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PerianalAbscessandFistula
StanfordUniversitySectionofColonAndRectalSurgery

PerianalAbscess
Aperianalabscessisaninfectionaroundyouranusthatbeganinamucoussecretingglandintheanalcanal.

PerianalFistula
Aperianalfistula,almostalwaystheresultofapreviousabscess,isasmallpassageconnectingtheanalgland
fromwhichtheabscessarosetotheskinwheretheabscesswasdrained.

CausesofanAbscess
Anabscessresultswhenasmallglandjustinsidetheanusbecomesinfectedfrombacteriaorstooltrappedin
thegland.Youdidnothingtocausethisinfection.Certainconditionsconstipation,diarrhea,colitis,orother
inflammationoftheintestine,forexamplecansometimesmaketheseinfectionsmorelikely.

CausesofaFistula
Afteranabscesshasbeendrained,apassagemayremainbetweentheanalglandandtheskin,resultingina
fistula.Iftheglanddoesnotheal,therewillbepersistentdrainagethroughthispassage.Iftheoutsideopening
ofthefistulahealsfirst,arecurrentabscessmaydevelop.

SymptomsofanAbscessandFistula
Perianalabscessesaregenerallyaccompaniedbyintenseanalpainandswelling.Feverispossible.Drainage
oftheabscess,eitheronitsownorwithanincision,relievesthepainandpressure.Fistulasareassociated
withdrainageofblood,pus,ormucus,buttheyaregenerallynotpainful.

DoesanAbscessAlwaysBecomeaFistula?
No.Afistuladevelopsinabout3050percentofallabscesscases,andthereisreallynowaytopredictifthis
willoccur.Ifdrainagepersistsfortwotothreemonths,thediagnosisofperianalfistulaismade.


TreatmentofAbscess
Anabscessistreatedbydrainingthepusthroughanopeningmadeintheskinneartheanus.Oftenthiscan
bedoneinthedoctor'sofficeusingalocalanesthetic.Alargeordeepabscessmayrequiredrainageinthe
operatingroom.Hospitalizationmaybenecessaryforpatientssusceptibletomoreseriousinfections,suchas
diabeticsorpeoplewithdecreasedimmunity.

TreatmentofFistula
Surgeryisgenerallynecessarytotreataperianalfistula.Thisusuallyinvolvescuttingasmallportionofthe
analsphinctermuscletoopenthepassage,joiningtheexternalandinternalopening,andconvertingthe
passageintoagroovethatwillthenhealfromtheinsideout.Mostfistulasurgerycanbeperformedonan
outpatientbasis.Ifthefistulainvolvestoomuchsphinctermuscle,atwostageprocedureormorecomplicated
repairmaybenecessary.

WhattoExpectAfterSurgery
Discomfortafterfistulasurgerycanbemildtomoderateforthefirstweekandcanbecontrolledwithpainpills.
Theamountoftimelostfromworkorschoolisusuallyminimal.Therewillbenolimitationonactivity.Soakthe
affectedareainwarmwaterthreeorfourtimesaday.Stoolsoftenersmayalsoberecommended.Youmay
needtowearagauzepadorminipadtopreventthedrainagefromsoilingyourclothes.Bowelmovementswill
notaffecthealing.
RecurrenceofAbscessandFistula
Ifproperhealingoccurs,theproblemusuallywillnotreturn.Ifyourbowelsareotherwisenormal,youare
probablynotathigherriskfordevelopinganotherabscess.

Revised:12/18/2007

ThisdocumentisintendedforusebystaffofStanfordHospitalandClinics.Norepresentationsorwarrantiesare
madeforoutsideuse.Notforreproductionorpublicationwithoutpermission.DirectinquiriestoStanfordHospital
andClinics.GISurgery10/08.