Anal fistulas

What are anal fistulas?

Anal fistulas are a tear in the anal skin and mucosa, which subsequently becomes chronically inflamed and forms a constantly rupturing, non-healing, narrow ulcer. These tears are noticed primarily from the back (coccyxward) of the anus. As a result, there may be high pressure from the sphincter muscle that sits under the mucosa. The reason why the wound does not heal is due to poor blood circulation, which in turn is due to increased resting pressure of the sphincter muscle. A skin fold often forms on the outside of the fissure.

The main complaint is sharp, burning pain during defecation. Occasionally, the pain is felt very strongly even without defecation and leads to very painful anal cramps. The cramps additionally prevent the fissure from healing. During defecation, the ulcer ruptures and may bleed. Occasionally itching occurs.

Causes

An anal fistula usually develops due to an accumulation of pus in the anal area caused by inflammation of the proctodeal glands. These glands are located between the external and internal sphincter muscles in the anus and open into the anal canal. When the glands are damaged by bacterial inflammation, an abscess may form, which is bounded by granulation tissue (tissue that forms temporarily as part of wound healing) and forms an abscess capsule around the focus of the pus. The abscess spreads in the direction of the tissue with the least resistance, resulting in the formation of the fistula tract.

Treatment

Treatment is recommended conservatively at first, with drug sphincter pressure reduction of a sphincter dilation the ulcer is stretched. This refreshing of the tissue and the resulting change in the non-healing tear should result in the formation of clean, well-healing scar tissue. In addition, local anesthetic ointments are applied and soft bowel movements are provided.

Alternatively, there is the possibility of complete removal of the fissure by a surgical procedure.

During wound healing after surgery, it is especially important to perform proper anal care. This means that the anus should not be wiped, but showered.

The sensitive skin around the exit of the intestine does not tolerate aggressive shower products or too much friction. Clear water is best and promotes the health of the intestine.