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Anal Abscess / Fistula

WHAT IS A PERI-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 (sometimes called fistula-in-ano) is a small tunnel connecting the anal gland to the skin of the buttocks outside the anus.  They almost always occur following a previous perianal abscess.

The diagram shows a cross-sectional image of a fistula.  The small tunnel can be seen traversing some of the muscles of the anal canal stretching from the anal canal to the skin.

WHAT CAUSES A PERIANAL ABSCESS?

A perianal abscess results from an infection of a small mucous gland just inside the anus.  It is thought to start when bacteria or foreign matter enters the tissues through the gland.  Certain conditions such as colitis or other inflammation of the intestine can sometimes make these infections more likely.

WHAT CAUSES A FISTULA?

After an abscess has been drained, a false tunnel (or track) may persist connecting the anal gland from which the abscess arose to the skin.  If this occurs, persistent drainage from the outside or external opening may indicate the persistence of this tunnel.  If the external 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 a swelling that is not necessarily related to bowel movements.   Other symptoms include irritation of skin around the anus, discharge of pus or blood (which often relieves the pain), fever, and a feeling of being generally unwell.

DOES AN ABSCESS ALWAYS BECOME A FISTULA?

No.  Many studies have tried to define the risks of developing further problems after abscess treatment,  results showed great variations  and therefore there is really no way to predict if this will occur.  After abscess surgery it is recommended that a follow up clinic appointment is arranged by a colorectal surgeon to ensure a fistula track is not remaining and the area has healed satisfactorily.

HOW IS AN ABSCESS TREATED?

An abscess is treated by a small operation to drain the pus from the infected cavity.  This is done by making cut in the skin over the site of the abscess near the anus (or back passage).

Unfortunately antibiotics are not an alternative to draining the pus, because antibiotics are carried by the blood stream and do not penetrate the fluid within an abscess.  Indeed there is evidence to suggest that in some cases antibiotics may make the problem worse in some cases.

HOW IS A FISTULA TREATED?

Surgery is necessary to cure an anal fistula.  Although fistula surgery is usually relatively straight forward, the potential for complications do exist.  This sort of surgery should be performed by an appropriately trained colorectal surgeon.  It may be performed at the same time as the abscess surgery, although fistulae 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 of the time, fistula surgery can be performed as a day case not requiring the patient to stay in over night.

Sometimes fistulas can be complex.  These may require several operations and additional scans and tests on the back passage in order to get the treatment as best that it can be.   Small elastic bands called SETONS are sometimes used in this process which are left in place for several weeks to allow infection to settle prior to more definitive surgery.

HOW LONG DOES IT TAKE BEFORE PATIENTS FEEL BETTER?

Discomfort after fistula surgery can be mild to moderate for the first week and can be controlled with painkiller tablets which should be provided following surgery.  You will also be given laxatives to avoid constipation and the discomfort it could cause.  The amount of time lost from work is usually minimal.

Treatment of an abscess is followed by a period of time at home, when soaking the affected area in warm water is recommended three or four times a day.   Stool softeners may also be recommended.  It may be necessary to wear a gauze pad to prevent the drainage from soiling clothes.  A district or practise nurse may need to help with dressing the area in the initial stages.  Bowel movements do not usually affect healing.

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 a colorectal surgeon to prevent recurrence.  Even in the hands of an excellent colorectal surgeon there is always a chance of developing new or recurrent disease.

WHAT ARE THE COMPLICATIONS?

The disease process its self, and the surgery can, on rare occasions, leave the anal sphincter muscles damaged, this can lead to varied degrees of incontinence.  

As stated above there is also the small possibility of further problems with abscesses or fistula.

If you wish to arrange an appointment with Mr. Rob Church contact your GP.

Or Contact Leanne Crow 07826 559444

Or the Hospital of your choice:

Spire Hospital Little Aston

Tel: 0121 5807151

Nuffield Hospital Wolverhampton

Tel: 01902 754177