Category Archives: anal abscesses

Comparing Anal Abscesses and Anal Fistulas | Minnesota

Hemorrhoids, abscesses, fistulas, fissures, anal itching, rectal prolapse—with so many anorectal disorders out there, it’s hard to keep track of which is which. Two of these conditions, anal abscesses and anal fistulas, are closely linked to one another but can be easily distinguished via the guidelines below.
 

Defining Each Disorder

Anal Abscess – This is a pus-filled, infected cavity near the opening of the anus or deep in the rectum. Most abscesses result from infection of anal glands in the lining of the anal canal near the anus opening. When bacteria from the gut passes the anal sphincter barrier and into the surrounding tissue of the rectum, an abscess of varying severity and depth forms. When an abscess fails to fully heal, an anal fistula may form.

Anal Fistula – As mentioned above, fistulas usually occur due to a previous anal abscess. A fistula is an inflamed tunnel under the skin, connecting the anal canal and the surface of the surrounding skin. The majority result from an anorectal infection, wherein the anal crypts are infected and cause pus-filled cysts to form near the anal canal.
 

Symptoms

Anal Abscess – The most common symptoms are pain around the anal area, swelling, redness, and fever. Rectal bleeding and urinary complications (difficult or painful urination) may also occur.

Anal Fistula – In addition to most likely having a history of anal abscesses, patients may also experience skin irritation around the anus, a throbbing pain when sitting, anal discharge, swelling and redness, and fever.

 

Causes

Anal Abscess – This usually occurs from infection of anal glands in the lining of the anal canal near the anus opening. Other causes include an anal fissure and sexually transmitted infections (STIs).

Anal Fistula – As previously mentioned, fistulas typically result from an abscess that did not fully heal. They may also, though less frequently, be caused by Crohn’s disease, STDs, trauma, tuberculosis, cancer or diverticulitis.
 

Treatments

Anal Abscess – Surgical incision and drainage should be performed ASAP, as antibiotics are ineffective at this stage of the infection. Delaying surgery can result in tissue destruction, fibrosis (scar tissue formation), and impaired anal continence. Drainage involves making a small incision above the abscess as close to the anus as possible, then removing the gauze after 24 hours. Sitz baths and stool softeners can help with post-surgery discomfort.

Anal Fistula – Surgery is generally needed to treat fistulas and involves cutting a small part of the anal sphincter muscle away. By doing so, the tunnel/fistula is opened up to form a trench that heals from the bottom outwards. After a few weeks, the trench ideally fills up with scar tissue and heals. Post-surgery discomfort is mild and can usually be addressed with painkillers.
 

Recurrence Rates

Anal Abscess – Nearly half of abscesses may recur, either in the form of a new abscess or as a frank fistula.

Anal Fistula – Fistulas can also potentially recur, with recurrence rates dependent upon the particular surgical technique utilized.

 

10 Reasons For Rectal Bleeding That Aren’t Hemorrhoids | Minnesota

Bleeding from your rectum or anus is never a pleasant experience, and it can understandably cause immediate panic. Generally, bright red blood indicates bleeding in the lower rectum, while dark red blood indicates bleeding from deeper and further up in the body. While passing dark red blood is usually a sign of digestive bleeding and requires immediate attention, any amount of rectal bleeding should be taken seriously.

While rectal bleeding can be caused by pesky hemorrhoids, there are a number of other potential causes ranging from fistulas and fissures to more serious cases of colon/bowel cancer.
 
1. Anal Fistula
An anal fistula is an inflammatory tunnel under the skin connecting the anal canal and the surface of the surrounding skin. Most fistulas occur from an anorectal infection, where the anal crypts are infected and cysts containing pus form near the anal canal. Fistulas are often misdiagnosed as hemorrhoids, as symptoms can be similar, including drainage from the anus, itchiness and pain during bowel movements. They can be treated with antibiotics, pain meds and a fistulotomy.

