Fistula in Ano

Subject: Medical and Surgical Nursing I (Theory)

Overview

An infected tunnel that forms between the skin and the muscle hole at the end of the digestive system is known medically as an anal fistula (anus). The majority of anal fistulas are caused by infections that begin in the anal gland. Its causes include anal abscess, a growth, ulcers (painful sores), etc. In addition to skin irritation around the anus, which includes swelling, redness, and soreness, it also has symptoms including pain that is often persistent, throbbing, and worsens while sitting down. It may be treated by fistulectomy. Ensure discretion when defecating. Remove any solid dressing to avoid bad odors. If you smell bad after dressing, use room deodorizers. 24 hours after rectal surgery, bed rest is advised. Its complications include heavy bleeding, heightened pain, swelling, or discharge, among others.

Fistula in Ano

An infected tunnel that forms between the skin and the muscle hole at the end of the digestive system is known medically as an anal fistula (anus).

The majority of anal fistulas are caused by infections that begin in the anal gland. This infection causes an abscess, which either drains naturally or is surgically removed through the skin next to the anus. The infected gland is connected to the fistula through a tunnel that develops beneath the skin.

Causes

  • Anal abscess,
  • a growth or ulcer (painful sore),
  • a complication of surgery.

Diagnosis

  • History taking,
  • Physical examination,
  • Digital rectal examination,
  • Fistula probe,
  • USG,
  • CT scan,
  • MRI.

Sign and Symptoms

  • Pain, which is usually constant, throbbing and worse when sitting down,
  • Skin irritation around the anus, including swelling, redness and tenderness,
  • Discharge of pus or blood,
  • Constipation or pain associated with bowel movements,
  • Fever.

Treatment

  • Fistulotomy: This is used in 85-95% of cases and involves cutting open the whole length of the fistula in order for the surgeon to flush out the contents. This heals after one to two months into a flattened scar.
  • Seton techniques:  A seton is a piece of thread which is left in the fistula tract. This may be considered if you are at high risk of developing incontinence when the fistula crosses the sphincter muscles. Sometimes several operations are necessary.
  • Advancement flap procedures: This option is usually when the fistula is considered complex or is there is a high risk of incontinence. The advancement flap is a piece of tissue that is removed from the rectum or from the skin around the anus. During surgery, the fistula tract is removed and the flap is reattached where the opening of the fistula was. The operation is effective in about 70% of cases.
  • Fibrin glue: This is currently the only non-surgical treatment option. The glue is injected into the fistula to seal the tract, then the opening is stitched closed. It is a simple, safe and painless procedure, but long-term results for this method are poor. Initial success rates as high as 77% drop to 14% after 16 months.
  • Bioprosthetic plug: This is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. Stitches keep it in place. However, this does not completely seal the fistula, so that it can continue to drain. New tissue usually grows around the plug to heal the fistula. Two trials show success rates of over 80% for this method, but long term success rates are uncertain.

 Nursing Management

  • Encourage to drink fluids 2000ml per day.
  • Eat high fibrous diet.
  • Provide privacy during defecation.
  • Remove solid dressing to prevent unpleasant odors. Use room deodorizers if dressing foul smell.
  • Bed rests 24 hours after rectal surgery.
  • Apply ice or analgesic ointments.
  • Topical anesthetic agents to relieve local irritation and soreness.
  • Positive at internal to promote dependent drainage of edema fluids.
  • Administer suppositories, antibiotics.
  • Reducing anxiety, explanation of procedures, orientation, diversional therapy, etc.
  • Preventing hemorrhage: direct pressure is applied to the bleeding area. Elevate the buttock on a pillow when a patient is in a bed.
  • Inform patient to keep perineal area clean.
  • Clean with warm water and dry with absorbent cotton wipes.

Complication

  • Heavy bleeding,
  • Increased pain, swelling or discharge,
  • A high temperature of 38C (100.4F) or more,
  • Nausea,
  • Constipation,
  • Difficulty passing urine,
  • Infection,
  • Troublesome scarring.

