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I have haemorrhoids, but I refuse to stop practising anal sex. Two weeks ago I’ve experienced bleeding from my anus, together with pain and itchiness. I thought those were caused by haemorrhoids, but it turned out that there was something called anal fistula in my body. Is this really possible? I was convinced that the cause was the combination of haemorrhoids and anal sex. What actually is anal fistula?

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Hi Behney, my name's George. What I meant to ask you is who diagnosed you? Were you to seek a specialist about that? An anal fistula represents a small tunnel that can possibly develop between the skin near the anus and the end of the bowel. It's easy to recognize but can be mistaken for hemorrhoids. The main symptom is skin irritation around the anus, blood around your anus, also it can get swollen. Anal fistula can be dealt with surgery, but also with fistulotomy or various kinds of procedures. But I advise you to consult your surgeon before doing anything. 

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One of the causes of rectal bleeding can be associated with haemorrhoids, but there are other causes, too. Some of them are fissure, diverticulosis, proctitis and colitis, polyps and cancer, protrusion of the rectum... And there is also anal fistula - a channel leading from your rectum to the skin around your anus. We cannot predict the appearance of anal fistula, but it is very often connected to anal abscess. Anal abscess is a pocket of pus located near the anus (but also possible deeper inside the body). Most of those abscesses do not have any particular cause (one of the causes can be bacterial infection), they appear spontaneously. About 50% of anal abscesses are followed by the development of anal fistula. Fistula, i.e. channel leads the pus from the abscess to the surface. The symptoms of anal fistula are pain and discomfort, bleeding, pus and thick liquid with very bad smell. Anal fistula can be treated with antibiotics, but usually the best solution is surgery - the recovery period is short and the problem does not occur again. However, anal fistula can sometimes point to the presence of Crohn's disease (chronic inlamation o the bowel).
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