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

When a small tear which resembles a paper cut develops in the inner lining of the anus, it is called as Anal Fissure. 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

An anal fistula is a small channel that develops when there is infection or inflammation in the anal canal and this channel runs from the rectum to the skin around the anus. Sometimes, fistula can also develop between rectum or colon and bladder or vagina especially in those patients who have Crohn’s Disease, Diverticulosis or obstetric injuries. An anal abscess may lead to anal fistula and certain other conditions such as Crohn’s Disease may also cause a fistula to develop.

An anal fistula is an infected channel that can even cause the discharge. Anal abscess and anal fistula can also develop together in that condition when the opening of fistula is closed before it is completely cured and then abscess may develop beneath it. Physical exams and Anoscopy are used to diagnose the fistulae. Colonoscopy can also be done to rule out other underlying conditions 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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