Anal Abscess and Fistula

What causes anal abscesses and fistulas?

Small glands inside the anus are a normal part of anatomy. When these glands become clogged, it may result in an infection, which can lead to an abscess. The infection can be caused by bacteria, feces, or foreign matter clogging the anal glands. In addition to anal gland infections, other significant causes that can increase the risk of abscesses and fistulas include:

• Inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
• Localized skin infections, such as hidradenitis suppurativa
• Trauma
• Radiation
• Infections caused by sexually transmitted diseases
• Rectal or anal cancer

What are the symptoms of anal abscesses and fistulas?

• Anal Abscesses: Patients may experience pain, redness, or swelling around the anal area or canal. Other common signs include feeling ill or tired, fever, and chills.
• Anal Fistulas: Symptoms are similar to other anorectal conditions and may be misdiagnosed if not properly examined. It is important to be evaluated by a colon-rectal surgeon to get an accurate diagnosis since treatments for anorectal conditions can differ significantly.

How are anal abscesses and fistulas treated?

The goal of treating anal abscesses and fistulas is to relieve pain, prevent recurrence by clearing blockages, and preserve muscle control. It is crucial that symptoms be evaluated by a colon-rectal surgeon, who will perform a thorough examination and recommend treatment. The physicians at Connecticut Colon & Rectal Surgery, LLC aim to preserve muscle function while effectively treating the abscess or fistula with individualized treatment plans.

• Anal Abscesses: Typically treated with surgical drainage. An incision is made in the skin near the anus to drain the infection. This procedure is usually done at the surgeon’s office with a local anesthetic but may require an operating room under anesthesia in certain cases. Some patients may need multiple surgeries.
• Anal Fistulas: Surgery is recommended if the fistula does not close or recurs. If the fistula is not too deep, a fistulotomy is performed, which involves opening the fistula track to allow healing from the inside out. This surgery may require dividing a small portion of the sphincter muscle. If a large amount of sphincter muscle is involved, it may not be divided to avoid problems with bowel control, such as fecal incontinence. In some cases, a fistulotomy involves inserting a drainage tube known as a seton through the fistula track to drain the infection. The seton may be used long-term but is often removed once healing begins, followed by a second procedure to close the fistula track.

  • Advanced Surgeries: For fistulas involving a large portion of the sphincter muscle, more advanced surgeries, such as an advancement flap, may be required to treat the fistula without harming the sphincter muscle. More complex cases may need multiple surgeries.

• Antibiotics: Antibiotics alone are not effective in treating abscesses or fistulas. They may be needed in addition to surgery if a patient has immunity issues, specific heart valve conditions, or widespread cellulitis (a bacterial infection of the skin and tissues under the skin). Providing your physician with an accurate medical history and undergoing a physical exam are essential for determining if antibiotics are required.