2. Anal Fissure
An anal fissure is a small rip or tear in the lining of the anal cana typically caused by trauma to the inner lining of the anus via a bowel movement or stretching of the anal canal. They can be painful, but fissures often heal within a few weeks through increasing fiber/fluid intake to keep stool soft and help ease bowel movements.

3. Colon Cancer
As scary as it may sound, rectal bleeding is a dangerous sign of colon cancer and must be taken very seriously. Symptoms of colorectal cancer include abdominal pain, a change in bowel habits, an anal or rectal lump, and bleeding during bowel movements. Click here to read our post on the differences between rectal cancer and hemorrhoids.

4. Gastroenteritis
Gastroenteritis, otherwise known as the stomach flu, is a common bacterial infection that causes diarrhea, fever and vomiting. Due to inflammation in the stomach and colon, the bowel becomes more sensitive during the illness and may cause bloody stools. While the process is uncomfortable, gastroenteritis normally clears up after a few days of rest and hydration.

5. Diverticulosis
Diverticulosis is a chronic bowel condition that causes small bulges or pockets to develop in the lining of the intestine/digestive tract. If these bulges become inflamed or infected, abdominal pain, bloating, constipation, diarrhea, and bloody stools can occur. More common in people over 40, diverticulosis can be treated using diet modifications, antibiotics and, if needed, surgery.

6. Rectal Prolapse
Believe it or not, a bit of your intestine can actually slip outside of your body. A rectal prolapse occurs when part of the large intestine slips outside the anus, which can happen during a bowel movement. This in turn causes pain and bright red blood in the stool, as well as difficulty in controlling your bowel movements. A prolapse usually requires surgical treatment, so call your doctor right away.

7. Polyps
Polyps are non-cancerous growths that can develop along the lining of your bowel. They’re pretty common and don’t usually manifest symptoms. In more severe cases, they can cause diarrhea, constipation, mucus in the stool and bloody stools. While most polyps do not escalate into cancer, there is still risk of cancer development. Be sure to call your doctor for a full examination.

8. Internal Bleeding
As mentioned earlier, darker colored blood can be a sign of internal bleeding in your digestive system. It can also be a sign of cancer, stomach ulcers or severe gastrointestinal disease. If you see dark red blood in your stool call your doctor ASAP.

9. Colitis
Colitis is a chronic inflammation of the innermost lining of the large intestine and rectum. Small ulcers develop in the lining of the bowel, which then bleed and produce pus. This causes recurring diarrhea, abdominal pain, rectal bleeding, and the frequent urge to pass stools. Management of colitis conditions can include antibiotics, medications and surgery.

10. Sexually Transmitted Infection (STI)
Sexually transmitted infections (STI) can result from unprotected anal sex and cause inflammation of the lining of the anus, which can lead to bleeding and pus. Treatment includes antibiotics and antiviral/antifungal medications.

 

Hemorrhoids vs. Rectal Cancer: How to Tell the Difference | Minnesota

Because the symptoms of hemorrhoids and early-stage rectal/colon cancer are very similar, people often confuse and, at times, misdiagnose the two conditions. Since the treatment method for each condition is vastly different, it’s important to know how to differentiate hemorrhoids from rectal cancer and proceed with the appropriate treatment options.

Rectal Cancer

The most obvious and noticeable symptom of rectal cancer is a malignant tumor (cancerous tumor that spreads) that forms in the tissues of the rectum. Additional rectal cancer symptoms can include:

  • Stools that are not round in shape
  • Bloody stools
  • A change in bowel habits (diarrhea, constipation)
  • Anal tenesmus (the feeling of urgently and constantly needing to pass stools due to rectal inflammation)
  • Unexplained weight loss (typically later symptom)
  • Unexplained fatigue (typically later symptom)
  • Pelvic or lower abdominal pain (typically later symptom)
  • The risk of rectal cancer increases as you age, so the condition is more common in individuals over 50, although it can also manifest in younger people. Those with either a personal or family history of colorectal polyps, colorectal cancer or inflammatory bowel disease (IBD) are at a higher risk.

