Anal Fistula (Child)

The anal canal is the end portion of the intestinal tract. It includes the rectum and anus. Sometimes an abnormal passage forms from the anal canal to the skin near the anus. This is called an anal fistula. Anal fistulas can also form from the anal canal to other organs, such as the vagina or urinary tract.

An anal fistula may be present at birth (congenital). It may also occur because of an anal abscess or infection or a condition, such as Crohn's disease. Trauma to the anal canal and surgery can also lead to anal fistulas.

Symptoms of an anal fistula can include:

• Pain in or near the rectum
• Drainage. This may contain blood, pus, or both. The drainage may be constant or stop and start again.
• Bleeding from the rectum
• Urinary problems

The main concern with an anal fistula is infection. If an infection can't drain, a collection of pus called an anal abscess may form. An infection or abscess may cause redness, swelling, or soreness in or near the anus or rectum. Your child may also have a fever.

If caused by Crohn's disease, an anal fistula may respond to medicines, such as antibiotics and immunosuppressants. This may lead to complete closure of the fistula. But there is still a chance that a fistula may form again.

Anal fistulas often need surgery if other treatments don't correct the problem. The type of surgery depends on the type of fistula. More than one surgery may be needed. In certain cases, the child is given a colostomy during the surgery. This creates an opening (stoma) in the belly (abdomen) for stool to pass through. The stool is collected in a bag or pouch worn outside the body. The colostomy may be temporary or permanent. Long-term care depends on the type of fistula and success of the surgery. Some children may be given a special diet to help them have regular bowel movements.

Your child may be prescribed medicines, such as pain relievers and antibiotics. Follow all instructions when giving these medicines to your child.

If your child had surgery, instructions for recovery may include:

• Watching the incision site for signs of infection (see below)
• Soaking in a warm bath 3 or 4 times a day ("sitz bath")
• Wearing a pad over the anal area until healing is completed
• Eating a diet high in fiber
• Drinking plenty of fluids
• Using a stool softener or bulk laxative as needed

If your child has a colostomy, you may be given the following care instructions:

• Wash your hands with soap and warm water before and after caring for the colostomy.
• Empty the pouch as often as directed. Also, make sure that the pouch is secure and fits well.
• Clean the skin around the stoma with soap and warm water and gently pat it dry. Protect the skin with a barrier as prescribed by the doctor.
• Watch the area for signs of infection (see below).

Note: Older children should be taught how to care for the colostomy and skin around the stoma. Younger children are more likely to need help caring for their colostomy.

Following treatment, you may be asked to keep a careful record of when your child has a bowel movement. Include details about the location (anus or colostomy) and the type of stool that was passed. This will help the doctor plan treatment for your child in the future. Older children may be taught to keep their own record.

Follow up with your child's doctor as advised. If you have any questions or concerns, discuss them with the doctor.

Contact your child's doctor right away if they have:

• A fever of any kind
• Abnormal bowel patterns
• Symptoms, such as pain or drainage, that may mean the fistula has returned
• Pain, redness, swelling, bleeding, or drainage near an incision or stoma site or near the anus or rectum
• Pain in the belly that does not respond to treatment or that does not go away after a few hours
• Swelling in the belly that does not go away after a few hours
• Mucus, pus, or blood in the stool (dark or bright red)
• Vomiting that won't stop