Anal Fissure, Fistula and Abscess

The intestinal tract or bowel ends with the rectum which opens outside as anus via anal canal. Three common diseases are seen in anus and anal canal:

Anal Fissure

An anal fissure is a small tear which resembles a paper cut in the lining of the anus. A hard, dry bowel movement can cause break in the lining. However, bouts of diarrhea, childbirth and abuse of laxatives may also cause such fissures.

A fissure can be quite painful during and immediately following bowel movements and can cause bleeding and itching. Muscles around the anal canal, called sphincters expand during bowel movements and stretch the fissure to cause pain and bleeding. During physical exam the fissure can be easily diagnosed. Usually fissure is single and seen in the posterior part.

Anal fissure treatment is usually conservative and stool softners, seitz baths, local creams help in symptoms. Chronic fissures require surgical intervention which is usually done on out patient basis. The cost of anal fissure surgery is cost-effective.

Anal Abscess

A localized collection of pus in the underlying tissues around anus and the anal canal, is called anal abscess. Anal abscesses are seen associated with conditions, such as Crohn’s disease and AIDS.

An abscess is diagnosed by presence of pain, tender swelling and fever. Anal abscess treatment includes antibiotics and surgery.

Anal Fistula

A fistula is a tiny channel that develops in the presence of inflammation and infection. It may or may not be associated with an abscess, but like abscesses, certain illnesses such as Crohn’s disease can cause fistulas to develop. The channel usually runs from the rectum to an opening in the skin around the anus. But sometimes the fistulae develop between rectum or colon and bladder or vagina in patients with Crohn’s disease or obstetric injuries or even in diverticulosis.

The fistulae are infected channels and cause discharge. An abscess and fistula often occur together. If the opening of the fistula seals over before the fistula is cured, an abscess may develop underneath it. The fistulae are diagnosed by physical exams and anoscopy. A colonoscopy is required to rule out a underlying condition such as Crohn’s disease.

Anal fistula treatment often depends on whether Crohn’s disease is present or not. Crohn’s disease which is a chronic inflammation of the bowel, needs to be treated first in associated fistulous disease. Medications such as Metronidazole, Remicade and 6 MP are required.

In absence of Crohn’s disease, a course of antibiotics and if no response, then anal fistula surgery is usually successful.

Hemorrhoids are described below alphabetically.

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