Anal abscess and fistula

Anal abscess and fistula

Infection and abscess mostly arise in glands or hair roots of the skin. The infected spot initially erupts and then forms an abscess. The abscess gets opened and discharges its contents (pus) and then heals. Depending upon the load of infection, septic conditions like fever and toxic symptoms can result in the course of anabscess. Abscess will be usually red hot with throbbing pain. The abscess, after getting fully blown up with pus, usually opens near the surface and lets out the pus naturally. To save time and live comfortably without pain, abscess is now dealt with surgically with incision and drainage (I&D). If it is deep, persistent, not properly drained or becomes chronic in nature, then it gets reformed as a small cavity or sinus with a single opening. Sometimes, it opens at both sides/ends and thus becomes a tunnel or tract – namely fistula.

Anus, the exit route of faeces and it surroundings are more vulnerable to bacterial or fungal infection due to moisture and folded skins. Germs/micro organisms will also be more concentrated in that area in spite of cleanliness. Usually, infection occurs and causes boils or abscess due to lack of hygienic condition, but sometimes the causes remain unknown.

Anal abscess – Abscess is a mere collection of pus which is supposed to drain either inside or outside where the points are weak and easily prone for an outlet. Anal abscess mostly presents itself as a tender swelling in or around the anus with throbbing pain. Even though perianal abscesses are more common after piles, fissure and gland infection, ischiorectal abscess and submucous abscess can also be seen. Common bacterias which usually cause infections are staphy, E.coli, strepto and proteus. Sometimes abscess arises spontaneously without any cause. Mostly abscess opens externally and drains to cure. But sometimes it can lead to a tract of deep location to open in and out, giving rise to fistula. Either way i.e. natural drain or surgical drainage, if it lacks care in healing, the chances of fistula formations are there.

Fistula – Fistula in general, means abnormal passage/tunnel/tract which connects gland and skin or mucous membrane and skin. It occurs as a complication while the abscess gets resolved. It is either lined with mucosal membrane or may be lined with granulation epithelial tissue. There are different types of fistula, i.e. anal, umbilical, urethral, perineal, thyroglossal, salivary, arterio-venous, etc. Usually, the fistula opening will be indrawn and covered with the crescentic fold of skin.

Anal fistula – Among fistula, anal fistula is the commonest and most bothersome. Most commonly it arises from perianal abscess. This anal fistula mostly connects anus / rectum to the outer skin. Sometimes, it may connect anus and vagina or anus and urethra. The fistula usually traces the drainage pathway of the abscess. It may have a single or multiple opening(s) in inner/outer aspect, depending upon the position and direction of the drainage of the abscess. The fistula having multiple opening should be seriously investigated for tuberculosis or Crohn’s disease.

Incidence – Males have higher incidences than females. It usually follows in at least 40-50 per cent of anal abscess cases. Unhygienic conditions also favour higher incidences.

Pathophysiology – Usually, every abscess opens one day or the other and lets out the pus. Sometimes it needs surgical intervention to drain, especially when it is deep. In any case, if it doesn’t heal up properly or if it is not properly drained after letting out the pus then it will usually remain as infecting foci and suppurates. Also this will constantly or intermittently discharge pus or fluid through the outlet/tract. In due course, this tract gets lined with granulation tissue which resists healing (joining the other surface). Fistula’s length and openings (internal and external) usually vary in size and number according to the location of the abscess and care taken over it. Usually, the fistula tract will be a curved one. Untreated fistula or clogged outlet of fistula (due to infection or draining debris obstruction) will usually promote multiple internal/external openings with recurrent anal abscess and re-formation of tract or tunnel.

Causes – Ill-treated or maltreated infection and abscess are the main causes for fistula formation, the other causes include negligence/lack in treatment of piles, anal fissures, Crohn’s disease, cancer, constipation, etc. Fistula formation is mainly due to improper and inadequate drainage of pus from abscess with narrow opening or block or high opening or presence of infective foci or foreign bodies or unhygienic conditions. Another important cause to be ruled out is nylon underwear which does not absorb moisture. The major aggravating factor is pressure exerted by physical strain while passing stool since it will propel the faecal matter into the fistula tract.

