9. Anal fistula / Anal abscess


Definition:

There are secretion producing so-called prokteal glands between interior and exterior sfincter (closing) muscles. If this secretion –yet unclear reason- is obstructed, it accumulates. The secretion tries to clear a way outward and arrives to skin between the muscles. Since it cannot break through the skin, it accumulates as pus and becomes a painful abscess. If this pus accumulation is not discharged it propagates and even starts of destruction of the surrounding tissues.

If the pus can be discharged, the inflammation calms down rapidly. However a connecting link between the anal channel and the skin remains over as a tiny canal, which is called anal fistula. This tiny canal is lined with a special coat (epithelium), whereby it cannot closed-off by itself. Depending upon the direction it takes, there are many different types of fistula, which most common types are the ones between the interior and exterior sfincter (closing) muscles.

Promoting factors:

The reasons of stoppage of the fluid flow-system are not yet sufficiently known. The occurrence of fistula is increases during inflamed illnesses such as Morbus Crohn or Criptitis. Furthermore injuries of the anal skin and the intestinal mucosa also causes for fistula generation.

Complaints:

One feels pain during abscess formation as well as general symptoms such as fever and indisposition. In the condition of no abscess, pinhead-size skin openings can be noticed around the anus area. Flowing secretion causes wetness and skin provoking. . It is not common to experience any pain. Pain would be, if at all, very small. The fistula can exist in such a way over long years and shows no tendency for self-healing.

Treatment:

It is necessary to widely open the area in order to drain the abscess.  After this operation, effected areas would self-heal in a few weeks.

Since the healing of the fistula with none-operational measures is hardly possible, only the operational interference remains as treatment. In the case of fistula, it has to be split open and entire channel tissue has to be removed (Fistulectomy). This would help self-healing process.

Since the fistula goes often through the sfincter (closing) muscles, these muscles will be split during the operation. This can cause to the disorder of the sealing function of the closing muscle.

After the operation an open wound healing takes place, i.e. the wound self-heals.

As an alternate to operation, one may insert a thread in fistula. This method is very lengthy processes with uncertain success.

Anal fistula

 The treatment practiced in Proktoklinik is a world-new technique called minimal invasive fistulectomy.  A special drill is introduced into the fistula and the fistula tract is cleansed from inside. Then cleansed tissue is sealed with using collagen sponge and internal fistula opening will be sewn with a stitch. When this technique used, the fistula neither needs to be split nor develops any open wound.

In case of impassable fistula, the tract will be explored openly until the muscles and then treated by this technique. In each case, a cutting of the sphincter muscle does not take place, so that the closing myasthenia, which often occurred after fistula operations cannot, happens any longer.

Prior to operation, the position of the fistula can be determined radiologicaly by Fistulography or more elegantly with the Endoultrasound. These methods might be necessary in the event of suspicion on an unusual fistula course. 

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 Anal diseases - still a topic with taboo   |   Anatomy of the final intestine   |   What are Hemorrhoids actually?   |   How does the illness of the hemorrhoids developed? 
 How does the hemorrhoidal illness express itself?   |   How Hemorrhoids are treated?   |   How is the treatment in the Proktoklinik?   |    Anal fissure   |   Anal thrombosis 
 Illness of the Linea Dentata   |   Skin folds (Mariscs)   |   Condyloms