very acidic and corrosive to the body — eats its way through the tissue to the outer regions of the skin around the anus. For women, it can sometimes even lead to vaginal fistulas.
I've dealt with many abscesses and fistulas because of my Crohn’s disease over the years, but I tried to ignore my first abscess, which occurred during my freshman year of college. I had all the symptoms listed above; it felt as though a water balloon was growing inside of me. I still went to class when I could and, to be honest, didn’t really know what was going on.
That is, until one day the fistula decided to pop in the middle of class and an enormous amount of infectious material flooded my pants. I was able to feel it, so I decided to not get up until everyone else left the room. I knew something bad had happened and ran across campus to take a shower, then lay face down on my bed to relieve the pain.
One of the most difficult problems that a patient has to deal with when anal fistulas begin is the pain. It is constant and there are only a few things you can do in order to temporarily relieve it. Warm baths help, but you can only stay in water for so long. Creams can help, but they wear off and most stop working soon after application. At one point I even tried to rest on my bed with a fan blowing on the area to cool the burning feeling. It didn’t work for as long as I’d hoped.
How are fistulas treated?
Surgery is often required and is performed by a rectal and colon surgeon. The surgeon will relieve the infection and then assess the situation. After surgery, there are a few options.
A fistulotomy, where doctors take skin in the surrounding area and try to cover up the fistula’s tunnel.
Other times they will place plastic or surgical thread setons through the fistula. This will keep the track open and, it is hoped, allow it to heal as there will be less chance of an infection building up. Setons allow the fistula to drain and possibly heal without cutting the surrounding muscles. These can be left in for more than six weeks at a time, and the patient is advised to take regular baths while moving the seton if possible.
If there is no active infection and the fistulas are kept under control, a surgeon might elect to try fibrin glue which can fill up the fistula like a plug. This is only an option when there are no infections and tissue damage has been controlled.
My experiences with anal fistulas have been extensive. After getting my ostomy, I did have a break from the pain since I wasn’t having normal bowel movements anymore. Still, the rectal disease didn’t go away and four years later I decided to have my ostomy made permanent and have a proctectomy to have my rectum removed.
In the end, anal fistulas aren’t talked about enough when it comes to Crohn’s disease. Everyone thinks it’s a stomach disease but it goes far beyond that — and it goes far beyond the bathroom. Fistulas are one of the most painful and difficult aspects of this disease to deal with. It’s important that we address and talk about all aspects of Crohn’s disease. By discussing such issues, it makes us more aware and more able to deal with problems when they crop up. Crohn’s affects patients from mouth to anus — a reality that should not be ignored.