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Feeling ill and complains of chills, fever, and pain in the rectum or anus could be could be indications of 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 an infected cavity filled with pus found near the anus or rectum.

What is an Anal Fistula?

An anal fistula, almost always is the result of a previous abscess. Anal fistulas are small tunnels connecting the anal gland from which the abscess arose to the skin of the buttocks outside the anus.

What Causes an Abscess?

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; colitis or other inflammation of the intestine can sometimes make these infections more likely.

What Causes a Fistula?

After an abscess has been drained, a tunnel may persist connecting the anal gland from which the abscess arose. If this occurs, persistent drainage from the outside opening may indicate the persistence of this tunnel. If the outside opening of the tunnel heals, a recurrent abscess may develop.

What are the Symptoms of an Abscess or Fistula?

Symptoms of both ailments include constant pain, sometimes accompanied by swelling that is not necessarily related to bowel movements. Other symptoms include irritation of skin around the anus, drainage of pus (which often relieves the pain), and fever.

Does an Abscess Always Become a Fistula?

No. A fistula develops in about 50% percent of all abscess cases, and there is no accurate method to predict if this will occur.

How is an Abscess Treated?

An abscess is treated by draining the pus from the infected cavity, making an opening in the skin near the anus to relieve the pressure. Hospitalization may 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.

What About Treatment for a Fistula?

Surgery is necessary to cure an anal fistula. Although fistula surgery is usually relatively straightforward, the potential for complication exists, and is preferably performed by a specialist in colon and rectal surgery. It may be performed at the same time as the abscess surgery. Fistula surgery usually 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 the inside out.

How Long Does it Take Before Patients Feel Better?

Discomfort after fistula surgery can be mild to moderate for the first week and can be controlled with pain management medications. The amount of time lost from work or school is usually minimal. 

What are the Chances of a Recurrence of an Abscess or Fistula?

If properly healed, the problem will usually not return. However, it is important to follow the directions of a colon and rectal surgeon to prevent recurrence.

ANAL FISSURE

What is an Anal Fissure?

An anal fissure is a small tear or cut in the skin lining the anus which can cause pain and/or bleeding.

What are the Symptoms of an Anal Fissure?

The typical symptoms of an anal fissure are extreme pain during defecation and red blood streaking the stool. Patients may try to avoid defecation because of the pain.

What Causes an Anal Fissure?

A hard, dry bowel movement can cause a tear in the anal lining, resulting in a fissure. Other causes of a fissure include diarrhea and inflammation of the rectal area.

Anal fissures may be acute (recent onset) or chronic (present for a long time or recurring frequently). An acute fissure is usually due to altered bowel habits while a chronic fissure may be either due to poor bowel habits, overly tight or spastic anal sphincter muscles, scarring or an underlying medical problem.

How can a Fissure be Treated?

An acute fissure is managed with non-operative treatments and over 90% will heal without surgery. Bowel habits are improved with a high fiber diet, bulking agents (fiber supplements), stool softeners, and plenty of fluids help to avoid constipation and promote the passage of soft stools. Warm baths for 10-20 minutes several times each day are soothing and promote relaxation of the anal muscles. Occasionally, special medicated creams may be recommended.

A chronic fissure (lasting greater than one month) may require additional treatment. Depending on the appearance of the fissure, other medical problems such as inflammatory bowel disease or infections may be considered and testing may be recommended. A manometry test may be performed to determine if anal sphincter pressures are high. An examination under anesthesia may be recommended to determine if a definite reason exists for lack of healing.

What Can be Done if a Fissure Doesn't Heal?

A fissure that fails to respond to treatment should be re-examined to determine if a definitive reason exists for lack of healing. Such reasons can include scarring or muscle spasm of the internal anal sphincter muscle. Those which continue to cause pain and/or bleeding can be corrected by surgery.

What Does Surgery Involve?

Surgery usually consists of a small operation to cut a portion of the internal anal sphincter muscle. This helps the fissure to heal by decreasing pain and spasm. Cutting this muscle rarely interferes with the ability to control bowel movements and can usually be performed without an overnight hospital stay.

How Long Does the Healing Process Take After Surgery?

Complete healing occurs in a few weeks, although pain often disappears after a few days.

Will the Problem Return?

More than 90% of patients who require surgery for this problem have no further trouble from fissures. If the problem returns without an obvious cause, the person may need further assessment including anal manometry testing or an exam under anesthesia.