Service

Perianal abscess and anal fistula

Section: Services
Specialist: Op. Dr. Dilara Hasanova
Clinic: Modern Hospital, Baku

The doctor's practice — examinations and treatments Dr. Hasanova performs herself
General information — educational text about diseases and methods

What is a perianal abscess (paraproctitis)?

Short answer

A perianal abscess (paraproctitis) is a collection of pus in the tissue around the anus and rectum. It usually starts with inflammation of the small glands in the anal canal. Its symptoms are throbbing pain around the anus that keeps getting worse, swelling, redness and fever. A perianal abscess requires urgent surgical intervention.

What is an anal fistula?

An anal fistula is an abnormal channel that forms between the inside of the anal canal and the skin around the anus. It often results from an earlier perianal abscess (paraproctitis). From time to time, a discharge containing pus or blood comes out of a small opening in the skin. A fistula does not heal on its own and requires surgical treatment.

Symptoms of a perianal abscess

Worsening, throbbing pain around the anus
Swelling, redness, pain when touched
Fever, chills, weakness
Difficulty sitting and walking
With a deep abscess there may be little change on the outside; pain and fever are the main features

Symptoms of an anal fistula

A small opening in the skin around the anus
Periodic discharge of pus or blood, and soiling of clothing
Recurring swelling and pain: when the opening closes, pus collects, and when it opens, the pain eases
Itching and skin irritation

Types of fistula

Fistulas are grouped according to their relationship to the anal sphincter:

Intersphincteric — the most common type; passes only through the internal sphincter
Transsphincteric — passes through both sphincters and opens onto the perianal skin
Suprasphincteric — loops over the top of the sphincter complex
Extrasphincteric — passes outside the entire sphincter complex and opens into the rectum

In addition, simple and complex fistulas (branching, recurrent, or passing through a large part of the sphincter) are distinguished.

Diagnostics

Inspection of the area around the anus and a digital rectal examination
Searching for the internal opening of the fistula with anoscopy or video proctoscopy
MRI (magnetic resonance imaging) — shows the course of the fistula and its relationship to the sphincter. It is important for planning the operation in complex and recurrent fistulas.
Fistulography — an X-ray examination in which a contrast agent is injected into the fistula channel (in selected cases)

A fistula may be associated with Crohn's disease. When this is suspected, an examination by a gastroenterologist and a colonoscopy are recommended.

Treatment

General information

Perianal abscess: the main treatment is urgent surgical drainage, that is, opening the abscess and draining the pus. Antibiotics alone do not cure an abscess; they are given in addition only in selected cases. After drainage, a fistula can develop in some patients. That is why a follow-up visit after treatment is important.

Anal fistula: the method is chosen depending on the type of fistula and its relationship to the sphincter:

Fistulotomy or fistulectomy — opening or complete removal of the fistula channel
Seton — a special thread placed for staged treatment of the channel in a complex fistula
Sphincter-preserving methods (for example, LIFT — closing the fistula channel in the intersphincteric space, flap techniques)

The goal of treatment is to eliminate the fistula, preserve the ability to hold stool and reduce the risk of recurrence.

The doctor's practice

Examinations and treatments Dr. Hasanova performs herself

For a perianal abscess, she performs surgical opening and drainage of the abscess.
For anal fistulas, she performs fistulectomy, including for complex fistulas and for fistulas that recurred after surgery at another clinic.
In complex cases, she carries out treatment in stages: first the inflammation is cleared, then a planned operation is performed.
She draws up the operation plan based on the MRI result, together with a radiologist colleague. When needed, she performs fistulography herself.

When should you see a doctor urgently?

A painful, steadily growing swelling around the anus
Pain accompanied by fever and chills
Inflammation around the anus in a person with diabetes or a weakened immune system

Frequently asked questions

Why does pus collect again after an abscess has been opened?

Draining an abscess does not always eliminate the source that caused it. If an abscess keeps coming back, a fistula has most likely formed between the anal canal and the skin. In this case an examination and surgical treatment of the fistula are needed.

Will an anal fistula heal with medication?

No. Antibiotics may reduce the inflammation temporarily, but they do not remove the fistula channel. Lasting treatment requires surgery. The method is chosen according to the type of fistula.

Is the ability to hold stool impaired after fistula surgery?

The operation plan is built precisely to preserve sphincter function. In simple fistulas this risk is low. In complex fistulas, sphincter-preserving methods and staged treatment are chosen. The risks are explained in detail before the operation.

Why is an MRI needed for a fistula?

An MRI shows the entire course of the fistula, its branches and its relationship to the sphincter muscles. This helps the surgeon choose the right method and reduce the risk of recurrence. In simple fistulas, an MRI may not always be necessary.