A patient who feels ill and complains of chills, fever and pain in the rectum or anus could be suffering from an anal abscess or fistula. These medical terms describe common ailments about which many people know little.
What is an anal abscess?
An anal abscess is a cavity filled with pus near the anus or rectum. An abscess results from an acute infection of a small gland just inside the anus, when bacteria or foreign matter enters the tissue through the gland. Certain conditions -- Ulcerative Colitis or other inflammation of the intestine, for example -- can make these infections more likely.
What is an anal fistula?
An anal fistula, almost always the result of a previous abscess, is a small tunnel connecting the anal gland from which the abscess arose to the skin of the buttocks outside the anus.
After an abscess drains on its own or has been drained by a physician, a tunnel (fistula) may persist, connecting the infected anal gland to the external skin. This typically will involve some type of drainage from the external opening.
What are the symptoms of anal abscess or anal fistula?
Symptoms of both anal abscesses and anal fistulae include constant pain, sometimes accompanied by swelling - not necessarily related to bowel movements. Other symptoms include irritation of skin around the anus, drainage of pus (which often relieves the pain), fever and general malaise.
How are these conditions treated?
An anal abscess is treated by draining the pus from the infected cavity, making an opening in the skin to relieve the pressure. This can often be done in the doctor's office, using a local anesthetic. Large or deep abscess may require hospitalization and use of a different anesthetic method. Hospitalization may also be necessary for patients prone to more serious infections, such as diabetics or people with decreased immunity. Antibiotics are not usually an alternative to draining the pus, because antibiotics are carried by the blood stream and do not penetrate the fluid within an abscess.
Surgery is necessary to cure an anal fistula. Fistula surgery is usually relatively straightforward. It may be performed at the same time as the abscess surgery, although fistulae often develop four to six weeks after an abscess is drained (sometimes even months or years later). Fistula surgery involves cutting a small portion of the anal sphincter muscle to open the tunnel, joining the external and internal opening and converting the tunnel into a groove that will then heal from within outward. Most times, fistula surgery can be performed on an outpatient basis, or with a short hospital stay.