Anal fistula - Page 1

My 9 year old male German Shepherd was diagnosed with a tiny, as in seed sized, anal fistula 4 weeks ago, he was given 2 weeks of Amoxyclav and at the moment it is clean, dry and looking good.

I discovered it during a morning walk when he was very constipated (not like him at all) but I did find him eating clay a few days earlier. He has never had an anal problem before so it was by chance that I noticed it. He has since then been getting wheatbran oil each day.

Yes I have been told that it will re occur so I need to be ready. I really don't want to go the surgey route unless as a last resort.

I would love to hear from others how it is best to deal with this dreadful afliction. Thank you for any advice......

Over the years, I have had dogs with anal fistulas. They do not necessarily have to come back. My DMVs have always treated either with Protopic Ointment (Tacrolimus) or Cyclosporine. Expensive but with about a 60% chance of eliminating the fistulas. I have been lucky so far. With this treatment, they disappeared and never returned. Surgery is only a temporary fix and a last resort...Read on. All you need to know below

Treatment has historically been surgical debridement combined with long courses of antibiotics. Results were often disappointing with a high recurrence rate, and, occasional complications such as fecal incontinence or anal stricture.

Based on a positive response to many dogs to immunosuppressive drug, an immunologic basis for the disease is now suspected. In 1996 a study described 27 dogs given prednisone and a novel protein diet. The prednisone dose (plus antibiotics) given was 1 mg/lb/day for two weeks, then 0.44 mg/lb/day for another four weeks, then 0.44 mg/lb every other day (adjusted as necessary to keep fistulation to a minimum). The outcome was complete resolution in one-third, partial resolution in one-third and no improvement in one-third of the dogs

The 1997 study of 20 dogs treated with cyclosporine was reported. By 16 weeks, fistulae were completely healed in 85 percent. Fistulae recurred between two and 24 weeks after the drug was discontinued. However in seven out of 17 dogs, no prognostic factors for recurrence were identified except mean duration of fistulae before treatment was significantly longer for dogs that developed recurrence

Since the original study, 50 more dogs were treated by this same group, using lower doses of cyclosporine (1.75-3.0 mg/kg BID, blood concentrations of 100-300 ng/ml). These doses were also effective. The authors recommend dogs are treated for as long as there is progressive improvement and for four additional weeks after all fistulae appear completely healed.

A small study of five dogs treated with azathioprine and metronidazole described all dogs improved, typically reaching a plateau four to six weeks after beginning treatment. All dogs still required surgical intervention to remove anal glands (four dogs) and/or residual fistulae (five dogs), but it was concluded that the use of the medical treatment followed by surgery minimized potential morbidity associated with the aggressive use of either medical or surgical treatment alone.

A 2000 study of the effect of topical tacrolimus in 10 dogs (Misseghers et al., "Clinical observations of the treatment of canine perianal fistulas with topical tacrolimus in 10 dogs" Can Vet J, 41(8), August 2000), daily gentle cleansing of the perianal skin followed by a thin film of 0.1 percent tacrolimus ointment was applied over the entire perianal skin; the volume of ointment used was thus empirical. After 16 weeks, five showed complete resolution, four showed partial resolution and one showed no improvement. Four of the five dogs with less than complete resolution were sexually intact (three females, one male).
Although 10 to 100 times more potent, tacrolimus and cyclosporine act similarly, blocking early events in T lymphocyte differentiation. Tacrolimus is effective in the treatment of dermatoses without affecting the systemic immune system, while cyclosporine won't work for dermatoses unless immunosuppressive levels are achieved. Therefore, systemic side effects can be avoided, costs reduced and higher drug concentration achieved locally with topical tacrolimus. Systemic cyclosporine costs can be substantial; including the cost of the drug itself and the cost of monitoring blood levels to ensure an adequate, but not excessive, concentration of drug. Costs can be reduced by using concurrent ketoconozole, which acts to inhibit cyclosporine clearance; cyclosporine dose may be reduced by as much as 80 to 90 percent when ketoconazole is used

Surgical management may still be necessary if there is incomplete resolution of the fistulae, anal gland involvement or extensive fibrosis, but initial medical management is an excellent first approach. In many cases, medical management will resolve the problem completely, but if surgery is still required, it will often be less extensive with less chance of complications.

Usually caused by food allergies, run a panel to find out what he's allergic to; probably will need a grain free diet and or specialty diet (  I recommend raw , if you want kibble then Orijen 6 fish )

good luck,

Thank you Gertrude, some great info there.

 

I had a GSD with AF, about 18 years ago. We were involved in the UK in the drugs trial for Cyclosporin to be used to treat it, which it did, and it was successful and never returned. It was horrifically expensive, but so worth it. Tacrolimus ointment was developed at the same time as a topical treatment. We had already had the surgery, but the fistula had come back.  Cyclosporin (Atopica now it is approved for vet use) is still the front line treatment with a high success rate.  However, now diet seems to come into it. I have a friend with a boy with AF which is 'managed' very successfully with a fish and potato diet and antibiotics if it flares up. He has been doing well like this for over 2 years.

http://perianal-fistulas.tripod.com/MainIndex.html

zinc oxide diaper rash creams are showing good to excellent results in the fight against PAF, according to the perianal fistual support group.

My male had them related to a food allergy ( we think ) ,,,Vet recommended a food change and a course of antibiotic ( 60 days worth ) ,,,,I used  zink in the form of Desitin ( twice daily ) , kept area clean and dry,,,,regime worked well,,,

 

 

Cleaning the area first with Hebiclens, rinsing, and drying it well before applying the zinc oxide based ointment is needed for some dogs. It's not a fun disease to deal with.

I am currently dealing with this with an 8 year old Samoyed male (in tact)...Not sure if in tact has anything to do with this but it might;  however I have had a few other dogs with this as sammies are known for this problem also.  I just purchased a fairly new product called Glandex (glandex.com) that is supposed to help keep everything flowing smoothly (ingredients are listed on web) mostly fiber and some probiotics.  Started my current male on it about a week ago, so far so good and all is healing very well and closing up nicely;  made up a solution of hydrogen peroxide, mild soap (dial forming bath soap) alcohol and water in spray bottle, sprayed and soaked down twice daily and rinsed well with hose (outside) and let dry.  Has healed up beautifully after only a week of spraying and washing twice daily.  Am keeping fingers crossed it does not come back as vet felt if one area imparticular did not heal that he may have trouble (tumor trouble).  Ugh.  So that is my pleasant experience with these little PITA's.  Hope your boy heals up well.  Best of luck  Nan

MY PF dog did not respond to local treatment, not all do; he was an aggressive dog and very hard to treat without a muzzle. He developed a malignant rectal tumor, so was never treated with atopica.