Anal abscess and anal fistula

What is an anal abscess?

An anal abscess occurs near the back passage or anus. It usually develops quickly and causes pain in the rectum, anus, along with fever, chills and general feeling unwell. An obvious pain may occur in the back or anus.

Anal fistulas are almost always caused by an abscess. Fistula is a connection between an infected anterior anal gland and the skin on the buttocks, outside of the anus. A persistent discharge from an area or sinus close to the anus is a sign. This may occur at the site where a perianal abscess has been discharged.

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What causes a perianal abscess abscess

Small glands are located just inside the anus. These glands can become clogged and infected, which could lead to an abscess.

An abscess is caused by an acute infection of the anal glands. This happens when bacteria or other foreign matter enters the tissue via the gland. These infections can be more common in certain conditions, such as colitis and other inflammations of the intestine.

What causes ano fistula?

Anal fistulas are usually caused by an anal abscess, a collection of pus that has burst, or when the abscess is not completely treated. A tunnel that connects the anal gland to the skin may remain after an abscess is drained. This could indicate that the tunnel is still present if there is persistent drainage from the opening outside. Recurrent abscess can develop if the tunnel's outside opening heals.

Fistula can also occur due to conditions that affect the intestines such as Crohn’s disease and ulcerative colitis. Anal fistulas can be seen in as many as half of those with Crohn's. Anal fistula can also be developed by HIV-infected people (a virus that attacks your immune system).

Anal fistulae is more common in men between the ages 20 and 40. In 2007, a study that examined four European countries including England found that anal fistulae are common in between one and three cases for every 10,000 persons.

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What are the signs of an abscess?

An abscess usually causes pain and swelling around your anus. People may also feel fatigue, fevers, and chills. The following symptoms are associated with fistula:

• Discharge pus from an area near the anus to relieve pain
• Anal pain and discomfort
• Itching of the skin around and around the anus
• Some blood is lost during the discharge
• Fever
• Malaise is caused by eating poorly

Is an abscess always a fistula.

About 1/3 of patients who have an abscess get it removed. A third of patients will have more abscesses. A third to half of those who get further abscesses will develop a fistula. It is impossible to predict when this might happen.

What is the diagnosis of a perianal fistula and abscess in ano?

Both conditions can usually be diagnosed by a specialist after a thorough clinical examination. Sometimes, specialist scans may be required (e.g. MRI, CT, or ultrasound scan. Alternatively, your specialist might need to have you come in for an anaesthetic examination to complete an assessment of the anal area.

What is the treatment for a perianal abscess?

Sometimes, an abscess can "burst" onto the skin and drain pus. This happens more often if an abscess forms at the site of an existing abscess, or an operation site that was used to drain an abscess.

A new abscess may need to be treated with an operation to drain the pus. To drain the pus from the abscess, make a small incision in the skin close to the anus. Sometimes, very superficial abscesses may be treated with local anaesthesia. Many patients prefer to have their abscesses treated under general anaesthesia. This can be done in a few hours or overnight. However, patients with more severe infections such as diabetes or those with weakened immunity may need to stay longer in hospital. Because antibiotics cannot penetrate the fluid in an abscess, they are not a good alternative to draining it.

What can be done to treat a fistula?

Anal fistula can be treated with surgery. Fistula surgery can be performed in a relatively simple manner, but complications are possible. It is best to have it done by a specialist who is experienced in both colon and rectal surgery. Although it can be done simultaneously with the abscess, fistulas may develop up to six weeks or more after the abscess has been drained.

A surgeon might decide to conduct an initial assessment to determine if there are any openings or if the fistula has traveled deeply through the sphincter muscles. Surgery is often performed in a series of stages. First, a Seton stitch is passed along the fistula to allow any remaining abscess to drain. 6-8 weeks later, definitive surgery is usually performed.

Anal fistulas can be treated with many different procedures. Your surgeon will discuss the best option for you. Your surgeon will consider a variety of factors when deciding which operation is best for you. These include the depth of your fistula through your sphincter muscles, whether you have ever had children or not, and whether you have any other bowel conditions like Crohn's disease. A division of too much muscle could lead to poor sphincter control or faecal leakage.

Your surgeon may recommend other methods to treat fistula. Below are the most commonly performed operations.

Fistulotomy. This procedure is used frequently and involves cutting the entire length of the fistula to allow the surgeon to flush the contents. The scar will become flattened after about one to two weeks.

Seton suture. Seton suture, also known as Seton drain, is a piece or silastic loop that is left in the fistula. If you have a high risk of developing incontinence after the fistula crosses over the sphincter muscles, this may be an option. Sometimes multiple operations are required. Gradually tighten the Seton suture until it gradually cuts through the fistula.

Rectal advancement flap. This is most often used when the fistula has been considered to be complex or if there is a high chance of incontinence. An advancement flap is a small piece of tissue that is removed either from the rectum, or from the skin surrounding the anus. The fistula tract must be removed during surgery and the flap must be reattached to the area where it was. In about 70% of cases, the operation is successful.

Fibrin glue. This is the only non-surgical option currently. To seal the fistula, the glue is injected. Then the opening is closed with a stitch. Although it is painless, simple and safe, the long-term results are not good. After 16 months, success rates of 77% are reduced to 14% from their initial rate.

Bioprosthetic plug. This plug is made of human tissue and is cone-shaped. It is used to close the fistula's internal opening. It is held in place by stitches. This does not seal the fistula completely, but it allows for drainage. To heal the fistula, new tissue is usually formed around the plug. This method has been tested in two trials and the success rate was over 80%. However, long-term success rates are not known.

LIFT (Ligation and Fistula Tract of the Intersphincteric Fistula Tract)

Fistula surgery is usually performed outpatient. A short hospital stay may be required for treatment of an extensive or deep fistula.

How long does it take for patients to feel better?

For the first week, discomfort following fistula surgery may be mild to moderate. Pain pills can be used to manage it. Most people don't lose too much time from school or work.

After treatment of an abscess, or fistula, it is recommended to stay at home for a few days. Warm water can be used to soothe the area. Some stool softeners (e.g. lactulose) or a bulk fibre laxative (e.g. Fybogel may also be recommended. To prevent clothes from getting soiled, it may be necessary to use a mini-pad or gauze pad. The healing process will not be affected by bowel movements.

What are the odds of an abscess/fistula recurring?

The problem should be treated properly and will not return. To prevent the problem from returning, it is important that you follow the instructions of a rectal and colon surgeon.

Is there any long-term side effects to surgery for a fistula?

Anal fistula surgery can lead to complications, such as:

• Infection
• Bowel incontinence
• Recurrences of the anal fistula (i.e. The fistula returns)

An example: After the most common type fistulotomy (also known as a fistulotomy), there is a 21% chance of an anal fistula returning. The type of procedure will determine the risks. This can be discussed with your surgeon.

Very rarely, if someone has weak muscles around their back passage (anal Sphincter), and a tendency towards difficulty controlling the bowels or leakage, it may get worse after the surgery. Talk to your Fistula doctor in Kolkata if you have any difficulties.