Anorectal Abscess And Anal Fistula

What are anorectal abscess and anal fistula?

• 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 intestine (bowel) that ends at the anus. Around the anus are muscles, called sphincters, which act like valves to control the passage of stool (bowel movement). An anorectal abscess develops in the space between these anal sphincters. The abscess may then spread up or down and is classified according to the area it involves. The perianal area (area around the anus) is the most commonly affected.
  
  
• An anal fistula is an abnormal connection (tunnel) from the anus or rectum to the skin or another organ. It usually forms in the presence of an abscess, but may happen along with other conditions. An anorectal abscess and fistula are conditions that often occur together.

What causes an anorectal abscess and anal fistula?

• An anorectal abscess is commonly caused by different kinds of bacteria (germs). Bacteria may enter the skin through a tear or infect plugged glands in the anus. This usually happens when you have constipation (dry, hard stools) or trauma to the anus. Putting enemas into your rectum to help empty your bowel may also cause a tear. Having a condition that weakens the immune system, such as cancer, or receiving radiation may put you at a higher risk of having an abscess. The immune system is the part of the body that fights infection.
  
  
• An anal fistula may form from an abscess that has ruptured or has been drained. It may occur in conditions affecting the intestine, in people with cancer, or after an injury to the anus. Sometimes, you may be born with an anal fistula.

What are the signs and symptoms of an anorectal abscess and anal fistula?

You may have any of the following:

• Abscess:
  
  
  • A hard, red, tender lump or swelling in the area near the opening of the anus.
    
    
  • Fever.
    
    
  • Pain in the lower abdomen (stomach) or anus.
    
    
  • Pain while having a bowel movement (BM).
  
  
• Fistula:
  
  
  • Discharge of pus or blood from the anus.
    
    
  • Pain around the anus that may be relieved as the discharge increases.
    
    
  • Pain while having a bowel movement (BM).

How are an anorectal abscess and anal fistula diagnosed?

Your caregiver will look for any swelling, redness, or opening of a fistula in the skin in your anal area. Your caregiver may also check your rectum by inserting a gloved finger into your anus. He may also try to feel a cord or abnormal tissue that may be present. You may need any of the following tests:

• 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.

How are an anorectal abscess and anal fistula treated?

You may have any of the following:

• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Pain medicine: This medicine may be given to ease your pain.
    
    
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
  
  
• Procedures:
  
  
  • 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.

Where can I find more information?

Having an anorectal abscess or anal fistula may be hard. You may contact the following for more information:

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

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.

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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.

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