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Perianal abscesses and anal fistulas: What are they?

An anal abscess, a pocket of pus near the anus, is usually caused by an infection of a small anal gland. As it drains, it can give way to an anal fistula: a tunnel that connects the inside of the anus to the perianal skin.

This fistula allows chronic discharge of purulent, bloody, or fecal secretions.

The complexity of anal fistulas varies according to their anatomical course. The main distinctions are:

• Subsphincteric fistulas: the simplest, located below the anal sphincter.
• Inter-sphincter fistulas: partially cross the sphincter muscle.
• Trans-sphincter fistulas: pass completely through the sphincter muscle.
• Suprasphincter fistulas: located above the sphincter muscle.
• Extra-sphincter fistulas: with a more complex course.

Treatment of anal fistulas depends on the type and severity of the fistula. The prognosis for recovery is variable and may be influenced by the presence of complications.

Causes of anal fistula

Anal fistulas are often the result of an inflammatory process that begins with an infection of an anal gland. This abscess, a collection of pus, may drain spontaneously or be surgically incised. In either case, a fistula may remain.

In addition to glandular infections, other factors may predispose to the development of anal fistulas:

• Inflammatory bowel disease (IBD): Crohn's disease in particular is often associated with the development of anal fistulas.
• Trauma and surgery: Injuries or surgery to the anal area can cause lesions that develop into fistulas.
• Sexually Transmitted Infections (STIs): Certain STIs can cause abscesses and fistulas.
• Anal or rectal tumors: These less common conditions can lead to fistula formation.

Common symptoms

The most common symptoms of anal fistula are:

• Pain: Often felt during bowel movements or while sitting, it can be sharp and localized around the anus.
• Discharge: A yellowish or whitish fluid (pus) is discharged regularly from the opening of the fistula.
• Swelling: A small, red, painful lump may appear around the anus, indicating an abscess.
• Itching and irritation: The skin around the anus may be irritated and itchy.
• Fever: In some cases, infection may cause fever.

Diagnosis of anorectal fistulas in Turkey

In Turkey, anal fistula is diagnosed by a specialized doctor (proctologist). It is based on a careful clinical examination of the anal region.

The clinical examination allows to:

• Observe the opening of the fistula and any areas of redness or swelling.
• Palpate the course of the fistula, which may feel like a hard string.
• Identify any associated abscesses.

In some cases, additional tests may be needed:

• Anoscopy: An examination to visualize the lower part of the rectum.
• Endoanal ultrasound: A test that uses ultrasound to visualize the tissues around the anus.
• Pelvic MRI: A medical imaging test that provides very precise images of pelvic tissues.

These scans are especially useful for complex or recurrent fistulas to clarify their course and identify possible complications.

If you suspect you have an anal fistula, you should see a doctor. Early diagnosis and appropriate treatment are essential to relieve symptoms and prevent complications.

Treatment of perianal abscess in Turkey

To treat anal abscesses, a surgical incision is made in the skin above the abscess to drain the infected pus. This procedure relieves pressure and promotes a quicker recovery. This procedure can be done under local anesthesia. In some cases, hospitalization and surgery under involuntary heavy sedation may be required for a large or deep abscess. People at higher risk of infection, such as diabetics or those with weakened immune systems, may also need to be hospitalized. The use of antibiotics has a limited and adjunctive role in the treatment of uncomplicated anorectal abscesses and is not a primary alternative to surgical drainage. They may be useful for associated cellulitis or in immunocompromised patients.

Surgical treatment of anal fistula in Turkey

Anal fistula does not heal spontaneously and requires surgical intervention. The goal of surgery is to remove the abnormal passage to prevent recurrence and complications.

The choice of surgical technique depends on the location and complexity of the fistula. Here are the options available in Turkey:

Each technique has advantages and disadvantages in terms of success rate, post-operative pain, recovery time, and risk of complications. It is important to discuss these with your surgeon in Turkey to choose the most appropriate technique for your situation.