When a patient reports the presence of swelling in the anal or perianal area with pain, fever, and red and tense overlying skin, they are likely suffering from an abscess and/or a perianal fistula.
WHAT IS A PERIANAL ABSCESS?
It is an infected cavity filled with purulent material located near the anus or in the rectum.
WHAT IS AN ANAL FISTULA?
It is a true pathway that originates in the anal canal or rectum, extending to the skin in the perianal or gluteal region. The main pathway can branch into one or more secondary pathways. It almost always presents with an abscess in the perianal area. In its course, the fistula passes through various levels of the anal sphincter apparatus; based on its relationships with the sphincters, it is classified as simple, complex, or even superficial, intersphincteric, transsphincteric, extrasphincteric, or suprasphincteric.
WHAT CAUSES AN ABSCESS?
Bacteria present in the anorectal tract can infect the gland located inside the anal canal. Certain specific medical conditions such as colitis or other intestinal diseases can lead to the formation of abscesses or perianal fistulas.
WHAT CAUSES AN ANAL FISTULA?
After the abscess has been drained, either spontaneously or surgically, the connection between the gland where the abscess originated and the perianal skin persists. In other words, the fistula is how the abscess attempts to drain itself outward. Sometimes, the external opening of the fistula located near the anus can close spontaneously, but the fistula typically does not heal and tends to recur.
WHAT ARE THE SYMPTOMS OF AN ABSCESS OR ANAL FISTULA?
Severe pain and burning in the anal region. As the abscess forms and "matures," fever develops, which can be quite high. The skin in the perianal area becomes increasingly red, and the pain tends to become unbearable.
HOW IS AN ACUTE ABSCESS TREATED?
The abscess may rupture spontaneously, in which case the patient experiences immediate relief, and the fever subsides within a few hours. At other times, the patient must seek emergency care or consult a specialist in colon and proctology. Incision and drainage of the abscess usually resolve the acute phase. It is a minor procedure that can be performed under local anesthesia if the abscess is superficial. When it is large and deep, hospitalization may be necessary. Antibiotic therapy, once the abscess has developed, may be less effective, making surgical drainage necessary.
HOW IS AN ANAL FISTULA TREATED?
Surgical treatment is always necessary and should be performed by a specialist in colon and proctology. Complications can be serious since fistulas have varying degrees of involvement with the anal sphincters, which are muscles responsible for fecal continence. Usually, the abscess is treated first, and the fistula is addressed after a few weeks. Depending on whether the fistula is simple or complex, the surgical procedure can be performed on an outpatient basis. However, it is customary to treat the fistula surgically in an operating room as day surgery (discharged on the same day) or one-day surgery (discharged the day after the procedure) under selective spinal or general anesthesia. Each surgical technique carries the risk of compromising the integrity of the sphincters, with fecal incontinence being the most dreaded complication (in some cases, around 30%). Recently proposed techniques such as VAAFT, FiLaC, or LIFT aim to preserve the sphincter apparatus, minimizing the possibility of sphincter damage. These techniques are referred to as minimally invasive.
HOW LONG DOES IT TAKE FOR HEALING?
Traditional techniques, aside from the risk of postoperative incontinence, involve large surgical wounds, requiring frequent dressings and causing inconvenience for the patient. When the wounds are extensive and setons (threads or elastics that pass through the sphincters) are used, healing can take several months. The aforementioned minimally invasive and especially video-assisted techniques like VAAFT provide faster healing without the need for daily dressings. Pain is almost entirely absent or easily controlled with common analgesics taken for a short period. Return to normal work activities occurs within a few days.
WHAT IS THE RECURRENCE RATE FOR AN ABSCESS OR PERIANAL FISTULA?
Simple fistulas, when correctly treated, have a very low recurrence rate, around 5-6%. If the fistula is complex, the possibility of recurrence is higher. It depends on many factors, not only related to the surgical procedure but also to preexisting anatomical and pathological conditions. The choice of a minimally invasive procedure aims to preserve the structure of the anal sphincters, minimizing the dreaded complication of postoperative incontinence. The advice is to rely on a highly experienced colon and proctology specialist for the treatment of these troublesome conditions, with proven expertise in individual minimally invasive surgical therapies.
