Patients who feel ill and complain of chills, fever and pain in the rectum or anus could be suffering from an anal abscess or fistula. These are common ailments, but not most people know very little about it.
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?
An anal fistula is a small tunnel connecting the anal gland from which the abscess arose to the skin of the buttocks outside the anus. They are almost always the result of a previous abscess.
What causes an anal abscess?
An abscess results from an acute infection of a small gland just inside the anus, when bacteria or foreign matter enters the tissue through the gland. Certain conditions including colitis or other inflammation of the intestine, can make these infections more likely.
What causes a fistula?
After an abscess has been drained, a tunnel may persist connecting the anal gland from which the abscess arose to the skin. If this occurs, persistent drainage from the outside opening may indicate the presence of this tunnel. If the outside opening of the tunnel heals, recurrent abscess may develop.
What are the symptoms of an abscess or fistula?
Symptoms of both ailments include constant pain, sometimes accompanied by swelling, that is not necessarily related to bowel movements. Other symptoms include irritation of skin around the anus, drainage of pus (which often relieves the pain), fever, and a general feeling of not feeling well.
Does an abscess always become a fistula?
No. A fistula develops in about 50 percent of all abscess cases, and there is really no way to predict if this will occur.
How is an abscess treated?
An abscess is treated by draining the pus from the infected cavity, making an opening in the skin near the anus to relieve the pressure. Often this can be done in our office using a local anesthetic.
A large or deep abscess may require hospitalization and use of a different anesthetic method. Hospitalization may also be necessary for patients prone to more serious infections, such as diabetics or people with decreased immunity. Antibiotics are not usually an alternative to draining the pus, because antibiotics are carried by the blood stream and do not penetrate the fluid within an abscess.
How are fistulas treated?
Surgery is necessary to cure an anal fistula. Although fistula surgery is usually not invasive, the potential for complication does exists, and should be performed by a colon and rectal surgeon.
Fistula surgery may be performed at the same time as abscess surgery, although fistulas often develop four to six weeks after an abscess is drained sometimes even months or years later. Fistula surgery usually involves cutting a small portion of the anal sphincter muscle to open the tunnel, joining the external and internal opening and converting the tunnel into a groove that will then heal from within outward. Most fistula surgery can be performed on an outpatient basis – or with a short hospital stay.
How long does recovery take?
Treatment of an abscess or fistula is followed by resting at home and soaking the affected area in a sitz bath 3-4 times a day. Some patients feel discomfort or pain that can be controlled with medication. Stool softeners may also be recommended. It may be necessary to wear a gauze pad or mini-pad to prevent the drainage from soiling clothes.
After surgery the amount of time lost from work is usually minimal and most patients can return to normal activity within a week.
What are the chances of a recurrence of an abscess or fistula?
If properly healed, the problem will usually not return. However, it is important to follow the directions of your CRS surgeon to prevent recurrence.