Anal abscess and anal fistula are two completely different clinical conditions of the same disease.
Anal abscess (abscessus ani) is an acute condition characterized by swelling near the anus, severe pain, and often fever. It’s caused by bacterial inflammation of perirectal glands, which are located at the level of the anal canal, and between the internal and external sphincter. Abscess formation develops quite rapidly, it takes two or three days for the process to spread to the skin around the anus, which turns red with visible swelling. It is painful and sensitive to the touch and at this stage, the patient is forced to seek medical attention.
Anal fistula (fistula ani) is a chronic condition, which occurs in 99% of cases after anal abscess. After abscess incision and when the contents have been drained it creates a channel that extends from the hole in the skin where the incision is to the inner hole where the perirectal glands are, which are located exactly at the site of the anal crypts. The clinical picture is completely different from the symptoms of anal abscesses. There is almost no pain whatsoever, no fever and the general condition of the patient is almost totally normal.
The thing that accompanies the anal fistula is that occasionally, blurred yellow fluid leaks onto the external opening in the skin around the anus, and this is the main symptom. There can also be a dull pain, which occurs when the fistula canal temporarily shuts.
This condition is chronic, which means that patients can have symptoms for years before deciding to have surgery, which is the only way of healing the fistula.
TREATMENT OF ANAL ABSCESS
The goal of treatment is to evacuate the accumulated purulent content, which is located under the skin in the area of swelling as soon as possible. It is really the only effective way at this stage of the disease. Under brief intravenous anesthesia, an incision is made over the swelling and thus evacuating the contents. Immediately after the intervention the patient feels much better, there is no pain, general condition improves, and the fever is gone. With the help of antibiotic treatment in a relatively short amount of time, the patient is functional and capable of work.
THE TREATMENT OF ANAL FISTULA
In most conventional operations the anal fistula is removed (excised) along with the external hole. However that resulted in a high percentage of recurrence, because it left the internal opening, which just re-creates the anal fistula.
The goal is always to find the inner hole (located in the anal crypts, as mentioned above).
When a special silver probe finds it, then the operation is very simple, because it is disrupted and the bridge between external and internal fistula opening is closed, thus preventing the possibility of creating a permanent fistula.
It is important to know that the procedure is completely harmless if an experienced physician performs it. It is performed under local anesthesia and postoperative patients have no symptoms. The patient goes home without assistance and is functionally capable of working the same day.