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Introduction
What is an anal abscess?
An anal abscess is an infected cavity filled with pus found near the anus or rectum. If the skin over the abscess breaks, pus may discharge out. Many people may confuse this with hemorrhoids (piles).
What is an anal fistula?
An anal fistula, almost always the result of a previous abscess, is a small tunnel connecting the anal gland from which the abscess arose to the skin of the buttocks outside the anus.
Causes
Anal Abcess
An abscess usually results from an acute infection of a small gland just inside the anus, when bacteria or foreign matter enters the tissue through the gland. Certain conditions, for example, inflammation of the intestine or colitis, can sometimes make these infections more likely.
Anal Fistula
After an abscess has been drained, a tunnel may persist connecting the anus or rectum to the skin. Persistent drainage of pus from the outside opening may indicate the presence of this tunnel. If the outside opening of the tunnel heals while the inside opening remains, recurrent abscess may develop.
Symptoms
Symptoms of both ailments include constant pain, sometimes accompanied by swelling that is not necessarily related to bowel movements. Other symptoms include discharge of pus (which often relieves the pain) and fever.
Does an abscess always become a fistula?
No. A fistula develops in about 50 percent of all abscess cases, and there is no way to predict if this will occur.
Treatment
Abscesses
The abscess is treated by a small operation. This entails making an opening in the skin over the abscess to allow the pus to drain out from the infected cavity. The skin opening is not stitched up after the operation, and the wound needs to be cleaned daily. A large or deep abscess may require hospitalization and surgery under anaesthesia. Antibiotics are usually not effective in treating the abscess, because antibiotics are not able to enter the fluid within an abscess.
Fistulas
Surgery is necessary to cure an anal fistula. Although fistula surgery is usually relatively straightforward, the potential for complication exists, and is preferably performed by a specialist in colon and rectal surgery. It may be performed at the same time as the abscess surgery, although fistulae often develop four to six weeks after an abscess is drained - sometimes even months or years later. Fistula surgery usually involves cutting a small portion of the anal sphincter muscle to open the tunnel, joining the external and internal opening and converting the tunnel into a groove that will then heal from within outward. However, if a large portion of the muscle is involved, your surgeon may choose to leave a suture (stitch) in the fistula first, followed by a second operation to cut the muscle at a later period. This operation needs to be done with care, as cutting too much muscle will lead to loss of control of bowel movement. Most of the time, fistula surgery can be performed on an outpatient basis - or with a short hospital stay.
Frequently Asked Questions
How long does it take before patients feel better?
Most patients can be discharged the same or next day after surgery. Discomfort after surgery can be mild to moderate for the first week and can be controlled with pain pills. The amount of time lost from work or school is usually minimal.
Treatment of an abscess is followed by a period of time at home, though the patient may need to see a family clinic daily for dressing of the wound. Stool softeners may also be recommended. It may be necessary to wear a gauze pad or mini-pad to prevent the drainage from soiling clothes. Bowel movements will not affect healing.
What are the chances of a recurrence of an abscess or fistula?
If properly healed, the problem will usually not return. However, it is important to follow the directions of your doctor to prevent recurrence.
For more information on treatment options, please click here: 
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