Best Anal-Abscess (এনাল-এবসেস ) Treatment in Bangladesh

Anal-Abscess

WHAT IS AN ANAL ABSCESS OR FISTULA?

An anal abscess is an infected cavity filled with pus found near the anus or rectum. Ninety percent of abscesses are the result of an acute infection in the internal glands of the anus. Occasionally, bacteria, fecal material or foreign matter can clog an anal gland and tunnel into the tissue around the anus or rectum, where it may then collect in a cavity called an abscess. An Anal Fistula (also commonly called fistula-in-ano) is frequently the result of a previous or current anal abscess. This occurs in up to 40% of patients with abscesses. A fistula is an epithelialized tunnel that connects a clogged gland inside the anal canal to the outside skin.

CLASSIFICATION

Anal abscesses are classified by their location in relation to the structures comprising and surrounding the anus and rectum: perianal, ischioanal, intersphincteric and supralevator. The perianal area is the most common and the supralevator the least common. If any of these particular types of abscess spreads partially circumferentially around the anus or the rectum, it is termed a horseshoe abscess.

Fistulas are classified by their relationship to parts of the anal sphincter complex (the muscles that allow us to control our stool). They are classified as intersphincteric, transsphincteric, suprasphincteric and extrasphincteric. The intersphincteric is the most common and the extrasphincteric is the least common. These classifications are important in helping the surgeon make treatment decisions.

SYMPTOMS

Anorectal pain, swelling, perianal cellulitis (redness of the skin) and fever are the most common symptoms of an anal abscess. Occasionally, rectal bleeding or urinary symptoms, such as trouble initiating a urinary stream or painful urination, may be present.

Patients with fistulas commonly have a history of a previously drained anal abscess. Anorectal pain, drainage from the perianal skin, irritation of the perianal skin, and sometimes rectal bleeding, can be presenting symptoms of a fistula-in-ano.

EXAMINATION

A careful history regarding anorectal symptoms and past medical history are necessary, followed by a physical examination. Common findings leading to the diagnosis of a anal abscess are fever, redness, swelling and tenderness to palpation. However, while most abscesses are visible on the outside of the skin around the anus, it is important to recognize that there may be no external manifestation of an abscess, other than a complaint of rectal pain or pressure. A digital rectal exam may cause exquisite pain.

When diagnosing an anal fistula, an external opening that drains pus, blood or stool is usually seen on examination. Heaped up tissue at the external opening suggests a well-established fistula. A digital rectal exam may produce pus from the external opening. Some fistulas will close spontaneously and the drainage may be intermittent, making them hard to identify at the time of the office visit. A ‘cord’ or tract can be occasionally palpated from the external opening toward the anal canal indicated where an internal opening of the fistula may be.

USE OF DIAGNOSTIC TESTS

Most of the anal abscess and fistula-in-ano are diagnosed and managed on the basis of clinical findings. Occasionally, additional studies can assist with the diagnosis or delineation of the fistula tract. Today, both traditional two-dimensional and three-dimensional endoanal ultrasound are a very effective manner of diagnosing a deep perirectal abscess, identifying a horseshoe extension of the abscess, and delineating the path of a fistula tract.

This may be combined with hydrogen peroxide injection into the fistula tract (via the external opening) to increase accuracy. CT scans can be useful for patients with complicated infections, multiple fistula tracts or with other medical conditions which may present similarly, such as Crohn’s disease. A pelvic MRI has been shown to have accuracy up to 90% for mapping the fistula tract and identifying internal openings. Some general surgeon practicing colorectal in our country do fistulogram test. We don’t suggest it because most of the time this test is misleading.

TREATMENT OF ANAL ABSCESS

The treatment of an anal abscess is surgical drainage under most circumstances. An incision is made in the skin near the anus to drain the infection. This can be done in a doctor’s office with local anesthetic or in an operating room under deeper anesthesia. Hospitalization and antibiotics may be required for patients prone to more significant infections, such as diabetics or patients with decreased immunity.

Up to 50% of the time after an abscess has been drained in the hand of a general surgeon, a tunnel (fistula) may persist, connecting the infected anal gland to the external skin. This typically will involve some type of drainage from the external opening. If the opening on the skin heals when a fistula is present, a recurrent abscess may develop. Until the fistula is eliminated, many patients will have recurring cycles of pain, swelling and drainage, with intervening periods of apparent healing. We eliminate the fistula at the time of initial abscess operation.

Antibiotics alone are a poor alternative to drainage of the infection. The routine addition of antibiotics to surgical drainage does not improve healing time or reduce the potential for recurrences in uncomplicated abscesses. There are some conditions in which antibiotics are indicated, such as patients with compromised or altered immunity or in the setting of extensive cellulitis (spreading of infection in the skin).

We recommend mandatory use of antibiotics for patients with prosthetic valves, previous bacterial endocarditis, congenital heart disease and heart transplant recipients with valvular pathology. A comprehensive discussion of your past medical history and a physical exam are important to determine if antibiotics are indicated.

TREATMENT OF ANAL ABSCESS & FISTULA

Currently, there is no medical treatment available for this problem and surgery is almost always necessary to cure an anal abscess and fistula.  

WHAT IS A SETON?

As mentioned above, if a significant amount of sphincter musculature is involved in the fistula tract, a fistulotomy may not be recommended as the initial procedure of anal abscess drainage or anal fistula surgery. Your surgeon may recommend the initial placement of a draining seton.  

