Anal Fistula Singapore – An anal fistula is a medical condition that often causes significant discomfort and distress to those affected. In Singapore, many individuals seek medical attention for this condition, which typically manifests as a small tunnel connecting an infected gland inside the anus to an opening on the skin around the anus. While the condition is treatable, it requires a clear medical diagnosis and a tailored management plan to ensure effective recovery and to minimise the risk of recurrence.
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What Is An Anal Fistula?
An anal fistula is essentially an abnormal track or communication between the epithelial-lined anal canal and the perianal skin. Most anal fistulas start as an infection in an anal gland, which develops into an abscess. If the abscess does not heal properly or if it is drained but the underlying infection persists, a fistula may form. This tunnel can cause symptoms such as persistent pain, swelling, and the discharge of pus or blood from the external opening.
What Causes An Anal Fistula To Develop?
The primary cause of an anal fistula is a previous anal abscess. Research indicates that approximately 50 per cent of individuals who experience an anal abscess will go on to develop a fistula. Other factors that may contribute to the development of this condition include:
- Inflammatory Bowel Disease (IBD): Conditions such as Crohn’s disease or ulcerative colitis can increase the risk of developing complex fistulas.
- Infections: Certain infections, including tuberculosis or sexually transmitted infections, may play a role in some cases.
- Trauma: Previous surgery or injury to the anal area can sometimes lead to fistula formation.
- Radiation Therapy: Treatment for cancers in the pelvic region can occasionally result in fistulas as a side effect.
There is currently an information gap regarding the specific genetic markers that might predispose certain individuals in the Singaporean population to anal fistulas more than others.
What Are The Treatment Options For Anal Fistula Singapore?
Surgery is almost always necessary to treat an anal fistula, as they rarely heal on their own. The goal of surgery is to heal the fistula while protecting the anal sphincter muscles to prevent incontinence. Common surgical procedures available in Singapore include:
1. Fistulotomy
This is the most common type of fistula surgery, especially for simple, low fistulas. It involves cutting open the fistula tract to allow it to heal from the inside out. It has a high success rate and is often performed as a day procedure.
2. Seton Placement
For complex or high fistulas that involve a significant portion of the anal sphincter, a seton (a thin piece of surgical thread) may be placed through the fistula tract. This allows the area to drain and reduces the risk of abscess formation. It also helps to avoid cutting through the muscle.
Setons are often used in staged procedures or in combination with other treatments.
3. LIFT Procedure (Ligation of Intersphincteric Fistula Tract)
This is a sphincter-preserving surgery designed for complex fistulas. It involves accessing the fistula tract between the sphincter muscles and securely closing it off. Healing time is generally faster, and continence is maintained.
4. Advancement Flap Surgery
This procedure involves removing the internal fistula opening and covering it with a flap of healthy tissue. It is typically used when previous surgeries have failed or in recurrent cases.
5. Fibrin Glue Or Plug
These approaches do not involve cutting. Fibrin glue is injected into the fistula tract to seal it, while a collagen-based plug is used to block the opening. Although these options are less invasive, they have lower success rates compared to traditional surgery. They are usually considered in specific scenarios, such as when a patient wishes to avoid more invasive procedures.
Minimally Invasive Approaches For Fistula Surgery
- Video Assisted Anal Fistula Treatment (VAAFT)
- FiLAC (Laser treatment for Anal fistula)
VAAFT (Video-Assisted Anal Fistula Treatment) and FiLaC (Fistula Laser Closure) are minimally invasive treatments that use an endoscopic or laser approach to close the fistula from the inside. These techniques aim to treat the fistula without cutting the sphincter muscle, which means there is little to no risk of losing bowel control.
According to the Ministry of Health (MOH) fee benchmarks, the surgical fees for “Anus, Fissure, Excision/Lateral Sphincterotomy” (TOSP code SF831A) in the private sector range between $2,100 and $3,400. For patients requiring inpatient care for this procedure, the historical hospital fee benchmark is between $5,568 – $7,325.
What Are The Chances Of Recurrence?
The risk of an anal fistula returning after surgery depends on the complexity of the fistula and the type of procedure performed. While most simple fistulas have a high success rate after a fistulotomy, complex fistulas—especially those involving a significant portion of the sphincter muscle—have a higher risk of recurrence. Proper post-operative care and following the advice of your medical professional are essential to reduce this risk. If symptoms like pain or discharge return, it is important to seek a medical review immediately.
How Can One Prevent Anal Fistulas?
While it is not always possible to prevent an anal fistula, particularly if it arises from an underlying condition like Crohn’s disease, certain steps can reduce the risk:
- Prompt Treatment of Abscesses: Seeking medical attention early for any anal pain or swelling can prevent an abscess from progressing into a fistula.
- Manage Bowel Habits: Maintaining soft, regular stools through a high-fibre diet and adequate hydration can reduce strain on the anal canal.
- Manage Underlying Conditions: If you have IBD, working closely with your doctor to keep the condition in remission is crucial.
Find A Doctor For Treatment Of Anal Fistula In Singapore
If you are looking for a Doctor for Anal Fistula Singapore treatment, you can consider our Preferred Doctors:
- Dr Chong Choon Seng is a highly experienced colorectal surgeon in Singapore known for his expertise in minimally invasive and robotic techniques for colorectal cancer, polyps, and complex anorectal conditions. With extensive training and years of surgical practice, he is trusted for delivering safe, precise, and evidence‑based care tailored to each patient’s needs.
- Dr Lee Kuok Chung is a highly experienced colorectal surgeon with nearly 20 years of practice, specialising in minimally invasive and robotic surgery for colorectal cancer and complex perianal conditions. He is also one of the few surgeons in Singapore skilled in advanced endoscopic techniques such as EMR and ESD, allowing large polyps and early cancers to be removed without major surgery.
- Dr Daniel Lee is a highly experienced colorectal surgeon in Singapore, known for his expertise in minimally invasive techniques such as laparoscopic colorectal surgery, TAMIS, and advanced laser procedures for piles, fistulas, and pilonidal disease. Dr Lee is trusted for handling even the most challenging cases.
Dr Chong Choon Seng 张峻诚医生
[SG] Featured Doctor- Dr Kevin Koo
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