Perianal abscess is the most common type of abscess. This often appears as a painful boil-like swelling near the anus and supralevator is the least. Also, sometimes these particular types of abscess spread partially circumferentially around the anus or the rectum when this happens then the condition is often described as horseshoe abscess.
On the other hand, fistula is classified by its relationship to parts of the anal sphincter complex.
Types of Fistula
The most common fistula isintersphincteric and extrasphincteric is considered as the least common. These classification or categorisation are done in order to help surgeons in making the treatment decisions.
Symptoms of an anal abscess and fistula
There are several symptoms of an anal abscess but throbbing and constant pain in the anal area are the most common symptoms.
Other symptoms of an anal abscess;
2. Rectal discharge or bleeding
3. Swelling or tenderness of the skin surrounding the anus
On the other hand patients with fistulas usually, have a history of a previously drained anal abscess.
Symptoms of fistulas;
1. Anorectal pain
2. Irritation and drainage from the perianal skin
4. Drain pus or a foul-smelling discharge
Why there is a need to examinean anal abscess and fistula?
It is very imperative for a doctor to be aware of the patient’s anorectal symptoms and past medical history which should be then followed by a physical examination. However, according to some findings, diagnosis of a perirectal abscess leads to fever, redness, swelling and tenderness to palpation.
On the other hand, a doctor diagnoses an anal fistula by examining an external opening that drains pus, blood or stool. Sometimes it is hard to identify it as closes spontaneously with the drainage may be intermittent.
Use of diagnostic studies
Most anal abscesses and fistula are diagnosed and managed on the basis of clinical findings. Often additional studies can assist or aid the diagnosis or delineation of the fistula tunnel.
With the advancement of the technology both traditional two-dimensional and three-dimensional endoanal ultrasound prove to be very effective in diagnosing a deep perirectal abscess and also identifying a horseshoe extension of the abscess. In order to achieve maximum accuracy, this may be combined with hydrogen peroxide injection and injected into the fistula tract.
Treatment of an anal abscess
Usually, there is less requirement of treatment in the anal abscess. The most common and simple treatment is to drain the pus from the infected area. The same treatment can be undertaken through the surgical procedure also. This is done through by making an incision in the skin near the anus to drain the infection. If it is left untreated, then it turns into painful anal fistulas that may require more complicated surgical treatment. In some cases, a catheter may be used to make sure the abscess drains completely. Drained abscesses are left open and don’t require stitches.
Post-surgery, it is often advised to have warm (not hot) baths. This helps in reducing the swelling and allows for more drainage of the abscess. The doctor may also prescribe antibiotics if the patient has a compromised immune system or if the infection has spread.
Treatment of anal fistula
There are several treatments that are been into the application;
However, currently there is no medical treatment available for this problem which nessaciate the surgery to cure it. The procedure of fistulotomy is usually performed if the fistula is straightforward. This procedure involves unroofing the tract, thereby connecting the internal opening within the anal canal to the external opening and creating a groove that will heal from the inside out. In fact, the surgery can be performed for the drainage of an abscess.
Fibrin glue injection
Apart from fistulotomy, there are several other options available for anal fistula which does not involve the division of the sphincter muscles. Fibrin glue injection is another treatment, in which fibrin glue is injected into the fistula tract to obliterate the tract with the objective of becoming incorporated in the surrounding tissue. It actually avoids the division of any sphincter muscle. However, the treatment is a failure with this approach.
Anal fistula plug
An anal fistula plug is an elongated piece of material that is actually placed throughout the length of the fistula tract to fill the tract space and incorporate itself into the tissue around it. The plug does not require the division of the sphincter muscle.
It is a procedure which is made to treat the complex fistulas or it is for patients with an increased potential risk for suffering incontinence from a traditional fistulotomy. Here, the internal opening of the fistula is covered over by healthy, native tissue is actually an attempt to close the point of origin of the fistula. Although the procedure does not involve the division of sphincter muscle but mild to moderate incontinence has still been reported.
LIFT (ligation of the intersphincteric fistula tract)
The procedure involves the division of the fistula tract in the space between the internal and external sphincter muscles. Although, it avoids the division of the sphincter muscle, but as much popular as fistulotomy.
Mostly the operations can be performed on an outpatient basis, but in special cases, it may require hospitalization.
What is a seton?
Setons is actually used as a temporary initial intervention in the management of a fistula. Seton is a thin piece of rubber or suture which is placed through the entire fistula tract and the ends of the seton (or drain) are brought together and secured, finally forming a ring around the anus involving the fistula tract. The surgeon may recommend the initial placement of a draining seton. In order to experience controlled drainage, seton is placed for 8-12 weeks. This facilitates with minimal pain and can have a normal bowel function.
Treatment of fistulas in crohn’s disease
Patients with Crohn’s disease are usually having an increased risk for faecal incontinence because it tends to recur and may lead to multiple operations involving the sphincter muscle. However, Fistula is very common while suffering from Crohn’s disease. It is imperative to treat Crohn’s perianal fistulas with surgery reserved for treating infection and, occasionally, as a supplement to medical therapy.
Recovery after surgery?
Often pain relief pills are consumed by the patient to control pain. Also, it is advised for sitz baths and avoiding constipation that can be associated with prescription pain medication. Also, there is a need to keep an eye as there are always possible risks with the reoccurrence of the condition.
Abscess and Fistula: Reoccurrence
According to a study, 50% of abscesses are another abscess or are a frank fistula. Despite properly treating it and with complete care, fistulas can potentially recur, with recurrence rates dependent upon the particular surgical technique utilized. So, it is imperative to always remain in touch with the doctor at the same time following the preventive measure advised by him.