    If you have any of above symptoms, you’ll need to still see a doctor for a digital rectal exam, colonoscopy and full work-up.
     

    Hemorrhoids

    Hemorrhoids are swollen, bulging blood vessels in the walls of the anus and lower rectum. When the tissues supporting the vessels become inflamed and stretch, the vessels expand and cause its walls to thin. This often leads to bleeding. If the intense stretching and internal pressure continue, these already weakened vessels ultimately protrude from the anus. Patients with hemorrhoids can suffer from internal hemorrhoids, external hemorrhoids, or both.

    Internal hemorrhoids are small or large hemorrhoids that develop inside the rectum and do not protrude outside the anus. They may bleed but are normally painless.

    External hemorrhoids are small or large hemorrhoids that protrude from the anus and bleed. Some external hemorrhoids retract back into the anal sphincter after a period of time, while larger, more severe ones require manual pushing to force them back into the interior of the anus. Hemorrhoids can exit the body via coughing, sneezing, laughing or standing for long periods of time. Prolapsed hemorrhoids can produce external anal mucus and itching around the anus.

    Symptoms of hemorrhoids include:

  • Discomfort, itching or pain around your anus
  • Bloody stools or seeing blood on the toilet paper when wiping
  • Moist, pink bumps around the edge of the anus, or bulging out from the anus
  • Severe or abnormal pain (advanced hemorrhoids)
  • Discomfort when sitting and laying down (advanced hemorrhoids)
  • Unlike rectal cancer, hemorrhoids are typically caused by changeable lifestyle habits such as lack of movement and exercise (lack of blood circulation), sedentary work, and straining from constipation, as well as pregnancy.

    If you experience any of the above rectal cancer or hemorrhoid symptoms, see a doctor immediately. For more on rectal examinations, check out our blog post about what to expect from a standard rectal exam.

     

    How Aging Increases Your Chances of Getting Hemorrhoids | Minnesota

    As we grow older and experience a variety of physical and mental changes to our bodies, we also become more susceptible to disease and illness. Because our regenerative powers slowly decrease over time, our bodies have a tougher time battling symptoms as we age—making hemorrhoids all the more common and bothersome.

    How Aging Affects the Development of Hemorrhoids

    Hemorrhoids, which develop when the veins in the anus and rectum become distressed and swollen, are much more of a threat when the body is sedentary. Decreased mobility (and increased amounts of time sitting), typically associated with aging, can cause blood flow to the lower part of the body to also decrease. The blood is then more likely to gather up/pool in the anal veins, causing irritation and swelling that can develop into hemorrhoids.

    Older individuals are also more prone to constipation as a result of having a more sedentary lifestyle. The straining that occurs from constipation, due to passing hard and dry stools, can cause prolonged stress to the anal and rectal veins. Once the blood vessels in these veins become extremely irritated, hemorrhoids can develop.

    Preventing Hemorrhoids in Old Age

    Diet Changes

    Hemorrhoids in the elderly can be effectively prevented by making conscious diet and lifestyle changes. A high-fiber diet helps maintain healthy bowel movements, thereby lowering chances of constipation and anal vein swelling. Consuming more fruits and vegetables, as well as legumes (chickpeas, lentils, soybeans) and whole grains (oatmeal, brown rice, barley), easily adds more fiber to your diet.

    Oatmeal bowlChickpeas

    DRINK. MORE. WATER. Consuming plenty of fluids helps keep the bowel healthy and functioning, and stools remain soft. This further prevents constipation and lowers your chances of having hemorrhoids.

    Exercise

    For elderly individuals who are capable of moderate levels of exercise, this is another good way to improve overall bowel movement and lower body blood circulation. Daily short walks, light swimming, and gardening are all appropriate examples of moderate exercise. However, you should always consult your doctor before starting any new diet or exercise routine.

