Tokushukai Medical Group

Treatment of disorder

Treatment of disorder

Gastroenterological Medicine: Anal Fistula

Status where bowel mucosal inside of anus and skin are penetrated.

Quote: “For Clone Disease Patient: Fundamental Knowledge Need-to-Know for the Treatment, 2nd edition (Research group (Suzuki Team) for Refractory Inflammation Bowel Disturbance)”
The exit of butt is called as Anal, and there is a boundary of skin and bowel mucosal. Muscle (sphincter muscle) for adjusting defecation is usually closed. The boundary of bowel mucosal of anal is merely injured (ostium primum), then inflammation is produced around it (perianal abscess), then stand pus is discharged from exit (ostium securdum), the cut at anal skin side (discharge of pus). As aforementioned, the status, where there is a path between bowel mucosal inside of anal and skin, is called as anal fistula. In inflammatory bowel disease like clone disease, there is a case of multiple anal fistula making many exits. On the other hand, when blood vessel around the anal gather to make bumps, it is called as hemorrhoid, or warts hemorrhoids. Also, instead of blood vessel, only skin around the anal is pushed out, is called as anal skin tag.

Troublesome if it is complicating disease of clone disease.

Anal fistula coming from perianal abscess is a quite common thing. It may be generated on less one-year old infants, but it is rarely happened in childhood. For male, it is generated from adolescent period to maturity, and for woman it may be generated after maturity.
Prognosis of this disease is good in most cases with applying appropriate treatment for common anal fistula, but in case of anal fistula complicated with clone disease may be generated from young person, and may sometime be in refractory nature. Especially for women younger than 20-year-old, it is said to be in high probability of clone disease. Other than that, it is merely generated by communicable disease like tuberculosis or syphilis, HIV, or scleroderma.

Diagnose if there is ostium securdum

The symptom of perianal abscess is generally pus swelling with sudden pain around the anal and reddening. When it turns into anal fistula, continuous pus discharge is seen, and sometime associated with bleeding.
To diagnose, firstly reddening and the size of pus are checked by anal exam (digital exam and anal digital exam). In case when ostium securdum is checked, it can be diagnosed only by exam. Generally, inflammation or spread of pus is verified with CT Exam or MRI examination. Depend on facility, endoanal ultrasound test or anal internal pressure measurement may be conducted.

Select treatment method corresponding to degree and spread of anal fistula.

Basics of perianal abscess treatment is incision and drainage. In case cellulitis, a kind of suppurative inflammation, is lead to broader area, or in case not cured by drainage, administration of antibacterial agent may be used.
In case of anal fistula, select various kinds of treatment by the degree and spread. Basically, surgical operation will be taken place to prevent recurrence of inflammation, because if medicine treatment takes longer time, then perianal abscess is repeated. However, in case if anal fistula is generated by inflammatory bowel disease like clone disease, because of the permanent surgical cure may cause wound site not to heal, detail checking of gut tract or treatment for entire body has a priority. For anal fistula accompanied with inflammatory bowel disease, or perianal abscess case, Seaton method treatment, indwelling through string, is performed for continuous drainage.

Care for encopresis when having anal fistula extended over anal sphincter muscle.

Treatment duration and recurrence rate may vary depend on degree and spread of anal fistula, but in case if appropriate surgical treatment has been done, they say that the recurrence rate is around 10%. It is necessary to know that when developed portion of anal fistula spread over anal sphincter muscle, encopresis may likely occur.

Maintain scheduled defecation habit and cleanliness

Bowel movement habit and cleanliness of anal part are important. Avoid standing off bowel motion, constipating or overstraining, to have consistent bowel movement habit will result to prevent disease. Also, inflammation may easily occur because of incompletion evacuation around anal so that take care for good sanitation with cleaning anal with flowing water.

Anorectal Disease (Hemorrhoid, Anal Fistula, Anal Fissure) Treatment Guideline, 2014 Edition, Japan Society of Coloproctology, Nankodo 2014
Knowledge of anal disease useful for practical doctors, Edit by Jyoji Utsunomiya, Nagai Bookstore 1999