Paonessa Colon & Rectal Surgery

Anal Abscess And Fistula

Nina Paonessa, DO, FACOS

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 is frequently the result of a previous or current anal abscess, occurring in up to 50% of patients with abscesses. Inside the anus are small glands. Sometimes, these glands become clogged and become infected. This leads to an anal abscess. The anal fistula is the tract or tunnel that forms between the clogged gland inside the anal canal and the infected skin/abscess outside of the anus. A fistula can present with or without an abscess. Other causes of anal fistula are: Crohn’s disease, radiation, trauma and malignancy/ cancer. How does a person develop an anal abscess or fistula?

Most anal abscesses are the result of an acute infection in the glands inside of the anus. Occasionally, bacteria, fecal material or foreign matter can clog the anal gland and create a condition for an abscess to form. Once an abscess is drained, in approximately 50% of cases, a tunnel (fistula) will persist under the skin connecting the infected gland to the outside skin where the abscess was located. When this occurs, patients typically experience some type of persistent drainage from the site of where the abscess had been in the perianal skin. What are the signs or symptoms of an abscess or fistula?

A patient with an abscess may have pain, redness or swelling in the area around the anus. Other common symptoms are fevers, chills, fatigue and generally not feeling well. Those patients that develop an anal fistula frequently complain of perianal irritation, moisture in the perianal area and/or persistent, episodic drainage in the perianal area. A common complaint of patients with anal fistula is the sensation that they cannot keep the perianal area clean or that they feel “wet” in the perianal area. Are there any tests performed to diagnose an abscess or fistula?

A majority of anal abscesses anal fistula are diagnosed by history and physical examination alone. Occasionally, additional studies such as CT scan or MRI can assist the surgeon with the diagnosis of deeper abscesses or to help identify a deeper or complex fistula tract/tunnel. How is an anal abscess treated?

The treatment of anal abscess is surgical drainage. Once the overlying and surrounding skin has been numbed with local anesthetic agents, an incision is made in the skin over the abscess to drain the pus. This can usually be performed in the surgeon’s office with local anesthetic and may sometimes require deeper anesthesia in the hospital setting. For patients, such as diabetics or patients with suppressed immune systems, hospitalization may be required for more significant infections. Are antibiotics necessary to treat anal abscess or anal fistula?

Antibiotics, alone, are NOT a wise treatment for anal abscess or fistula. Studies have shown that for uncomplicated abscesses, the addition of antibiotics to surgical drainage does not improve healing time or reduce the potential for recurrences. There are, however, certain circumstances in which antibiotics may be added to surgical drainage. These would include those patients with extensive cellulitis, patients with cardiac valvular disease, and those patients with altered or suppressed immune systems. This determination is made by your surgeon after taking a careful, detailed medical history and performing a physical examination. What is the treatment for anal fistula?

Surgery is almost always necessary to treat an anal fistula. This may require a single stage or multi staged procedure. Colorectal surgeons are specialists who are trained to treat anal fistula and are well versed in the different types of surgeries to treat anal fistula. Surgery for anal fistula involves connecting the external opening (site of drainage on the skin) to the internal opening (the clogged gland in the anus). There are several different types of surgical procedures to accomplish this and a colorectal surgeon would determine which procedure is best suited to your condition.

The different types of surgery for anal fistula include anal fistulotomy which connects the internal opening (clogged gland) with the external opening (site of drainage on the skin). This creates a groove that will heal from the inside out. Other procedures to treat anal fistula include filling the fistula tract with a material to occlude the fistula or disrupting the tissue around the fistula in order to close the fistula. If performed correctly, surgery for fistula is unlikely to affect bowel control. What to expect when recovering from fistula surgery?

Patients will be provided pain medication to assist with the discomfort associated with fistula surgery. Taking stool softeners, laxatives and fiber supplement will help to avoid constipation in the postoperative period. Patients should plan for some time at home to recover. Discussing with your colorectal surgeon the anticipated time away from work is very important. Sitz baths also play a key role in the postoperative care.

Dr. Paonessa is a fellowship trained colorectal surgeon who is skilled at treating patients with anal abscess and anal fistulas. She has a 24 hour policy in her office so that if you are in pain from an anal abscess, you can be guaranteed to be seen within 24 hours. Most anal abscesses are drained right in the office under local anesthesia. Dr. Paonessa is also well trained in a variety of techniques to treat simple and complex anal fistulas with excellent outcomes. If you are experiencing any of the symptoms above, call Dr. Paonessa’s office to make an appointment and get on the road to feeling well.

Colon and Rectal Surgery

Board Certified in General Surgery and Proctology • laparoscopic surgery • abdominal/pelvic surgery • fecal incontinence • endoanal/rectal ultrasound • anorectal surgery • pelvic floor disorders • office proctology • anorectal manometry/ physiology

603 Higgins Avenue Brielle, NJ 08730 1364 Route 72, Suite 5 Manahawkin, NJ 08050

Phone: (732) 282-1500 • Fax: (732) 292-9600

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