Central Indiana Proctology
Anal Fissure, Abscess, and Fistula
The intestinal tract (or bowel) ends with the rectum. The last part of the rectum is a section about 1 1/2 inches long, known as the anal canal. It ends with the anus - the opening to the outside of the body. There are several common problems, including hemorrhoids, that can occur in the area from the rectum to the anus. While almost everyone has heard of hemorrhoids, the other conditions are not so well known.Anal Fissure
Most people have experienced a tear or fissure at the corner of the mouth that
can occur in cold weather or when yawning. Similarly, an anal fissure is a
small tear in the lining of the anus, frequently caused by constipation. A
hard, dry bowel movement results in a break in the tissue. However, fissures
can also occur with severe bouts of diarrhea or inflammation. This results in
the anus becoming dry and irritated, causing it to tear. Injury to the anal
area during childbirth and abuse of laxatives may be other causes.
A fissure can be quite painful during and immediately following bowel movements. This is because the anus and anal canal are ringed with muscles to control the passage of stool and to keep the anus tightly closed at other times. When those muscles expand, it stretches the fissure open. There may also be bleeding or itching with an anal fissure.
Diagnosis
A simple visual examination of the anus and surrounding tissue usually reveals the fissure. It is quite tender when examined by the physician. Fissures are most often located in the middle posterior (back) section of the anus.Anal Abscess and Fistula
An abscess is a localized pocket of pus caused by infection from bacteria. It can occur in any part of the body. When bacteria seep into the underlying tissues in the anal canal, an abscess may develop. Certain conditions, such as Crohn's disease (chronic inflammatory bowel disease), can increase the risk of abscess in and around the anal canal. Patients with conditions that reduce the body's immunity, such as cancer or AIDS, are also more likely to develop anal abscesses.An abscess causes tenderness, swelling, and pain. These symptoms clear when the abscess is drained. The patient may also complain of fever, chills, and general weakness or fatigue.
A fistula is a tiny channel or tract that develops in the presence of inflammation and infection. It may or may not be associated with an abscess, but like abscesses, certain illnesses such as Crohn's disease can cause fistulas to develop. The channel usually runs from the rectum to an opening in the skin around the anus. However, sometimes the fistula opening develops elsewhere. For example, in women with Crohn's disease or obstetric injuries, the fistula could open into the vagina or bladder.
Since fistulas are infected channels, there is usually some drainage. Often a draining fistula is not painful, but it can irritate the skin around it. An abscess and fistula often occur together. If the opening of the fistula seals over before the fistula is cured, an abscess may develop behind it.
Diagnosis
Diagnosis of an abscess is usually made on examination of the area. If it is near the anus, there is always pain, and often redness and swelling. The physician will look for an opening in the skin (a sign that a fistula has developed), and try to determine the depth and direction of the channel or tract of the fistula. However, signs of fistula and abscess may not be present on the skin's surface around the anus.Whenever the physician finds an abscess, and especially a fistula, further tests are needed to be sure Crohn's disease is not present.
Treatment for Anal Abscess
An abscess must be surgically opened to promote drainage and relieve pressure. This is often done in the physician's office under local anesthesia. However, patients with a large or deep abscess, or those who have other conditions, such as diabetes, may be admitted to the hospital for the procedure.Antibiotics cannot take the place of draining an abscess. Antibiotics are carried by the bloodstream but do not reach the pus within the abscess. However, they are usually prescribed along with surgical drainage, especially if the patient has other serious diseases, such as diabetes or those associated with reduced immunity.
