Vaginal or uterine prolapse
I am suffering from a perianal fistula or abscess
An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. An abscess is a painful collection of pus, usually caused by a bacterial infection.
What is the cause
This is most frequently the result of an inflamed sebaceous gland in the rectum. These glands, together with haemorrhoids, are a natural part of the anus. As a result of the accumulation of pus in the gland, it either swells and an abscess occurs resulting in the need for acute surgery, or it may empty spontaneously into the area between the muscles and into the subcutaneous fat. An anal fistula can also occur as the result of Crohn's disease.
How the problem is diagnosed
The problem depends on the location of the abscess and the length and extent of the problem. A common symptom is a gradually intensifying and possibly throbbing pain around the anus which is aggravated when pushing during defecation and in hot conditions. A sign of an advanced stage of the disease is an increase in the patient’s temperature or even fever accompanied by chills and shivers. Sometimes pus is emitted and the patient observes a smelly discharge from the hole which has formed, while sometimes blood can be present in the pus. If the abscess is located high within the pelvis, there will also be pain and fever.
The symptoms of a fistula are much less dramatic, sometimes marked by pain, itching around the anus, or pus that can be found in a variety of formations.
How the problem is treated
Both these problems should be managed by a proctologist. There is an initial examination of the rectum which is performed with the patient in a kneeling or gynecological position. A part of this involves the doctor inserting a finger into the rectum of the patient to allow them to assess the problem using the sense of touch. The second standard examination is the performing of an anoscopy. In this case, a special device called an anoscope is inserted into the rectum which allows the doctor to visually examine the rectum.
Treatment of the abscess is always acute. A point of entry into the cavity containing the pus must be created surgically, which almost always involves the introduction of a drain into the remaining cavity. Sometimes antibiotics are required as part of the treatment. As a rule, the procedure is carried out under general anesthetic in the operating theatre.
Fistula treatment always involves surgery, and is a very complicated problem. The basis of the treatment depends on how the muscles of the anus are affected. The surgery often requires some degree of injury to the sphincter in order to be successful, and this might cause a subsequent incontinence. This condition is therefore associated with a significant number of relapses. The operation can be performed under a general anesthetic, local anesthetic or analgosedation. The treatment is varied, depending on the location of the fistula, and on whether it is simple or branched. It consists of the removal of the fistula, which is sometimes "cleaned" from the inside and then "treated" with a laser. In other cases, however, more complex surgery is needed.
The risks of surgery
The greatest risk of this type of surgery is sphincter injury and subsequent incontinence.
Post-operative care
The most important aspect of post-operative care is the monitoring of defecation and maintaining appropriate hygiene.
Official sick leave from work
Depending on the nature of the patient’s employment, official sick leave from work may not be prescribed at all, or there may be up to 6 weeks leave following the most extensive procedures.