For more information on VAAFT, CLICK HERE.
WHAT IS A PERIANAL ABSCESS?
It is an infected cavity filled with purulent material located near the anus or in the rectum.
WHAT IS AN ANAL FISTULA?
It is a true pathway that originates in the anal canal or rectum, extending to the skin in the perianal or gluteal region. The main pathway can branch into one or more secondary pathways. It almost always presents with an abscess in the perianal area. In its course, the fistula passes through various levels of the anal sphincter apparatus; based on its relationships with the sphincters, it is classified as simple, complex, or even superficial, intersphincteric, transsphincteric, extrasphincteric, or suprasphincteric.
WHAT CAUSES AN ABSCESS?
Bacteria present in the anorectal tract can infect the gland located inside the anal canal. Certain specific medical conditions such as colitis or other intestinal diseases can lead to the formation of abscesses or perianal fistulas.
WHAT CAUSES AN ANAL FISTULA?
After the abscess has been drained, either spontaneously or surgically, the connection between the gland where the abscess originated and the perianal skin persists. In other words, the fistula is how the abscess attempts to drain itself outward. Sometimes, the external opening of the fistula located near the anus can close spontaneously, but the fistula typically does not heal and tends to recur.
WHAT ARE THE SYMPTOMS OF AN ABSCESS OR ANAL FISTULA?
Severe pain and burning in the anal region. As the abscess forms and "matures," fever develops, which can be quite high. The skin in the perianal area becomes increasingly red, and the pain tends to become unbearable.
HOW IS AN ACUTE ABSCESS TREATED?
The abscess may rupture spontaneously, in which case the patient experiences immediate relief, and the fever subsides within a few hours. At other times, the patient must seek emergency care or consult a specialist in colon and proctology. Incision and drainage of the abscess usually resolve the acute phase. It is a minor procedure that can be performed under local anesthesia if the abscess is superficial. When it is large and deep, hospitalization may be necessary. Antibiotic therapy, once the abscess has developed, may be less effective, making surgical drainage necessary.
HOW IS AN ANAL FISTULA TREATED?
Surgical treatment is always necessary and should be performed by a specialist in colon and proctology. Complications can be serious since fistulas have varying degrees of involvement with the anal sphincters, which are muscles responsible for fecal continence. Usually, the abscess is treated first, and the fistula is addressed after a few weeks. Depending on whether the fistula is simple or complex, the surgical procedure can be performed on an outpatient basis. However, it is customary to treat the fistula surgically in an operating room as day surgery (discharged on the same day) or one-day surgery (discharged the day after the procedure) under selective spinal or general anesthesia. Each surgical technique carries the risk of compromising the integrity of the sphincters, with fecal incontinence being the most dreaded complication (in some cases, around 30%). Recently proposed techniques such as VAAFT, FiLaC, or LIFT aim to preserve the sphincter apparatus, minimizing the possibility of sphincter damage. These techniques are referred to as minimally invasive.
HOW LONG DOES IT TAKE FOR HEALING?
Traditional techniques, aside from the risk of postoperative incontinence, involve large surgical wounds, requiring frequent dressings and causing inconvenience for the patient. When the wounds are extensive and setons (threads or elastics that pass through the sphincters) are used, healing can take several months. The aforementioned minimally invasive and especially video-assisted techniques like VAAFT provide faster healing without the need for daily dressings. Pain is almost entirely absent or easily controlled with common analgesics taken for a short period. Return to normal work activities occurs within a few days.
WHAT IS THE RECURRENCE RATE FOR AN ABSCESS OR PERIANAL FISTULA?
Simple fistulas, when correctly treated, have a very low recurrence rate, around 5-6%. If the fistula is complex, the possibility of recurrence is higher. It depends on many factors, not only related to the surgical procedure but also to preexisting anatomical and pathological conditions. The choice of a minimally invasive procedure aims to preserve the structure of the anal sphincters, minimizing the dreaded complication of postoperative incontinence. The advice is to rely on a highly experienced colon and proctology specialist for the treatment of these troublesome conditions, with proven expertise in individual minimally invasive surgical therapies.
For more information on VAAFT, CLICK HERE.