Anal Fistulas – Causes, Treatment, and Gentle Care with an Intimate Shower
“Caring for the buttocks and anal wounds is significantly easier with a bidet shower, as it makes cleaning inflamed skin conditions much simpler.”
– Dr. Daniel Paul Sterzing, Specialist in Proctology
What are anal fistulas?
Anal fistulas are tears in the anal skin and mucosa that become chronically inflamed, resulting in a perpetually reopening, non-healing, narrow ulcer. These tears are often noticed at the back (towards the coccyx) of the anus. Over time, high pressure in the anal sphincter, which lies beneath the mucosa, can develop. The persistent nature of the wound is due to poor blood circulation, which is in turn caused by elevated resting pressure in the sphincter muscle. Externally, a skin tag often forms at the fissure site.
The condition primarily causes sharp, burning pain during bowel movements. In some cases, the pain is also intensely felt without bowel movements, leading to painful anal spasms. These spasms further inhibit the fissure's healing. During bowel movements, the ulcer can reopen, causing bleeding. Occasionally, itching may also occur.
Causes
An anal fistula typically develops due to pus accumulation in the anal area caused by inflammation of the proctodeal glands. These glands are located between the internal and external sphincter muscles and open into the anal canal. When the glands are damaged by bacterial inflammation, an abscess may form. This abscess is encapsulated by granulation tissue (a temporary tissue formed during wound healing), creating an abscess capsule around the pus. The abscess spreads through tissue with the least resistance, leading to the formation of the fistula tract.
Treatment
Treatment often begins conservatively. Using medication to reduce sphincter pressure or performing a sphincter dilation helps to stretch the ulcer. This refreshes the tissue and promotes the formation of clean, healing scar tissue in the non-healing tear. Additionally, topical anesthetic creams are applied, and care is taken to maintain soft stool consistency.
Alternatively, surgical removal of the fissure is an option.
Proper anal care is crucial during wound healing after surgery. This involves rinsing the anus with water rather than wiping it.
The sensitive skin around the anal opening cannot tolerate harsh soaps or excessive friction. Clear water is the best option and promotes overall anal health.
