Things You Need To Know About Fistula-in-ano

What Is An Anal Abscess?

An anal abscess is an infected cavity filled with pus found near the anus or rectum.

What Is An Anal Fistula (Fistula-in-ano)?

An anal fistula is frequently the result of a previous or current anal abscess. The small glands just inside the anus occasionally get clogged and potentially can become infected, leading to an abscess. The fistula is a tunnel that form under the skin and connects the infected glands to the abscess. A fistula can present with or without and abscess and may connect just to the skin of the buttocks near the anal opening. Other causes of fistula include Crohn's disease, tuberculosis, radiation, trauma and malignancy.

How Does Someone Get An Anal Abscess Or A Fistula?

The abscess is most often a result of an acute infection in the internal glands of the anus. Occasionally, bacteria, faecal material or foreign matter can clog the gland and create a condition for an abscess cavity to form.

After an abscess drains on its own or has been drained (opened), a tunnel (fistula) may persist connecting the infected anal gland to the external skin. This typically will involve some type of drainage from the external opening and occurs in up to 50% of the abscesses. If the opening on the skin heals when the fistula is present, a recurrent abscess may develop.

What Are The Signs And Symptoms Of An Abscess Or Fistula?

A patient with an abscess may have pain, redness or swelling around the anal area. Fever or chills are also common. In a patient with a fistula, there will be additional symptoms of irritation of the perianal skin or drainage from an external opening.

Is Any Specific Testing Necessary To Diagnose An Abscess Of Fistula?

No. Most of the abscesses or fistula are diagnosed and managed on the basis of clinical findings. Occasionally, a MRI or endoanal ultrasound can assist with the diagnosis of deeper abscesses or the delineation of the fistula tunnel to help guide treatment.

What Is The Treatment Of An Anal Abscess?

Surgical drainage is needed under most circumstances. An incision is made in the skin near the anus to drain the pus. It can be performed under local anaesthesia or general anaesthesia for bigger and deeper abscess. The wound would be left open and let it heal by itself. Hospitalisation may be required in patients prone to more significant infections such as diabetics or patients with decreased immunity.

What Is The Treatment Of An Anal Fistula?

Surgery is almost always necessary to cure an anal fistula. Although surgery can be fairly straightforward, it may also be complicated, occasionally requiring staged or multiple operations. It is advisable to consult a colorectal surgeon to discuss the different types of potential operations.

The surgery may be performed at the same time as drainage of an abscess, although sometimes the fistula does not appear until weeks to years after the initial drainage. If the fistula is straightforward, a fistulotomy may be performed. Other procedures include placing material within the fistula tract to occlude it or surgically altering the surrounding tissue to accomplish closure of the fistula, with the choice of procedure depending upon the type, length and location of the fistula.

What Is The Recovery Like From Surgery?

Pain after surgery is controlled with painkillers, fibers and bulk laxatives. Sitz bath is encouraged and to avoid constipation. You can discuss with your surgeon the specific care and time away from work prior to surgery to prepare yourself for post-operative care.

Can The Abscess Or Fistula Recur?

Yes. Both abscesses and fistulas can potentially recur. Should similar symptoms arise, suggesting recurrence, it is recommended that you visit a colorectal surgeon to manage your condition.

Source:ASCRS