Motherhood is a beautiful journey, but pregnancy and childbirth can bring unexpected health challenges. One such rarely discussed, however deeply uncomfortable issue is post-pregnancy anal fistula. Many women suffer silently due to embarrassment, lack of awareness, or fear of surgery. As a leading fistula specialist in Pune, Dr. Samrat Jankar at Kaizen Fistula Care Clinic explains why these fistulas develop after childbirth and the advanced treatment options available today for complete recovery.
What is an Anal Fistula?
An anal fistula is an abnormal tunnel-like connection between the anal canal and the skin near the anus. It usually develops after an infection in an anal gland leads to an abscess, which, if not healed completely, forms a tract connecting the infected gland to the skin.
Why Do Anal Fistulas Occur Post-Pregnancy?
While anal fistulas are common in both genders, certain childbirth-related factors increase their risk in women:
- Obstetric Injury: During vaginal delivery, specifically with prolonged labor, forceps delivery, or a large baby, there can be perineal tears extending into the anal sphincter complex. These injuries, known as obstetric anal sphincter injuries (OASIS), can damage the anal glands, creating conditions for abscess formation and fistula development.
- Episiotomy Complications: An episiotomy (surgical cut to enlarge the vaginal opening) performed improperly or with poor healing can predispose to infections and fistula formation.
- Perianal Infections: Post-delivery hygiene challenges, constipation, or minor injuries during delivery can cause infections near the anus, leading to abscesses that turn into fistulas if not treated promptly.
- Crohn’s Disease Activation Postpartum: For women with underlying Crohn’s disease, hormonal and immune changes after delivery can trigger perianal disease activity, leading to complex fistulas.
- Prolonged Pressure: Long labor hours cause constant pressure on the pelvic floor and perianal region, impairing blood flow and increasing infection risk.
Symptoms to Watch For:
Post-pregnancy anal fistula symptoms often arise within weeks to months after delivery and include:
- Recurrent perianal abscesses or boils
- Persistent discharge of pus or blood from an opening near the anus
- Pain and swelling near the anus
- Irritation and difficulty in maintaining hygiene
- Foul-smelling discharge causing embarrassment
Women may ignore these symptoms, thinking they are minor postpartum problems, but early diagnosis and treatment are essential to prevent worsening.
Diagnosis: How Is It Confirmed?
At Kaizen Fistula Care Clinic, Dr. Samrat Jankar uses a combination of:
- Clinical Examination: Recognizing external openings, discharge, and pain points.
- MRI Fistulogram: The gold standard imaging to map fistula tracts, internal openings, and their relation to sphincter muscles.
- Endoanal Ultrasound: Useful for assessing sphincter involvement and complex tracts.
Precise mapping is vital to plan effective treatment, especially in post-pregnancy fistulas, which often run close to or through sphincter muscles.
Modern Treatment Options for Post-Pregnancy Anal Fistulas:
1. Fistulotomy:
- Suited for simple superficial fistulas away from the sphincter muscles.
- Involves cutting open the fistula tract to heal from the inside out.
- Rarely used in post-pregnancy fistulas due to the high risk of sphincter injury and incontinence.
2. Seton Placement:
- Involves placing a medical thread (seton) through the fistula tract to keep it open and drain infection.
- Used as a staged procedure for complex or high fistulas to lower infection rates before definitive treatment.
- Minimises risk to sphincter muscles.
3. LIFT Procedure (Ligation of Intersphincteric Fistula Tract):
- A sphincter-saving technique is ideal for transsphincteric fistulas, which are common post-pregnancy.
- The fistula tract is accessed in the intersphincteric plane and ligated, allowing it to heal without dividing sphincter muscles.
- Minimal pain, quick recovery, and high success rates.
4. VAAFT (Video Assisted Anal Fistula Treatment):
- A minimally invasive endoscopic technique was performed by Dr. Samrat Jankar.
- A fistuloscope is used to visualise and clean the tract internally, followed by closure of the internal opening.
- Preserves anal sphincter function, decreases postoperative pain, and stimulates faster healing.
5. Fistula Plug or Glue:
- A collagen-based bio plug or fibrin glue is inserted into the fistula tract to seal it.
- No cutting of muscles, but success rates vary; used in select patients.
6. Advancement Flap Surgery:
- For fistulas with internal openings close to the sphincter, an advancement flap is created to cover the internal opening after cleaning the tract.
- Good option when preserving the sphincter is critical.
7. Laser Fistula Treatment (FiLaC):
- A radial laser probe is inserted into the fistula tract, delivering energy to close it from within.
- Minimally invasive, preserves sphincter, with reduced postoperative discomfort.
Conclusion:
Post-pregnancy anal fistulas can harshly impact a woman’s quality of life, emotional health, and confidence. However, with modern minimally invasive treatments, a complete cure is possible without fear of incontinence or long hospital stays. If you are experiencing persistent perianal pain, discharge, or recurring abscesses after delivery, consult Dr. Samrat Jankar at Kaizen Fistula Care Clinic today. Early intervention not only ensures faster healing but also restores your comfort and confidence in daily life. For appointments and expert fistula care, contact Kaizen Fistula Care Clinic, Pune.
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