Anal fistula is one of the chronic gastrointestinal disorders and is among the most common diseases affecting many adults. It is the development of a hole or a tunnel running from inside the anus to an opening on the skin around the anal orifice (Abcarian, 2011). The openings start from an infected cavity in the anus. Around the anus' walls are small glands that secret mucus to aid in the passage of stool. These glands usually develop fistula when they get infected. Abscesses are believed to start as an infection of the anal glands spreading to the neighboring tissues and causing fistula in approximately 40% of its cases. Examination of the surgical series reveals the age and sex bracket of the disease. As Abcarian (2011) notes, most people affected by the condition are between the ages of 20 and 60 with the average age of 40 in both sexes.
Several things cause an anal fistula. Crohn's disease, which is manifested in the intestine's inflammation, radiation, especially for cancer patients and trauma, can also cause anal fistula (Whiteford, 2007; Abou-Zeid, 2011). As stated before, the blockage and infection of the mucus glands around the anus also cause fistula. It is caused by the development of branch-like openings of anal glands around the submucosa, internal sphincter, and openings in the anus crypts. In some cases, the infection extends from the lumen of the anus reaching the anal verge, and this is called a peri-anal abscess. In other cases, it can tear through the external sphincter, becoming ischiorectal abscess. Sometimes, the abscess can extend cephalad in the wall of the rectum, resulting in a high inter-muscular abscess, and when the abscess is extended above the levators, it results in supralevator abscess (Abcarian, 2011).
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Sexually transmitted diseases or an ongoing illness affecting the bowels also can cause this condition. The symptoms of this condition include frequent anal abscesses, swellings and pain around the anal opening, foul-smelling drainage from the body, pain during bowel movements, and bleeding, among others (Chen et al., 2020). Assessment for anal fistula includes the examination of the medical history of the patient. The doctor may carry out a physical examination of the presence of openings around the anal opening or foul smell and puss. A fistula that is clinically draining is easy to diagnose through anoscopy, which is conducted to check for the internal openings. The Goodsall’s rule may be applied if the anatomy has not been damaged by fibrosis or prior operations. If the physician cannot easily identify a primary opening intraoperatively, a diluted hydrogen peroxide solution with small drops of methylated blue can help. As Abcarian(2011) further points out, patients with long-standing fistulas are at risk of developing cancer, and as revealed in one study, six cancer cases were diagnosed in fistula patients who have had the condition for 13 years on average.
Imaging tests such as X-Rays or a CT scans can also be used if the condition is undetectable from a physical examination (Ratto, 2007). Nursing care for this condition would involve carrying out a complete physical assessment of the body. The nurse can assess the patient for the presence of hemorrhoids or anal discomfort and administer drugs to help reduce the swellings, the pain, or itching so that the patient can remain comfortable. Working with a gastroenterologist would involve consulting for the severity of the condition and getting the right medicine to ease the pain. For example, a gastroenterologist is the one to recommend the right treatment method for the condition, depending on its severity.
References
Abcarian, H. (2011). Anorectal infection: abscess-fistula. Clinics in colon and rectal surgery , 24 (1), 14–21. https://doi.org/10.1055/s-0031-1272819
Abou-Zeid, A. A. (2011). Anal fistula: intraoperative difficulties and unexpected findings. World journal of gastroenterology: WJG , 17 (28), 3272.
Chen, Q., Li, Y., Wang, X., & Li, H. (2020). Hot topics in global perianal fistula research: A scopus-based bibliometric analysis. Medicine , 99 (17), e19659.
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Ratto, C., Doglietto, G. B., Lowry, A. C., & Romano, G. (2007). Fecal Incontinence : Diagnosis and Treatment . Milano: Springer Milan. Bottom of Form
Whiteford M. H. (2007). Perianal abscess/fistula disease. Clinics in colon and rectal surgery , 20 (2), 102–109. https://doi.org/10.1055/s-2007-977488
