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Anal Abscess and Fistula

What is an Anal Abscess?

An anal Abscess is an infected cavity filled with pus near the anal opening.

What is Anal Fistula?

An anal fistula usually arises from an anal abscess. It is a persistent tract connecting between a skin opening and the anal gland from which anal abscess originated.

Causes

An acute infection of anal glands located just inside the anal opening results in an anal abscess. Bacteria may infiltrate through the anal gland and cause infection. In about half the patients, a persistent drainage tract between the skin and the anal gland persists. Patients with Crohn's disease are more likely to develop anal abscesses and fistula.

Symptoms

A patient with an anal abscess often develops a painful lump near the anal opening. If an abscess becomes large, the patient may experience fever, chills, or malaise. Sometimes, an abscess may spontaneously rupture and drain pus. This often results in improvement in pain. Patients with anal fistulas present with persistent drainage through a skin opening located adjacent to the anal opening. The drainage fluid is usually clear. Patients with anal fistula usually do not experience pain or signs of infection such as fever or chills.

Treatment

Anal Abscess
An abscess is treated by draining the pus from the infected cavity. A catheter is sometimes placed for several days to allow an adequate drainage. This is usually done in the office under local anesthesia. A complex or large abscess may require a surgical drainage in the operating room. Hospitalization may be required for patients with risk for more serious infections such as diabetics. It is important to realize that antibiotics are not an alternative to surgery. Antibiotics does not adequate penetrate infected cavity filled with pus and may result in delay in definitive treatment.

Anal Fistula
An anal fistula is nearly always treated by surgery. Surgical treatment consists of cutting open the entire fistula tract and allowing it to heal from inside. This usually involves cutting a small portion of the anal control muscles. Depending on the location of the fistula tract, there is a small risk of developing minor fecal incontinence. For fistula tracts that encompass a significant amount of the anal control muscles, anal advancement procedures are often performed at our institution. This procedure involves surgical mobilizing a portion of normal rectal inner lining on to the inner fistula opening located inside anal canal. This procedure is done in the operating room and may require a short hospital stay.

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