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Operation Theater

How are Anal Abscess and Fistulas Treated?

The goal of treating anal abscess and fistulas is to lessen the pain, stop their reoccurrence by clearing the blockages, and preserve muscle control.  Therefore, it is important that symptoms be evaluated by a colon-rectal surgeon.  A colon-rectal surgeon will perform a thorough examination and recommend treatment. The physicians at Connecticut Colon & Rectal Surgery, LLC have a goal to preserve muscle function while effectively treating the fistula by developing individualized treatment plans based on the type of abscess and fistula.

Treatment

Under most circumstances, the treatment of an abscess is surgical drainage.  For most patients, an abscess can be drained surgically through a simple procedure.  An incision is made in the skin near the anus to drain the infection. Typically, this can be done at the surgeon’s office with a local anesthetic but under certain circumstances, this may need to be done in an operating room under anesthesia.  Some patients may require multiple surgeries to take care of the problem. Surgery is recommended to treat an anal fistula that does not close or recurs.

Fistulotomy

In many patients, if the fistula is not too deep, a fistulotomy is performed. During this surgery, the fistula track will be opened to allow healing from the inside out. The surgery may require dividing a small portion of the sphincter muscle. If a large amount of sphincter muscle is encountered during surgery, it is not divided, as this could lead to problems with bowel control such as fecal incontinence.  In some cases, a fistulotomy involves the insertion of a drainage tube known as a seton, which is thread through the fistula track.  This allows the inflammation to settle by draining the infection.  This can stay in place long term but is frequently used for a short period of time.  Once the infection resolves and the tissue begins to heal a second procedure is performed to remove the seton drain and close the fistula track.  

When Would I Need More Advanced Surgery?

 

If the fistula track does involve a large portion of the sphincter muscle, it may require other more advanced surgeries, such as an advancement flap, that are done to treat the fistula without harming the sphincter muscle. More difficult cases may require multiple surgeries.  

Antibiotics alone are not effective in treating abscesses or fistula. Antibiotics may be needed, in addition to surgery, if a patient has immunity issues, specific heart valve conditions or widespread cellulitis (a bacterial infection of the skin and tissues under the skin). Providing your physician with an accurate medical history and undergoing a physical exam are important steps in deciding if antibiotics are required.

If you believe you are suffering from an anal abscess or fistula, give our office a call at (860) 826-3880 to schedule an appointment or request an appointment online.  If appropriate and availability allows, a consultation appointment will be scheduled for you to be seen by one of our experienced physicians, generally, within a two-week timeframe of contacting the office.  Procedures are generally scheduled shortly thereafter.

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