    Treating Hemorrhoids at Home

    If the above prevention methods fail, and you find yourself with pesky hemorrhoids, there are a few home remedies that can help alleviate your symptoms. Sitz baths (soaking the affected area in warm water for 10-15 minutes) can soothe anal tissues and decrease pain and discomfort. Oils and creams may also be good options for early-stage hemorrhoids, such as witch hazel ointment or witch hazel hemorrhoidal pads.

    If symptoms do not clear up (or become worse) despite home treatment efforts, make sure to see a doctor for a full examination and advanced treatment method.

    Anal Fistula & Hemorrhoids | Minnesota

    An anal fistula is an inflammatory tunnel under the skin, connecting the anal canal and the surface of the surrounding skin. 80% occur as a result of an anorectal infection, wherein the anal crypts are infected and cysts containing pus form near the anal canal. If the abscess breaks or is opened a fistula is often formed.

    Symptoms of an anal fistula can be similar to those of hemorrhoids, manifesting as drainage from the anus, itchiness, and constant, throbbing pain, and is exacerbated by bowel movement. An anal fistula is commonly mistaken for a hemorrhoid upon first notice; however it eventually has episodes of recurrent infection. They are two very different issues that are important to distinguish. The patients with anal fistula usually have the history of anal abscess and recurrent fistula infection.

    In the complex cases advanced diagnostic methods may be necessary.

    1. Fistula probe, a thin metal instrument specially designed to be inserted through a fistula.
    2. Anoscope, a small tube used to view the anal canal
    3. Flexible sigmoidoscopy
    4. An injected dye solution into fistula.
    5. Imagine tests with endoscopic ultrasound and MRI
    6. Fistulography with X-ray of the fistula after a contrast solution is injected.

    Treatment varies depending on the severity and location of the fistula. Antibiotics, antipyretics and, pain medication is prescribed if there is drainage (indicating abscess). For simple rectal abscesses, antibiotics are usually not needed. The surgical procedure for simple fistulas are called a fistulotomy, where the fistula tract is cleared out surgically and allowed to heal properly. For simple fistulas, success rate with fistulotomy is over 90%. More complex fistulas may be to twisted or branching for a fistulotomy so fibrin glue or fibrin plug may be used instead. Fibrin glue is largely out of favor now due to its low success rates. The fistula is filled with this glue, which hardens and then dissolves, allowing scar tissue to form and the fistula to heal. Fibrin plug is a similar concept, but it is not a liquid. Like the glue, it dissolves, allowing growth of scarr tissue. Fibrin treatment has the advantage of not causing incontinence, which can be a risk of fistulotomy. Though in common, staged surgery may be needed.

    With this condition, it is better to seek help sooner than later. Advanced abscesses that become complex are much more difficult to treat. For most however, it seems procrastination is not much of a problem- pain is a very effective motivator.

    Dr. Shu manages the simple or superficial anal fistula with fistulotomy or fistulectomy, and he usually refers the patients with complex anal fistula to the colorectal specialist for further evaluation and treatment.

    Why Are Infected Hemorrhoids So Rare? | Minnesota

    Have you ever noticed blood on the tissue after wiping too hard, or experienced bleeding due to hemorrhoids? Blood indicates the presence of a wound, fecal matter is obviously teeming with harmful bacteria, and most people in America do not use anything other than dry toilet paper to wipe. Yet, hemorrhoidal infections are incredibly rare, especially in healthy people.

    Why is this?
    First, it’s important to note the immune system is different in different parts of the body- the Immune system in the gut is very well adapted to prevent serious infection. Immune cells constantly “sample” bacteria in the gut and create antibodies that bind the proteins on surface of the bacteria which prevents them from passing through the epithelium (wall of cells lining the inside of the intestines). This keeps the bacteria inside the intestine and outside the body. This “scanning” of the bacteria is something unique to the gut; this does not occur on the skin or elsewhere.

