What is an Anal Abscess?

An abscess is a collection of pus in any localised space in the body. An anal abscess is one that develops in the tissues around the anus.

What is the cause of an Anal Abscess?

A number of small glands are normally present between the inner and outer layers of the anal sphincter muscle. Bacteria may lodge in these glands, setting up an infection. An abscess develops from this infective process. This may extend to various areas around the anal canal to involve the anal sphincter muscle and surrounding structures. The abscess may enlarge and burst through the overlying skin or may be drained by surgical treatment.

What are the symptoms of an Abscess?

As the amount of pus in an abscess increases, the pressure within it rises. This produces constant throbbing pain which continues until the pus escapes. Other symptoms are fever and sweating.

How is an Abscess treated?

The pus is drained from the abscess cavity by making an opening through the overlying skin. This may be done under local anaesthesia in the doctor’s office. A large abscess may require wider drainage, under general anaesthesia. Hospital admission is needed for such a procedure. Antibiotics may be used to control the spread of infection, but antibiotics alone will not cure an abscess. Drainage of the pus is always necessary. 

What is a Fistula?

An anal fistula is an abnormal track (“tunnel”) between the internal lining of the anus and the skin outside the anus. A fistula may develop after drainage of an anal abscess but may occur spontaneously. Discharge of pus may be constant or intermittent as the external opening on the skin may heal temporarily. 

What are the different types of Perianal Fistula’s?

The most widely used classification is the Parks Classification which distinguishes four kinds of fistula: intersphincteric, transsphincteric, suprasphincteric and extrasphincteric. The most common fistulas are the intersphincteric and the transsphincteric.

• Intersphincteric anal fistula: Passes through your internal anal sphincter muscle and then burrows out through the space between your internal and external sphincter muscles.

• Transsphincteric fistula: Travels through both layers of your anal sphincter muscles.

• Suprasphincteric fistula: Passes through your internal sphincter and then goes around your external sphincter.

• Extrasphincteric fistula: Goes around both sphincter muscles. This less common type usually originates from your rectum rather than your anus, so it doesn’t come from an anal gland.

• Superficial anal fistula: Travels from the lower part of your anal canal, below your anal glands, through the skin nearby, bypassing your muscles. This type doesn’t come from an anal gland.

Is a Fistula related to Cancer?

No, a fistula is not related to cancer.

Is a Fistula related to other Diseases?

Most fistulae are the result of infections in an anal gland. However patients suffering from inflammatory bowel disease (Colitis and Crohn’s disease) are more likely to develop anal abscesses and fistulae.

How is a Fistula treated?

Surgery is needed to cure a fistula. The course of the track between the anus and the skin has to be identified and exposed. This track may be treated in one of three ways according to its complexity.

Fistulotomy opens the length of the track to the skin’s surface allowing the open wound to heal slowly. Some sphincter muscle is divided. This is the most common treatment employed.

• A Seton is a loop of flexible material placed along the track to maintain drainage for a period of time.

• Fistula repair closes the internal opening of the track and preserves anal sphincter muscle. This is a more complex operation.

Examination under anaesthesia may be necessary to assess the process of healing. Most operations for fistulae are performed in hospital but small fistulae can be managed in Day Care Centres.

Anal fistula can be a difficult and frustrating condition for a patient, as healing rates are variable, and there is often the need for several surgeries in the situation of a complex anal fistula. As a patient, it is important that you receive a clear description of the likelihood of healing from your surgeon. Please discuss any concerns around this with your surgeon, in particular if the condition is affecting your mood and your ability to carry out your normal daily activities.

We have two very useful resources that you can download and give to your Colorectal Surgeon to help them prepare and plan for treatment and/or surgery and also for you to ask any questions or discuss any concerns you may have before and after surgery. Click here to download. Communication before and after surgery is essential for patient satisfaction.

What is the difference between a Standard Seton Drain and a Comfort Seton Drain?

Standard Seton Drains have knots. Current knotted setons used in perianal fistula drainage cause pain and discomfort for patients, leading to complications requiring additional treatment.

Comfort Seton is knotless.
Due to its discrete design, the miniaturisation of the silicon drain and the absence of extra sutures and knots, patients enjoy less inflammatory skin irritation and more comfort, especially when seated.

Anal Sphincter control after surgery

Fistulotomy divides a varying depth of anal sphincter and this may result in some weakness of the muscle. The effect on continence will depend on the anatomy of the fistula and the amount of intact sphincter remaining after surgical treatment.

What is a Colonoscopy?

Colonoscopy is a procedure for diagnosing and treating a variety of problems encountered in the colon (also called the large bowel or large intestine). It is performed using an instrument called a colonoscope which is a flexible tube that is about the thickness of a finger. It is inserted via the rectum into the colon and allows the doctor to carefully examine the lining of the bowel. Abnormalities suspected by x-rays can be confirmed and studied in detail. Abnormalities which are too small to be seen on x-ray may also be identified and colonoscopy is now considered to be a more accurate examination of the large bowel than barium enema x-ray. If the doctor sees a suspicious area or needs to evaluate an area of inflammation in greater detail, the doctor can pass an instrument through the colonoscope and take a piece of tissue (a biopsy) for examination in the laboratory. Biopsies are taken for many reasons and do not necessarily mean that a cancer is suspected.

Is there any special preparation necessary?

Yes. For a successful colonoscopy, it is essential that the bowel is thoroughly emptied. This will usually mean taking clear liquids as well as a special laxative before the colonoscopy. More specific preparation instructions will be given to you. Occasionally one or more enemas may also be required. This preparation can usually be done at home. Failure to carry out the full preparation may leave solid material in the colon and could prolong the procedure or necessitate a repeat examination at another time .Retrograde pre-colonoscopy preparation (e.g. rectal pulse or colonic irrigation) may be a safe and effective alternative to oral bowel preparation that may be recommended in some cases when available.

What happens DURING a Colonoscopy?

When you arrive for the colonoscopy you will be asked to change clothes and may be given a small enema. The examination may be performed with intravenous sedation or a light anaesthetic and your particular management will be explained to you. If you are being managed with sedation you will probably sleep during most of the procedure but you may be aware of changes in position, inflation of the colon with air (distension) and temporary abdominal discomfort. Examination of the large bowel lining is made as the instrument is being inserted, and again as it is withdrawn. The examination may take 60 minutes especially if polyps are to be removed.

What happens AFTER a Colonoscopy?

You will be asked to rest for a hour or two until the effects of the sedatives have worn off, and you have passed much of the inflated air. Although most of the effects of the sedative/anaesthetic wear off quickly you should not drive yourself home after your colonoscopy. You should therefore arrange for a friend or relative to accompany you when you leave.

Are there any complications from a Colonoscopy?

Colonoscopy is a very safe procedure with a very low risk of complications, although these occur very occasionally. Localized irritation of the arm vein may occur at the site of injections of the sedatives. A lump may develop and remains for several weeks or even months, it will eventually disappear. Perforation of the colon rarely occurs during colonoscopy however this can require abdominal surgery to close the defect in the bowel wall. Great care is taken to avoid this complication.

What is a Sitz Bath for?

A sitz bath can reduce inflammation, improve hygiene and promote blood flow to the anogenital area.

Common uses of the sitz bath include keeping the anus clean, reducing inflammation and discomfort caused by Fistulas, hemorrhoids, and healing the perineal area after surgery.

Can I still exercise?

After surgery you should avoid strenuous exercise for a couple of weeks. Resuming normal activities only when you are cleared by your surgeon.

Source: www.cssanz.org