ANAL ABSCESS, FISTULA, OR FISSURE
Sometimes infections or tears can occur around the area of the anus, the final sphincter valve of the gastrointestinal tract. An anal abscess is an infected cavity that fills with pus near the anus and rectum. Usually the abscess itself is on the buttock tissues near the anus and it is first noticed when the patient starts having some tenderness and swelling and pain with bowel movements. Sometimes the area bursts open and drains. This often requires antibiotics if there is no pus involved. However, once a hard nodule has formed it is most likely a pus filled cavity and this will not go away until the pus is drained. Unfortunately antibiotics cannot sterilize the pus in the cavity. Drainage can be performed in an office procedure with administration of local injectable anesthetic. Sometimes larger more complicated abscesses require hospitalization and drainage in the operating room.
Sometimes if abscesses continue to recur the cavities can become lined with granulation tissue and form tunnels called an anal fistula. A fistula is a connection between the deep abscess cavity or the wall of the rectum to the outside skin. This cavity has been so chronically irritated it does not close down and it is now lined with tissue that keeps it open and it will continue to secrete mucus and other materials. It often can get intermittently infected. Unfortunately a fistula can develop in almost half of the cases of Perirectal abscesses. There is no good way to predict which patients are more likely to develop a fistula. If a fistula occurs, surgery is usually required to get rid of it.. Treatment of a fistula involves excising the tunnel out, either coning the area out and leaving a wound, or filleting the fistulous tract open and leaving it open. Sometimes this involves cutting into the anus (the sphincter muscle) as well to keep the tract open. Most of the time a fistula is rather simple and can be treated easily with an outpatient surgery. More complicated cases may require hospitalization. Patients can have some pain and discomfort after this procedure and usually benefit from having narcotic pain medications in conjunction with Ibuprofen and Tylenol over the counter to help control their pain. Good bowel function is essential as well which involves drinking plenty of fluids and having high fiber in the diet to keep the stools soft and well formed to prevent constipation or diarrhea that would irritate the healing area. Usually with these types of surgeries the area heals up and does not recur.
Anal fissure. An anal fissure results from a tear of the inner lining of the anus usually from a hard stool and is often related to the fact that the anal sphincter is too tight and spasming and cannot properly relax. This usually results in exquisite pain with bowel movements and sometimes the pain can be so severe that people become severely constipated to avoid having a bowel movement in order to avoid the pain. Most treatments for anal fissures are taking warm baths three to four times a day to help relax the anus and help keep the area nice and clean. Increaseing drinking of liquids and eating of fiber can help in healing by keeping the stools soft and well-formed and limits the frequency of bowel movements to just once a day. Numerous studies have shown that using a topical cream that relaxes the muscle (Nitroglycerine or calcium channel based creams) can help speed the healing of the fissure. The vast majority of the time the fissures will help up faster. Unfortunately, it can take several weeks but usually over time this becomes much more manageable. Sometimes fissures cannot heal and are chronic fissures. In that case that may imply another cause of the problem and therefore it is very important that any procedure done on the anus whether it is drainage of an abscess, excision of a fistula, or management of a fissure needs to be followed up closely with a surgeon. Sometimes anal fissures do not heal properly with medications only and require a surgery where part of the anal sphincter muscle is cut to allow the muscle to relax more easily and take tension off the anus to allow the area to heal better. This is usually an outpatient surgery.
The surgeons at Regional Surgical Specialists can help manage these problems should they arise. If you have any questions or concerns please contact us at 828-252-3366.
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