Click on a question to see the answer.
An abscess is an infected cavity filled with pus found in the perianal or perirectal area.
A fistula is a small tunnel that drains infected material. It connects a previously infected site to the skin outside the anus. A previously infected site may consist of an anal gland (most frequently a former abscess), a site of an inflammatory process (i.e. Crohn's disease), or on rare occasions it may be a site of a tumor. When the outside opening heals, recurrent abscess can develop. A fistula develops in about 50 percent of all abscess cases.
Typically it is pain and swelling around the anus associated occasionally with fevers and chills. Symptoms of the fistula include irritation of skin around the anus and drainage of pus (which often relieves the pain).
An abscess is treated by making an incision in the skin to drain the pus. This can be done in the doctor's office under a local anesthetic or in the operating room using general or regional anesthesia. Hospitalization and/or the administering of antibiotics may be necessary for patients prone to more serious infections such as diabetics or people with decreased immunity.
Surgery is necessary in most instances. Preferably, it should be performed by a specialist in colon and rectal surgery because of the potential for complications. Fistula surgery usually involves joining the external and internal openings of the tunnel and turning it into a groove that will heal from the base to the surface. Most of the time fistula surgery can be performed on an outpatient basis. Treatment of a deep or extensive fistula may require other techniques such as Seton drain, endorectal flap, LIFT procedure, plug repair, etc.
Discomfort after fistula surgery is dependent on the extent of the surgery performed - the more extensive the surgery, the more pain you may experience. Surgery is followed by a period of time at home where it is recommended that you soak the affected area in warm water (sitz bath) three or four times a day. Stool softeners or a bulk fiber laxative may also be recommended. It may be necessary to wear a gauze pad to minimize soiling of clothes.
It is unusual after proper treatment.