An in-depth analysis regarding the causes,
symptoms, diagnosis and the treatments of these acute anal infections
Abscess and anal fistula: two states of the same pathology
Abscess and anal fistula represent two different stages of the same pathology and are the result of an inflammatory process caused (in most cases) by a non-specific infection originating from microscopic glands located inside the anal canal. Hermann and Desfosses glands are anatomical structures that function to secrete mucus to facilitate the passage of feces. When bacteria or foreign material penetrate the gland, its duct becomes obstructed, leading to an infection that spreads to the surrounding tissues. Once the inflammatory process reaches the perianal skin, it stops permanently due to the resistance offered by it. Under the skin, all the material produced by the inflammatory process accumulates, evolving subsequently into pus and giving rise to a perianal abscess. The characteristic swelling does not manifest immediately but only towards the end of the pathological process.
Anal fistula ad a chronic evolution of abscess
On the other hand, the anal fistula represents the chronic evolution of the abscess. It is a medical condition that involves the formation of an abnormal opening between the intestine or anus and the surrounding skin in the anal area. The anal fistula arises because the purulent material constantly seeks an outlet and therefore makes its way, generating tubular-like lesions towards the outside. Common symptoms of anal fistulas include:
- irritation around the anus with itching, burning, and pain;
- intermittent or constant pus discharge from a small hole located near the anus;
- fever and general discomfort;
- pelvic pain.
The symptoms tend to worsen during defecation and can also be associated with the appearance of blood loss and purulent material mixed with feces. The progression of the canalization process and the formation of the fistula with its subsequent chronicity can cause severe damage to the sphincters..
CLASSIFICATION OF ANAL FISTULAS
There are various types of anal fistulas, and the most common classification, according to Parks, divides them into five groups:
- superficial;
- intersphincteric;
- transsphincteric;
- suprasphincteric;
- extrasphincteric.
Depending on the path they take, a fistula can also be defined as:
- simple or complex;
- complete or incomplete;
- internal or external;
- horseshoe-shaped.
If their origin is considered, they are defined as:
- traumatic (including surgical trauma);
- congenital;
- related to inflammatory bowel diseases;
- induced by childbirth.
Risk factors
There are several factors that can contribute to the development of an anal fistula, including:
- local trauma;
- Repeated changes in stool consistency;
- anal ulcers;
- HIV and immune-compromising diseases;
- rectal cancer;
- tuberculosis;
- sexually transmitted diseases;
- complications following surgical interventions.
The unpleasant relationship between anal fistulas and IBD
Chronic Inflammatory Bowel diseases (IBD), such as Crohn’s disease and Ulcerative Colitis, are conditions characterized by chronic inflammation of the intestine. There is evidence suggesting a correlation between anal fistulas and IBD, particularly with Crohn’s disease. Fistulas are indeed a frequent occurrence: approximately 40% of affected individuals develop at least one fistula during the course of their disease, and about 20% develop a perianal fistula. These fistulas can develop due to chronic inflammation and ulceration in the intestinal tissue. Anal fistulas in patients with Crohn’s disease can be challenging to manage and may require a combination of treatments, including medications (antibiotics, immunomodulators, and anti-TNF drugs), surgical procedures, and therapies for IBD management. It is important for patients with IBD who experience symptoms of anal fistulas or other complications to consult their specialist doctor for accurate evaluation and a personalized treatment plan. Proper control of intestinal inflammation and management of anal fistulas can help improve quality of life and reduce long-term complications associated with IBD.
DIAGNOSIS AND SURGICAL TREATMENT OF ANAL FISTULAS
An evaluation by a proctologist, accompanied by a careful medical history, is sufficient to diagnose simpler fistulas. Usually, the specialist proceeds with an endoanal ultrasound to evaluate the path of the fistula and identify any openings. The study of more complex fistulas requires more in-depth and detailed examinations such as magnetic resonance imaging.
Fistulas rarely regress spontaneously; therefore, treatment for this condition is exclusively surgical and usually involves multiple interventions. There are numerous surgical techniques, and the choice is made based on the type of fistula and the patient’s general condition. After the surgical procedure, several weeks may be required for complete healing. During this period, it is crucial to follow the doctor’s instructions for caring for the operated area and preventing complications. In some cases, antibiotic treatment may be necessary to treat infection. It is important to note that anal fistulas can recur in some patients even after surgical treatment; therefore, careful monitoring of symptoms and regular check-ups with the doctor are essential.
Anal fistula is a dangerous and degenerative condition that requires proper evaluation and treatment. If you suspect you have an anal fistula or experience related symptoms, it is advisable to consult a proctologist for an accurate diagnosis and the planning of the most appropriate treatment.
The contents of this page are for informational purposes only and should in no way replace the advice, diagnosis, or treatment prescribed by your physician. Responses to the same treatment may vary from patient to patient. Always consult your doctor regarding any information related to diagnoses and treatments, and meticulously follow their instructions.
