Some of the common problems occurring at the Anus & Rectum

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SPECIALITY CENTRE FOR ANORECTAL PROBLEMS.

FISTULA

Infected tract line by granulation tissue starting from anal canal or rectum & opening on the skin around the anus. The fistula has internal & external openings. Fistula rarely heals without surgery.

LOW LEVEL FISTULA: (Most common.) Internal opening is below the anorectal ring. Pain, swelling & Pus discharge from the opening around the anus, iIrritation of the surrounding skin, discomfort. Recurrent episodes may occur. Multiple external openings or opening far away from the anal canal, e.g.in buttock, perineum or thigh.

Internal opening: most common- post-midline, next common site is anterior midline & least common will be any other site in the anal canal. Fistula tract could be strait or curved.

HIGH LEVEL FISTULA: (Rare.) Internal opening is above anorectal line.

Causes: traumatic, penetrating foreign body, iatrogenic or secondary to other diseases like tuberculosis, Crohan's disease, carcinoma rectum or ulcerative colitis. Per say non specific high level fistula is very rare.

Treatment :
Fistula in ano almost always requires surgery & could be one of the difficult problems to be treated. Assessing the pathology & planning of the treatment is necessary. The fistulous tract must be laid open & allowed to drain openly & heal by secondary intension. Partial closure can be attempted.

Low level fistula: Permanent incontinence will not occur as it does not involve the entire Anorectal ring. High level fistula: The internal opening opens above the ano-rectal ring, therefore permanent incontinence may occur only if the entire anorectal ring is divided. Staged surgery is recommended in high level fistula. The secondary fistula due to granulomatous diseases, tuberculosis, ulcerative colitis, carcinoma the rectum will require appropriate treatment for the disease.