Symptoms – Anal fistula is mostly present with the following symptoms, when there is infection or strain or block.
Feeling of lump near the anus with stabbing/throbbing pain

• Pain will shut off immediately after letting out the pus
• Continuous or intermittent (on and off) leakage of foul pus/mucous/faecal matter from the fistula’s external opening, soiling the inner garments
• Discomfort and skin infections due to constant wetness caused by leaked fluids
• Constipation or diarrhoea
• If fistula gets blocked, again there will be abscess formation with the symptoms of swelling, fever, malaise and septicaemia.

Diagnosis – Anal fistula can be diagnosed easily by physical examination of the anus and its surroundings. Rectal examination, sigmoidoscopy and fistulography give more details about the abscess, its tracts and openings.

Management

• Take plenty of water and fruit juices to avoid constipation
• Follow hygienic measures in cleaning and caring
• Pass stool twice a day to avoid strain to rectum and anus
• Don’t strain while defecating. It is better to have semisolid stool for easy defecation
• Sitz bath – After passing stool, sit in a shallow bath tub filled with antiseptic lotions or warm salted water for 10 minutes, to make the condition hygienic
• Hot compress can help anal abscess by enhancing blood circulation for diluting the infective toxins over there and healing faster with supply of nutrients

General treatment Fistula is usually very difficult to cure with medicines. So, allopaths mostly opt for surgical excision of fistula namely Fistulectomy. But, even after surgery, the chances of recurrence are more, which may be due to leftovers of fistula tract or abscess residuals or suppuration after surgery. Caution should be exercised during post-operative care for otherwise the tendency to form abscess will post another innings with a new tract formation. Other than delayed healing, abscess formation and recurrence of fistula, surgical removal can also cause incontinence of anus related to urge. These make the sufferers dejected and shameful.

Preventive measures

• Follow regular bowel habits without any strain
• Follow hygeinic measures to keep anal area clean and dry
• Treat any infections or boils immediately
• Avoid nylon underwear and use cotton ones

Homeopathic approach to fistula – Homeopathy can help avoid fistula formation, when anal abscess is properly treated with Homeopathic medicines. Treatment for fistula should be started at the earliest, to heal it before gets granulations in the tract so that it can heal completely without giving any residual gaps or chances of recurrences.

Homeopathy usually cares fistula by controlling infection and helping the wound to heal. It aids natural cure. Patients need patience while getting treated for fistula since the fistula opening looks like it has healed but opens suddenly on strain or with a new anal abscess. Everyone can keep hygienic condition externally, but not internally. Since faecal matter is full of microorganisms, no one can avoid getting infection unless they have gained resistance to infection. Homeopathy can provide this. Also, for complete healing, fistula should get healed or closed from within first. Otherwise, the outer opening can reopen anytime or open a new tract to a new place.

Homeopathy can abort the tendency to abscess formation and suppuration by increasing resistance. So it can thus avoid the hindrances to cure by helping the healing process to continue naturally without interference. Also, to heal the fistula, first of all, the flow of fluid must get stopped since the draining fluid itself acts as a layer of separation to resist healing. For that, the tendency to fluid collection and suppuration must be stopped. Homeopathy provides this without any surgical measure. If the flow gets stopped, the pathway dries up naturally and shrinks to get close approximation for better healing.

Homeopathic medicines commonly used in cases of fistula are – Acid Nit, Apis mel, Bacilinum, Calc Flour, Calc Phos, Calc Sulf, Calendula Q, Capsicum, Carboveg, Causticum, Collinsonia, Graphites, Hamemelis, Hepasulf, Hydrastis, Hypericum, Lachesis, Lycopodium, Mag Phos, Mer cor, Merc sol, Muriatic acid, Silicea, Sulphur, Thuja, etc.. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)