Rectal fistula: causes, symptoms, diagnosis, treatment

Fistulas are a serious problem for proctologists. The disease can cause serious problems for the patient, some of which can be fatal.

For this reason, if you have characteristic symptoms, you need to visit a doctor for diagnosis. Only this will help determine the effective tactics of treating this disease.

What are rectal fistulas

Fistulas of the rectum (perianal fistula) are purulent formations that represent a passage between the rectum and the outer skin. Sometimes connection with the external environment does not occur, the holes are inside the intestine.

The canal itself is formed under the influence of pathogens that destroy the soft tissues of the organ. In the course of the fistulous canal, branchings, pockets with pus can form, which worsens the treatment process and slows down the patient's recovery.

The risk of getting sick is higher in an adult patient, but children can also be affected by this pathology. The disease in a child develops and proceeds similarly to that in patients of the older group.

Classification of rectal fistulas

Rectal fistulas are classified according to several criteria. They are divided into different types according to their structure and location. The following fistulas are distinguished:

1. Complete, incomplete and internal. The latter can be distinguished into a separate group. Full is characterized by the presence of 2 holes - internal and external, from which there is an outflow of pus into the external environment. Incomplete fistulas have an internal opening, no external one. An incomplete fistula ends blindly in the cavity of the organ, but tissue destruction gradually occurs under the influence of pathogens and an external opening is formed.
2. The formations described above are external. As for the internal formations, they are characterized by the presence of 2 holes at once, but the fistula of the posterior the passage is located within the rectum, there is no outflow of pus, only into the cavity of the organ.
3. By location relative anus allocate intra-, trans- and extrasphincteric fistulas of the rectum. The first can be located slightly inward from the anal or adjacent to the hole itself. Transsphincteric ones are located directly in the tissues of the sphincter. Extrasphincteric formations are formed outside of the hole, they are easy to detect by visual inspection.

Also, fistulas can be divided into straight and branched, depending on the configuration of the fistulous canal. In the second option, the formation of purulent pockets is possible, which complicates and delays the treatment.

Causes of rectal fistulas

Fistulas of the rectum are formed when bacteria penetrate into the tissues of the organ. An inflammation occurs, which is called proctitis. The pathological process is able to penetrate the surrounding soft tissues, they become infected. This disease is called paraproctitis, it proceeds in an acute and chronic form.

With these pathologies, an accumulation of purulent contents occurs in a limited cavity, that is, abscess. Then pus breaks out, the abscess cavity communicates with the environment. This is the fistula of the anus. In such cases, pus can flow not only onto the patient's skin, but also into the internal cavities of the body.

In the pathogenesis of fistulas, the timeliness and completeness of treatment of the underlying disease, concomitant pathologies of the digestive tract, especially stomach ulcer, Crohn's disease, diverticulosis, tuberculosis and cancer of any part of the intestine, haemorrhoids.

People with fungal infections, immunodeficiencies are prone to fistula formation, syphilis.

Rectal fistulas can form after proctological and gynecological surgeries.

Symptoms of rectal fistulas

Patients with this disease notice the appearance of purulent discharge (see. photo) on underwear or clothes, which brings significant discomfort to the patient's daily life.

With a large amount of pathological discharge, irritation of the skin occurs, complaints of itching and burning in the anal region appear.

It is also inconvenient that pus has an unpleasant odor. Other complaints of patients with rectal fistulas:

• The presence of pain syndrome. Its severity depends on the type of fistula. If it is external and full, then the pain is minimal. In the case of an incomplete fistula, especially an internal one, the symptoms are more pronounced. The intensity of pain increases with a long stay in an uncomfortable position, sudden movements, prolonged walking, during the act of defecation.
• Intoxication of the body may occur with complaints of high temperature, weakness, headaches, decreased ability to work, emotional lability.
• Fistulas of the rectum have a tendency to wave-like course, with exacerbations and remissions. During decompensation, patients develop the complaints described above. During the period of remission, the general condition of patients does not suffer, but the presence of purulent discharge in small quantities may be present.
• With a long course of the disease, a gradual depletion of the body occurs, and even during remissions there are complaints about general weakness, increased irritability, poor sleep, fever, headaches and dizziness.

External fistulas of the rectum are easy to detect during external examination. To diagnose internal formations, instrumental methods are required. Rectal fistulas are an extremely unpleasant pathology, but possible complications are especially dangerous.

Complications

It is important to know what the danger of a rectal fistula is. An acute process threatens the spread of infection to the entire body, that is sepsis. This complication has a high risk of death.

Also, pathology is able to turn into a chronic state, which affects the general condition of patients. They become emotionally labile, irritable, the level of working capacity is significantly reduced.

