Anal Fistula Assessment and Treatment in Bahrain

Symptoms to look out for

• Persistent or intermittent discharge of pus, fluid or blood near the anus.
• A small opening in the perianal skin that closes and reopens.
• Recurrent perianal abscesses in the same area.
• Irritation, moisture and skin soreness around the anus.
• Pain that builds up until the area discharges, then eases.

The link with perianal abscess

Most fistulas begin as an infection of a small anal gland, which forms an abscess. Once the abscess is drained, a residual tract may remain between the gland and the skin. This is why a fistula so often follows an abscess, and why an abscess that keeps returning in the same place suggests an underlying fistula.

Anatomy and why it matters

Fistulas are classified by their relationship to the sphincter muscles — intersphincteric, transsphincteric, suprasphincteric or extrasphincteric — and may be simple or complex with side branches. The amount of sphincter muscle crossed by the tract directly determines which operations are safe, because continence depends on keeping those muscles intact.

When an MRI is appropriate

• Recurrent fistula after previous surgery.
• Suspected complex or branching tracts.
• High fistulas involving a significant part of the sphincter.
• Suspected Crohn's disease or multiple openings.
• Simple, low fistulas can often be assessed clinically and at examination under anaesthesia without MRI.

Treatment planning and protecting continence

• Drainage first if an abscess is present.
• Fistulotomy: laying open a low, simple tract, with excellent healing rates when little muscle is involved.
• Seton placement: a soft thread that drains the tract and protects the sphincter, sometimes as a staged approach.
• Sphincter-preserving options such as LIFT or advancement flap for higher tracts.
• The plan balances the chance of cure against the risk to continence, and is discussed in detail before any operation.

Your booking journey

• Book if you have perianal discharge lasting more than two weeks, or a second abscess in the same area.
• Bring any previous operative notes, MRI reports and images.
• The consultation includes examination and a discussion of whether MRI is required.
• A staged plan is common, and each stage is explained in advance.