    After a small tear in the epithelium occurs, there is an immediate inflammatory/clotting response around the broken blood vessels. This prevents the bacteria from spreading deeper into the surrounding tissue. The bacteria that do make it past that are met with a strong response. The antibodies marking the bacteria are used by the immune cells to target them, and not enough bacteria makes it through to cause a severe infection. The particular antibody used, known as “IgA” is non-inflammatory, which is why there are no symptoms typically associated with infection (swelling, pain, itching, etc).

    That said, this only applies to small tears and hemorrhoids- large tears and injuries increase the risk of infections. While rare, the risk of infection holds serious consequences and it is best not to delay treatment of hemorrhoids.

    Although the infection of hemorrhoids is rare, anorectal abscess is relatively common. Anorectal abscess is a different disease from hemorrhoids, and it is the result of infection of anal glands in the lining of the anal canal. Most perirectal abscesses form from obstruction of the anal gland crypts.

    Procedure Clinic can diagnose and treat both hemorrhoids and anal abscess at low cost and little down time.

    Differences Between Hemorrhoids and Anal Abscesses | Minnesota

    Although both hemorrhoids and anal abscesses appear to be tissue lumps protruding from the rectum, they are two very different issues that are important to distinguish.

    Hemorrhoids could be as painful as anal abscesses when thrombosis develops. Anal abscesses are an infection around the opening of the anus or deep in the rectum, where there is pus. An anal abscess is commonly mistaken for a hemorrhoid upon first notice; however it eventually becomes more painful and leads to a fever.

    Hemorrhoids are usually a chronic condition, while anal abscess is an acute disease, which can cause serious complications that could result in death if left untreated. If you are experiencing any of these symptoms, medical attention should be found as soon as possible.

    ANORECTAL ABSCESS?
    Anorectal abscesses are the result of infection of anal glands in the lining of the anal canal near the opening of the anus. The anal glands secrete fluid into the anal canal, passing through a crevice known as the anal crypt. Most perirectal abscesses form from obstruction of the anal crypts (approx. 90% of cases). Normally the internal anal sphincter acts as a barrier between bacteria in the gut and the tissue surrounding the rectum, but it is possible for bacteria to pass this barrier through the anal crypt. Once bacteria passes through the crypt, it can easily move to the surrounding tissue. This results in the formation of an abscess of varying severity and depth depending on how deep the infection is and where it spreads.

    Anal abscesses most commonly occur in the third and fourth decade of life, and are more common in men. Deaths due to anorectal abscesses are very rare.

    Most abscess can be easily identified via physical examination and digital rectal examination. Deep rectal abscesses are more difficult to find and may require a CT scan, MRI scan, or ultrasonography to confirm.

    Most of the time a perirectal abscess can be detected upon initial examination. Digital rectal examination involves the doctor putting the finger of their gloved hand into the rectum in order to feel out the presence of an abscess. Sometimes anesthetic is used in cases where pain from the abscess would limit the effectiveness of the examination.

    Sometimes the formation of a fistula can accompany this infection (approx. 30-60%% of cases). 10% of patients suffer from recurring and chronic anal fistula. An anal fistula is an abnormal passage between the anal canal and the skin near the anus.

    TREATMENT
    The presence of an abscess warrants surgical incision and drainage as soon as possible. Just antibiotics would be ineffective at this stage in the infection. Delaying surgical intervention can result in tissue destruction, fibrosis (scar tissue formation), and impaired anal continence.

    Drainage of perianal abscesses involve a small incision above the abscess made as close to the anus as possible. After 24 hours the gauze is removed. Postoperative care involves sitz baths three times a day and after bowel movements. Painkillers and stool softeners may be prescribed for pain and constipation. The patient will follow up with the doctor 2-3 weeks later. After the procedure, antibiotics are generally not necessary in healthy adults.

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