Anal Fissures, Fistula, and Abscesses

The lower portion of the intestinal tract is the rectum and anal canal. Several conditions affect this area and may be confused with the more widely known problem in this area, hemorrhoids.

Anal Fissure

An anal fissure is a small tear that develops in the lining of the anus. Anal fissures most often develop due to straining during bowel movements, which often occur as a result of hard stools, constipation or chronic diarrhea. Anal fissures are often seen in infants but also affect children and adults.

Signs and symptoms of anal fissures often include:

• A visible crack in the skin surrounding the anus
• Pain during and following bowel movements
• Blood in the stool
• Itching or irritation around the anus

Anal Abscess

Anal abscesses are small pockets of pus that develop in the lining of the anal canal, often as a result of a bacterial infection. Inside of the anus there are small glands, and if these glands become clogged they can then become infected and an abscess may form. In certain situations, an anal abscess can lead to the development of an anal fistula.

Signs and symptoms of anal abscesses often include:

• Tenderness
• Swelling
• Pain
• Fever
• Chills
• Fatigue

Fistula

A fistula is a small abnormal tunnel that develops in the anal lining. Fistulas often develop in the rectum and move outwards towards the skin near the anus. Fistulas may develop independently, or may develop in association with an anal abscess. After an anal abscess is drained, a tunnel may continue to connect the anal gland that was previously infected to the skin, resulting in a fistula.

Signs and symptoms of an anal fistula often include:

• Irritation of the skin surrounding the anus
• Drainage of pus
• Fever

Diagnosis of Anal Fissure, Abscess or Fistula

Your gastroenterologist may diagnose any one of these conditions after a simple visual examination of the anus and the surrounding tissue. In certain situations where an anal abscess or fistula are suspected your gastroenterologist may wish to examine the anal and rectal areas with an anoscope, which provides visibility of the anal canal and lower rectum.

If an anal abscess is found, then your gastroenterologist may recommend a colonoscopy exam to evaluate the health of the gastrointestinal tract and to determine if the abscess may have been caused by an inflammatory bowel disease like Crohn’s disease.

Treatment of Anal Fissure, Abscess or Fistula

If any one of these conditions is diagnosed, then your gastroenterologist will provide you with detailed information concerning the best route of treatment.

Most anal fissures heal on their own, but additional therapy may be needed.

An anal abscess is usually drained to empty pus from the infected area, as well as to relieve pressure and discomfort.

Anal fistulas may require surgical correction using a procedure called a fistulotomy. This procedure is performed by a colon and rectal surgeon and is often performed on an outpatient basis.