Introduction

what is Anal (abscess) ?

An anal abscess is an infected cavity filled with pus found near the anus or rectum. If the skin over the abscess breaks, pus may discharge out. Many people may confuse this with Haemorrhoides (piles).

what is Anal (fistula) ?

An anal fistula, almost always the result of a previous abscess, is a small tunnel connecting the anal gland from which the abscess arose to the skin of the buttocks outside the anus.

How a fistula is Developed ?


Anal Abcess

An abscess usually results from an acute infection of a small gland just inside the anus, when bacteria or foreign matter enters the tissue through the gland. Certain conditions, for example, inflammation of the intestine or colitis, can sometimes make these infections more likely.

Anal Fistula

After an abscess has been drained, a tunnel may persist connecting the anus or rectum to the skin. Persistent drainage of pus from the outside opening may indicate the presence of this tunnel. If the outside opening of the tunnel heals while the inside opening remains, recurrent abscess may develop.

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Causes

1. An anal fistula usually develops after an anal abscess (a collection of pus) bursts.
2. When an abscess has not been completely treated.
3. A fistula can also be caused by conditions that affect the intestines, such as Crohn's disease or ulcerative colitis.
4. Tuberculosis.
5. As a complication of previous surgery.

Types

There are basically 2 broad groups of anal Fistula in clinical practice - simple and complex anal Fistula.

The 'complexity' of the anal Fistula is basically dependent on:

1. The amount of anal sphincter muscle involvement
2. Presence of more than one anal Fistula (secondary tract and/or with abscess cavity)
3. Anal Fistula with tracts above the anal sphincter complex or with the internal opening in the lower rectum or with the external opening further away from the anal verge
4. Anal Fistula associated with other diseases (eg. Crohn's disease, tuberculosis)

'Complex' anal Fistula is a more severe form of anal Fistula. They will definitely require more complicated treatment. Sometimes, the treatment for these Fistula is carried out in stages.

Symptoms

1. Pain (usually relieved after discharge of pus )
2. Discharge — either bloody or purulent
3. Itching
4. Systemic symptoms, if abscess becomes infected like Fever, weakness etc.

Complications

If Haemorrhoides are ignored and no treatment is given to cure them, they can lead to-

Iron Deficiency Anaemia (from heavy bleeding).

Weakness.

Prolapse of whole hemorrhoidal tissue outside the anus.

Diagnosis

Diagnosis is by examination, either in an outpatient setting or under anaesthesia. The examination can be an anoscopy. Possible findings:

1. The opening of the Fistula onto the skin may be seen
2. The area may be painful on examination
3. There may be redness
4. There may be redness
5. A discharge may be seen
6. It may be possible to explore the Fistula using a Fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the Fistula
7. In complicated Fistula some invasive investigations may be advised like Fistulography, Endo-Anal Ultrasound, MRI- Fistulogram etc.

Treatment

Conservative Therapy

1. Sitz baths.
2. High fiber diet.
3. Topical Analgesics.
4. Antibiotics.
5. Laxatives.

Kshar Sutra Therapy

1. Indications.
2. Non-healing Fistulas.
3. Complex anal Fistulas.
4. High Rectal Fistulas in which surgical interventions may cause incontinence (loss of control of bowel movements).
5. Increased risk factors for complications.
6. Patients not suitable for major surgery.
7. Patients not responding to major surgeries and Fistula appearing again and again.

Introduction

Haemorrhoides - commonly known as Piles - are swollen blood vessels (veins) which develop inside and/or outside the anus. They are felt as lumps around and inside the anus . The lumps are formed by increased pressure on blood vessels in the area, causing them to enlarge and swell. If they become infected, they can cause bleeding, pain and discomfort and require medical attention.