anal fistulas

What are anal fistulas?

Anal fistulas are tears in the anal skin and mucous membrane, which subsequently become chronically inflamed and form a narrow ulcer that constantly reopens and does not heal. These tears are mainly noticed on the back (towards the coccyx) of the anus. This can result in high pressure from the anal sphincter, which sits under the mucous membrane. The reason the wound does not heal is poor circulation, which in turn is due to increased resting pressure of the anal sphincter. A fold of skin often forms on the outside of the fissure.

The main complaint is sharp, burning pain during bowel movements. Occasionally, the pain can be felt very strongly even without bowel movements and leads to very painful anal cramps. The cramps also prevent the fissure from healing. When bowel movements occur, the ulcer ruptures and can bleed. Occasionally, itching occurs.

causes

An anal fistula usually occurs due to a collection of pus in the anal area caused by inflammation of the proctodeal glands. These glands are located between the external and internal anal sphincter in the anus and open into the anal canal. If the glands are damaged by bacterial infections, an abscess can form, which is bordered by granulation tissue (tissue that is temporarily formed during wound healing) and forms an abscess capsule around the pus source. The abscess spreads towards the tissue with the least resistance, which leads to the formation of the fistula tract.

Treatment

The treatment is initially conservative, with medicinal sphincter pressure reduction (sphincter dilatation) to stretch the ulcer. This refreshment of the tissue and the resulting change in the non-healing tear should lead to the formation of clean, well-healing scar tissue. In addition, local anesthetic ointments are applied and soft stools are ensured.

Alternatively, it is possible to completely remove the fissure through a surgical procedure.

When healing wounds after surgery, it is particularly important to provide proper anal care. This means that the anus should not be wiped, but rather 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 intestinal health.