Anorectal Abscess And Anal Fistula

WHAT YOU SHOULD KNOW:

• An anorectal (a-no-REK-tal) abscess (AB-ses) is a collection of pus in the anus (rear end opening) or rectum. The rectum is the last part of the large bowel (colon) that ends at the anus. Sphincters are muscles around the anus that act like valves to control the passage of stool (bowel movement). An anorectal abscess may develop in the space between these anal sphincters and may then spread up or down. An abscess is classified according to the area it involves. An anorectal abscess may be caused by bacteria (germs) that may enter the skin through a tear or infect plugged glands in the anus. A tear may be due to constipation (dry, hard stools), trauma, or putting enemas into your rectum. An anal fistula is an abnormal connection (tunnel) from the anus or rectum to the skin or another organ. It may form from an abscess that has ruptured or been drained, or with conditions affecting the intestine. Sometimes, an anal fistula may happen as a birth defect. An anorectal abscess and fistula are conditions that often occur together.
  
  
• An abscess may cause a hard, red, tender lump or swelling in the area near the anus. Pain may be felt in your anus or lower abdomen (stomach), and may be worse when having a bowel movement (BM) or passing urine. You may also have a fever. A fistula may cause pain around the anus when having a bowel movement. There may be a discharge of blood or pus that may relieve the pain as the discharge increases. Your caregiver may need to carefully check your anal area and rectum to diagnose an anorectal abscess and anal fistula. Tests, such as anoscopy, fistulography, magnetic resonance imaging (MRI), and sigmoidoscopy may also be done. Treatment may include medicines and procedures to drain the abscess or remove the fistula. With treatment, your abscess may be cured and more serious problems may be prevented.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Surgery used to treat an anorectal abscess or anal fistula may cause you to bleed too much. You may get another infection from the surgery. A fistula may form even after treatment of the abscess. Surgery to treat a fistula may injure other body parts, including the sphincter muscles. This may lead to problems with controlling bowel movements. If left untreated, the infection may spread to other parts of your body and make you very sick. If an abscess is not treated, it may also return. Ask your caregiver if you are worried or have questions about your condition, treatment, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Medicines:

You may be given the following medicines:

• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

Tests:

You may have any of the following:

• Anoscopy: This test lets caregivers look inside your anus and rectum. The anus is the opening where BM is passed from your body. The rectum is the last part of the intestine (bowel). During an anoscopy, a clear jelly-like lotion is put onto a short plastic or metal tube. The tube is then gently pushed into your anus and up the rectum. Your caregiver can also take samples of BM to be sent to a lab for tests. This may help caregivers find the cause of your problem.
  
  
• Fistulography: This is a type of x-ray that may show how deep the fistula is and where it started. A probe or catheter (tube) will be inserted into the opening of the fistula. A dye may be put into the fistula tract (pathway) before the x-ray to make it show up better.
  
  
• Magnetic resonance imaging test: This test is also called an MRI. It uses magnetic waves to look at your intestine. This will help caregivers check how long the fistula is. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.
  
  
• Sigmoidoscopy: A sigmoidoscopy test looks for changes in your intestinal (bowel) wall that may be caused by a disease or condition. This test may also help find the cause of bleeding or pain. A long, thin tube with a tiny camera on the end is put through your anus into your rectum (rear-end). It also goes to the part of your intestine called the sigmoid. Caregivers will look for problems in your rectum and lower colon. A small amount of tissue may be taken from the intestine wall and sent for tests. Follow your caregiver's instructions for what to do before, during and after the test.
  
  
• Transanal ultrasound: This is a test that looks inside your rectum to check for a large fistula. A small tube is placed into your anus. Sound waves are used to show pictures of your organs and tissues on a TV-like screen. A liquid called hydrogen peroxide may be injected into the tract of the fistula before the test.

Treatment options:

• Incision and drainage: Your caregiver may break the abscess to drain the pus. This is done by making an incision (cut) in or near the affected area. Sometimes, a catheter (tube) may be put in place for some time to allow the remaining pus to drain.
  
  
• Surgery: You may need to have surgery to drain a very large abscess. If you have a fistula, surgery may be done to open and clean up the fistula tract. This may be left open until it heals on its own.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Anorectal Abscess And Anal Fistula (Inpatient Care)