References

  • crchyderabad.com/post/anal-fistula-overview/2169
  • colorectalcentre.co.uk/abscess-fistula.html

everestpharmacy.co.uk/condition/anal-fistula/

  • health5049.rssing.com/chan-22152481/all_p62.html
  • ibdrelief.com/learn/treatment/surgery/treating-an-anal-fistula
  • koslandtours.com/billy-gibbons-nudu-hat/
  • mayoclinic.org/diseases-conditions/anal-fistula/basics/definition/con-20032352
  • prezi.com/l0d9eqwsetmp/
  • wn.com/Perianal
  • webmd.boots.com/digestive-disorders/anal-fistula
Things to remember
  • The majority of anal fistulas are caused by infections that begin in the anal gland.
    Rectal exam with a digital device
    Encourage people to consume 2000 ml of liquids daily.
    Eat a diet rich in fiber.
    Pain that is typically constant, throbbing, and gets worse when seated
    Direct pressure is applied to the bleeding area in order to stop the bleeding. When a patient is in a bed, raise the buttock on a pillow.
Questions and Answers

Anal Fistula 

An infected tunnel that forms between the skin and the muscle hole at the end of the digestive tract is known medically as an anal fistula (anus). The majority of anal fistulas are caused by infections that begin in the anal gland. This infection causes an abscess, which either drains naturally or is surgically removed through the skin next to the anus. The infected gland is connected to the fistula through a tunnel that develops beneath the skin.

Causes

  • A nail abscess
  • An expansion or ulcer (painful sore).
  • A postoperative complication.

 

Sign and Symptoms

  • Pain that is typically constant, throbbing, and gets worse when seated
  • Swelling, redness, and tenderness are all symptoms of skin irritation around the anus.
  • Bleeding or pus discharge
  • Having trouble passing stool or experiencing bowel movement pain
  • Fever

Treatment

  • Fistulotomy
    • This procedure, which is used in 85–95% of cases, entails cutting open the entire length of the fistula so the surgeon can remove the contents. After one to two months, this turns into a flattened scar.
  • Seton Techniques
    • A seton is a thread fragment that has been left inside the fistula tract. If you are at a high risk of developing incontinence when the fistula crosses the sphincter muscles, you might want to take this into consideration. Multiple operations are occasionally required.
  • Advancement Flap Procedures
    • This choice is typically made when the fistula is complicated or there is a substantial risk of incontinence. A tissue fragment known as the advancement flap is taken from the rectum or the skin surrounding the anus. The fistula tract is excised during surgery, and the flap is then reattached to the site of the fistula's entrance. Approximately 70% of the time, the procedure is successful.
  • Fibrin Glue
    • Currently, this is the only non-surgical approach available. The tract is sealed by injecting glue into the fistula, and afterward, the opening is sewn shut. Although it is a quick, easy, and safe treatment, this approach has poor long-term effects. After 16 months, initial success rates as high as 77% fall to 14%.
  • Bioprosthetic Plug
    • This cone-shaped plug, which is comprised of human tissue, is utilized to close off the fistula's interior opening. It is held in place with stitches. The fistula can still drain because this does not entirely close it. To repair the fistula, new tissue typically develops around the clog. This method has shown over 80% success rates in two trials, but it is unclear how well it will work over the long term.

Nursing Management

  • Encourage people to consume 2000 ml of fluid daily.
  • Eat a diet rich in fiber.
  • Ensure discretion while defecating.
  • Remove any solid dressing to avoid bad odors. Use room deodorizers if your clothing stinks.
  • 24 hours after rectal surgery, bed rest is advised.
  • Apply ice or painkilling creams.
  • Topical anesthetics help soothe local discomfort and itch.
  • Internally supportive to encourage dependent outflow of edema fluids
  • Provide antibiotics and suppositories.
  • Calming down, explaining the process, orientation, distraction therapy, etc.
  • Direct pressure is applied to the bleeding location in order to stop the bleeding. When a patient is in a bed, raise the buttock on a pillow.
  • Tell the patient to keep the perineal area tidy.
  • Dry with absorbent cotton wipes after cleaning with warm water.

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