Anorectal fistula is a fistula formed by the gradual reduction of the pus cavity after the abscess around the anorectum breaks down or is excised. Anal fistula is a common and frequent disease, accounting for 1.67% to 3.6% of anorectal diseases in China and 10% to 20% of anorectal diseases and 6% of surgical diseases. The age of onset is mainly 20-40 years old young adults, infants and children are not uncommon, male infants are significantly more than female infants, and the ratio is 5:1.
I. Symptoms of anal fistula
1, the main symptom of pus anal fistula, how much pus is related to the length of the fistula and how much, from time to time, due to the constant and repeated outflow of purulent secretions, patients often feel wet at the anus, underwear is not clean.
2, painful fistula is often not painful when there is no inflammation, but only feel the local swelling and discomfort, walking aggravated. When the fistula is infected or the pus is not drained properly and swollen and inflamed, it can cause pain. In the case of internal fistula, you often feel burning discomfort in the lower part of the rectum and the anus, and pain when defecating.
3, itching because the pus constantly stimulates the perianal skin, often feel itching, perianal dampness and discomfort, skin discoloration, epidermal peeling, fibrous tissue proliferation and thickening, and sometimes the formation of eczema.
4, poor defecation complex anal fistula mouth for a long time, can cause the formation of large fibrotic scar or ring-shaped strip around the anorectum, affecting the anal diastasis and closure, feel difficult when defecating, with the feeling of incomplete stool.
5, systemic symptoms in the acute inflammatory phase and repeated attacks of complex anal fistula, there may be different degrees of fever, or accompanied by wasting, anemia, weakness and other symptoms of long-term chronic consumption.
Diagnosis of anal fistula
1.Anal palpation: palpation around the anus, anal canal and lower rectum to determine the relationship between tenderness, nodules, cords and depressions and anal fistula according to the feeling, so as to determine the course of the anal fistula and the internal opening.
2.Probe examination: Use a probe to reach into the fistula from the outer fistula opening and the index finger to reach into the anal canal, most probes can penetrate the inner opening at the tooth line. The fistula is curved, the probe can not pass smoothly, do not use too much force, so that the probe penetrates the fistula wall, causing new infections.
3, the beauty blue mark: a moderate gauze placed in the anus, and then the 5% methylene blue water solution from the external mouth into the fistula, and then gently pull the gauze out to observe the location of the internal mouth. Afterwards, the anus is dilated with a speculum, and near the dentate line, where the coloring is most conspicuous, an anal sinus hook or probe is used to probe, and most of them can find the internal opening.
4.Other methods for diagnosing anal fistula: such as X-ray examination, anorectal cavity ultrasound, magnetic resonance imaging, spiral CT, anal canal pressure measurement and other examination methods.
III. Treatment methods
At present, the only way to cure anal fistula is surgery. The common surgical methods are: anal fistula excision, anal fistula excision and suture, anal fistula incision and suturing, anal fistula incision and suturing, and anal fistula incision and suturing.
IV. Post-operative precautions
The wound treatment and care after surgery is very important to the success or failure of the operation.
The first time the patient takes a bath, observe whether there is discomfort; change the dressing daily.
The patient should pay attention to whether the rubber strips are too loose or too tight after the fistula surgery, and make appropriate adjustments according to the situation.
3.Within 48~72 hours after fistula incision, observe the dressing outside the wound and check the wound drainage. In the late stage of wound healing, we should pay attention to the trauma in the anal canal, and perform rectal diagnosis every few days to expand the anal canal and prevent adhesions.
The first thing you need to do is to take a look at the following pictures
V. Measures to prevent anal fistula disease are.
(1) Prevention of constipation and diarrhea is important to prevent the formation of perianal abscess and anal fistula.
(2) timely treatment of anal cryptitis and anal papillitis to avoid the development of perianal abscess and fistula.
(3)Actively treat systemic diseases that can cause perianal abscess, such as Crohn’s disease, ulcerative colitis, intestinal tuberculosis, etc.
(4)If the anus is burning and uncomfortable with a feeling of falling, promptly consult and treat.
(5) Establishing normal life content (dietary balance), developing good defecation habits, taking a sitz bath after daily defecation and keeping the anus clean will have a positive effect on preventing infection.