Acute and Chronic Anal Pain
What is an anal abscess? anal fistula?
An anal abscess is an infected cavity filled with pus found near the anus or rectum. Small glands just inside the anus may get clogged (usually, by feces) and become infected, thus leading to abscess formation.
An anal fistula is an abnormal connection or a small tunnel that forms under the skin connecting a previously infected anal gland to the skin of the buttocks, and is almost always (90% of cases) the result of a previous abscess.
A patient complaining of chills, fever, and pain in the anus may be suffering from an anal abscess (pigsa sa puwit). Often,there may be purulent discharge (nana) observed especially if the abscess has ruptured. This may later form an anal fistula.
What are the symptoms of an abscess and fistula?
• Pain and tenderness, erythema (redness), and swelling around the anus.
• Fatigue, fevers and chills.Fistula
• Irritation of skin around the anus.
• On and off drainage of pus (which often relieves the pain).
• Staining of underwear.
• Fever and generalized weakness.
Abscess drainage is the most important part of abscess management.In the presence of an anal fistula, surgery becomes the only treatment option.
• Fistulotomy usually involves opening up the fistula tunnel and converting it to a groove that will allow it to heal from the
inside out. The procedure, however, is not expected to significantly affect the patient’s capability to control bowel movements, particularly when done by a colorectal specialist.
• Other surgical options such as Seton application, ligation of intersphincteric fistula tract (LIFT), mucosal and anocutaneous advancement flaps, anal fistula plug, and fibrin glue application are best discussed with a colorectal specialist.
Home care includes intake of pain medication for post-operative discomfort, warm sitz bath (soaking the affected area in warm water) three or four times a day and stool softeners or a bulk fiber laxative. The amount of time lost from work or school is usually minimal. Bowel movements will not affect healing, although it may be necessary to wear a gauze pad or mini-pad to prevent the drainage from soiling clothes
If properly healed, an abscess or fistula will usually not return. However, if the outside opening of the tunnel heals, recurrent abscess may develop. Persistent drainage from the skin opening may indicate the persistence of the fistula. A recurrent (repeating) fistula will be less likely to improve immediately; thus, it is best to consult a colorectal specialist at the outset and to carefully follow care instructions to prevent recurrence.