This is often a thin piece of rubber or suture which is placed through the entire fistula tract and the ends of the seton (or drain) are brought together and secured, thereby forming a ring around the anus involving the fistula tract. The seton may be left in place for 8-12 weeks (or indefinitely in selected cases), with the purpose of providing controlled drainage, thereby allowing all the inflammation to subside and form a solid tract of scar along the fistula tract.

This is associated with minimal pain and you can still have normal bowel function with a seton in place. Once all the inflammation has resolved, and a mature tract has formed, one may consider all the various surgical options detailed above as staged procedures. 

WHAT IS THE RECOVERY LIKE FROM SURGERY?

Pain after anal abscess surgery is controlled with pain medication, fiber, and water. Patients should plan for time at home using sitz baths and avoiding the constipation that can be associated with prescription pain medication. Discuss with your surgeon the specific care and time away from work prior to surgery to prepare yourself for post-operative care.

CAN THE ABSCESS OR FISTULA RECUR?

As previously mentioned, up to 50% of anal abscess may re-present as another abscess or as a frank fistula in the hand of a general surgeon.  Despite proper treatment and apparent complete healing, fistulas can potentially recur, with recurrence rates dependent upon the particular surgical technique utilized.  Should similar symptoms arise, suggesting recurrence, it is recommended that you find a colon and rectal surgeon to manage your condition. We have documented success rate of around 99% in treating anal abscess and anal fistula including complex fistula.

Which Doctor is best for the treatment of anal abscess and fistula?

A Colorectal surgeon is best for the treatment of anal abscess and fistula.

Who is a Colorectal Surgeon?

A colorectal surgeon should have a MS degree on Colorectal Surgery &/or is the faculty of Bangabandhu Sheikh Mujib Medical University (BSMMU). He/she has huge knowledge, expertise and experience on this field enough to do both medical and surgical treatment. There are very few colorectal surgeons in Bangladesh.

We can offer you the best treatment in this field. We treat piles (haemorrhoid), colon cancer, rectum cancer, Anal cancer, anal fistula, anal abscess, anal fissure, rectal prolapse, incontinence, constipation, chronic dysentery, abdominal pain, IBS, ulcerative colitis, Crohn's disease, tuberculosis, polyps, vomiting, abdominal gas, per rectal bleeding, anal pain, pilonidal sinus, obstructed defecation(ODS), rectocele, rectal intussusception, pelvic floor descend.

We do colonoscopy, LASER Surgery, Laparoscopic surgery, rubber band/ring ligation, injection sclerotherapy, Longo, STARR, rectopexy, fistula surgery, Colon/rectal/anal cancer treatment, APR, Anterior resection, colectomy etc with excellence and hospitality.

কলোরেক্টাল সার্জন হচ্ছেন পায়ুপথ, মলাশয়, বৃহদান্ত্র ও ক্ষুদ্রান্ত্র এর সকল রোগের চিকিতসা ও অপারেশনে বিষেশজ্ঞ। তিনি কলোরেক্টাল সার্জারী বিষয়ের উপর এমএস ডিগ্রী করেছেন কিংবা বঙ্গবন্ধু শেখ মুজিব মেডিকেল বিশ্ববিদ্যালয়ের কলোরেক্টাল সার্জারী বিষয়ের শিক্ষক হিসাবে কর্মরত আছেন অথবা কর্মরত ছিলেন। একজন কলোরেক্টাল সার্জন এসব রোগ সম্পর্কে দীর্ঘদিন পড়ালেখা ও গবেষণা করেছেন তাই তিনি এসব বিষয়ে ডিটেইল জানেন এবং তাদের ভুল করার সম্ভাবনা কম।

আমরা যেসব রোগের সর্বোত্তম চিকিৎসা নিশ্চিত করিঃ পাইলস, কোলন ক্যান্সার, রেক্টাম/মলাশয় ক্যান্সার, পলিপ, এনাল/মলদারের ক্যান্সার, ফিস্টুলা, ফোঁড়া, এনাল ফিসার, রেক্টাল প্রোলাপ্স (হালিশ), কোষ্ঠকাঠিন্য, মলত্যাগে বাধাগ্রস্ততা, ডায়রিয়া, আমাশয়, পেটে ব্যাথা, আইবিএস, আলসারিটিভ কোলাইটিস, ক্রনস ডিসিস, পেটের ও মলদারের যক্ষা, বমি, বদ হজম, পেটে গ্যাস, মলদারে রক্ত যাওয়া, মলদারে ব্যাথা, পাইলোনিডাল সাইনাস ইত্যাদি।

আমরা বিনা অপারেশনে পাইলসের চিকিৎসা, লেজার চিকিৎসা, কলোনস্কপি, রাবার ব্যান্ড/রিং লাইগেশন, ইঞ্জেকশন স্কেরোথেরাপি, লঙ্গো, STARR, ফিস্টুলা সার্জারী, ল্যাপারোস্কপিক রেক্টোপেক্সি, মলদার রেখেই কোলন ও রেক্টাম ক্যান্সার অপারেশন ইত্যাদি সেবা আন্তরিকভাবে দক্ষতার সাথে দিয়ে আসছি।

Read more:

1.https://www.webmd.com/a-to-z-guides/anal-abscess

2.https://fascrs.org/patients/diseases-and-conditions/a-z/abscess-and-fistula-expanded-information

3.https://www.healthline.com/health/anorectal-abscess

4.https://en.wikipedia.org/wiki/Anorectal_abscess

5.https://www.hopkinsmedicine.org/health/conditions-and-diseases/anorectal-abscess

6.https://emedicine.medscape.com/article/191975-overview

Appointment

For anal abscess treatment and care by Colorectal Surgeon Dr Tariq Akhtar Khan please call 01736-369536 and take an appointment.