With a long course of the disease, malignant degeneration of tissues can occur, that is, rectal cancer is formed. Also, an anal fistula can lead to scarring and narrowing of the anal sphincter, which negatively affects the fullness of its functioning.

Diagnosis of rectal fistulas

The doctor analyzes the patient's complaints, collects anamnesis, conducts a general examination and rectal examination. The patient is prescribed general analysis of blood and urine, blood biochemistry. After that, they begin to instrumental research methods, namely: colonoscopy, sigmoidoscopy and irrigoscopy. They allow you to determine the localization of the fistula.

To clarify its location and structure of formation, probing is required, sometimes together with a staining test or fistulography. They allow you to determine the nature of the fistulous course, the presence of pockets and the amount of pus.

If necessary, female patients are prescribed a gynecological examination, all patients can be Ultrasound of the abdominal and pelvic organs. Sometimes it takes rectal ultrasound and sphincterometry - a method that allows you to determine the completeness of the functioning of the anus.

Rectal fistula treatment

Treatment without surgery cannot lead to a complete recovery, so doctors always resort to surgical removal. Surgical intervention is carried out in the acute period, since when the process subsides, it is impossible to accurately determine the localization and structure of the fistulas.

If the operation is performed under general anesthesia, then the doctor excises the fistula completely, while capturing the surrounding tissue, the edges of the wound are stitched together, this area is washed with antiseptics. Healing occurs within 45 days, additionally patients take broad spectrum antibiotics, analgesics. Physiotherapy is also prescribed - ultraviolet irradiation, electrophoresisthat accelerate tissue healing, stimulate blood flow and metabolism in the surgical site.

After the operation, it is important to adhere to the diet, you must do everything personal hygiene recommendations, physical activity should be limited and built up gradually. Herbal sitz baths are recommended to reduce pain and improve healing.

With this type of intervention, there is a risk of relapse and postoperative complications. If you have complaints of severe pain in the perineal region, the appearance of pathological discharge, difficulties with urination and defecation, increased body temperature, you must immediately report this to the doctor. More often, in such situations, repeated surgical treatment cannot be avoided.

Minimally invasive methods are becoming more widespread. As for fistulas, treatment is popular. laser, electrocoagulation and filling. These operations are performed under local anesthesia, are characterized by a minimal risk of complications, they are bloodless and fast. The recovery period after surgery is also significantly reduced, and the risk of recurrence is also minimized.

Laser treatment involves cauterizing the fistula using a special tube with a radiator. The edges of the wound are sealed with special glue, and several sutures made of absorbable material are also applied.

Rectal fistula in patients with electrocoagulation is treated according to a similar scheme, only the tissue is cauterized with a thermal knife.

Good result shows filling the so-called collagen plug, which behaves like a transplant of the body and stimulates the epithelization of the affected area. The fistula of the rectum itself in the patient is stitched in a circle, fixed and excised. The resulting area is filled with a cork and fixed. The technique is also bloodless, with a minimum of complications, but expensive.

The principles of treating rectal fistulas in a child are the same as in adult patients. Sometimes doctors recommend refraining from operations when it comes to a patient under 1 year old. If this does not affect the general condition of the little patient (this happens quite often), then the intervention is carried out a little later. But in case of emergency conditions, they do not hesitate with operations.

Important! Treatment with folk remedies for this disease is ineffective, it can lead to a deterioration in the patient's condition, especially if they are children. Therefore, it is important to see a doctor as early as possible for timely and complete treatment.

Prevention of rectal fistulas

Rectal fistula in patients can be prevented with timely treatment of diseases not only of the organ itself, but also of all parts of the digestive tract. Other preventive measures:

• compliance with the rules of personal hygiene;
• quitting smoking and drinking alcohol (recommendation for adult patients);
• it is important to prevent constipation;
• regular physical activity.

To prevent the disease in an adult and a child, it is important to rationalize the diet. You should give up fatty, fried foods, spices, sweets, spices. The menu should include lean meats and fish, dairy products, vegetables and fruits. It is recommended to drink at least 1.5 liters of clean water per day.

Forecast for life

In most cases, rectal fistulas are successfully treated. What matters is the timeliness of the visit to the doctor and the implementation of all the recommendations of a specialist. The prognosis for life is also positive. The exception is complicated cases of the disease in which there is a threat to the patient's life. We are talking about sepsis, malignant transformations.

It can be summed up that it is necessary to have an idea of ​​the signs of the disease and know what the danger of a rectal fistula is, and what methods of treatment and prevention are available today. This will help to quickly get rid of the pathology without any harm to the body, while maintaining the full functioning of the rectum.