Fistula of the rectum

The fistula of the rectum develops as a consequence of an acute purulent process in the cellulose surrounding the anus - acute paraproctitis. The superficial fistula of the rectum is treated quickly enough because it passes close to the superficial skin integuments. Chust-ficciform, deeper fistulas are treated more difficult, because they are located parallel to the rectum in deep layers of fiber.

The rectum in turn is also the passage, the final rectal zone of the digestive system. Rectum, as an excretory canal, extends from the sigmoid colon to the anus. The length of the rectum varies from 15 to 18-20 centimeters, the diameter of the rectum depends on the functional sector: its initial part reaches 4 centimeters, in the middle the rectum can be up to 7.5-8 centimeters in diameter. The rectum differs from other parts of the intestine in that it does not have twists and turns, in fact, it received the name from its direct orientation. The uppermost zone of the rectum is the ampulla, located in the sacrum, the narrowest, the lower part is called canalis analis - anus, in this zone paraproctitis (rectal abscess), often resulting in fistula formation, fistula, often develops.

[1], [2]

Causes of the fistula of the rectum

The main reason for fistula formation in the rectum is that clinicians call paraproctitis and proctitis. Proctitis is the infection of the rectal canal wall itself - the rectum, and paraproctitis is the infection of the cellulose that surrounds the rectum. When the infection penetrates into the tissues of the rectum, an abscess is formed, which is subsequently drained. After the opening of the perianal abscess, a pathological course is formed. 

Also, the reason for the formation of the fistula of the rectum, there may be granulomatous regional enteritis or Crohn's disease. 

Factor provoking internal fistula of the rectum, may be hernial inflammatory protrusion of the walls of the rectum. 

Fistula of the rectum of the cause can have a tuberculous etiology. Mycobacteria provoke the formation of granulomas in the intestine, then the process goes to the lower parts of the digestive tract - into the rectum. Tuberculosis of the rectal passage is quite rare and is a secondary disease following pulmonary tuberculosis. 

Chlamydia can also provoke the development of abscesses, and then fistulas in the rectum. 

Oncology of the rectum is often accompanied by fistulas. Often the recurrence of the fistula of the rectum is the primary symptom of the pathological process and the reason for a comprehensive examination. 

HIV and AIDS, syphilis are those diseases that can also be accompanied by the formation of rectal fistulas.

[3], [4]

How does the fistula of the rectum develop?

Fistula of the rectum is also called HP - a chronic paraproctitis, since the fistulous course appears due to acute paraproctitis - an inflammatory process in the surrounding fatty tissue. If the tissues that surround the rectum are inflamed, damaged, infected and inflamed, a fistula of the rectum develops - a pathological course between the intestine itself and the skin around the anus. Fistula of the rectum can be detected in both men and women, less often in children. Men suffer from chronic paraproctitis much more often than women. Removing the fistula of the rectum quite often happens to be independent, spontaneous, when the abscess is opened, and its contents are displayed outside with a caloric mass. This is a false "victory", since the inflammation in the anal crypts (sinuses) remains, therefore, the constant infection of the cellulose continues. All without exception, cases of spontaneous breakthroughs of the abscess and secretions of the contents to the outside are accompanied by the formation of a fistula with a preserved inflamed inner zone (in the crypt). Thus, the recurrence of the fistula of the rectum lasts a very long time, and chronic paraproctitis can persecute a person for many years while there is inflammation, that is, the root cause of the disease.

Fistula of the rectum is divided into the following types: 

1. Complete fistulas. 
2. Incomplete fistulas. 
3. Internal fistulas of the rectum.

Complete fistula is a course with two holes, one of which is internal, which is located in the crypt (sinus) of the anus and exits into the lumen of the rectum, the second - goes out to the skin surface next to the anal opening. A complete fistula can be with many holes that combine within the layer in one turn, ending on the surface of the skin.

An incomplete internal fistula of the rectum is a stroke with an internal opening that opens onto the mucous surface. It is believed that the incomplete internal fistula of the rectum is the stage of formation of a full-fledged fistula, followed by the inevitable process of tissue melting and the formation of the external opening.

Internal fistulas of the rectum - a move in which the two holes are located directly in the wall of the rectum.

Also, the fistulas are distributed at the place of formation of the internal exit and are systematized for localization relative to the anus and can be as follows:

• On the output: 
  • Fistula of anterior localization. 
  • Fistula of rectum of posterior localization. 
  • Svishch lateral localization.
• By localization: 
  • Intrasfinctorial fistula of the rectum. 
  • Transsfinctory fistula. 
  • Extrasfinctorial fistula of the rectum (high fistula).

Intrasfinctorial fistula of the rectum is a course that is localized along the edges of the anus in the subcutaneous-mucous layers. These fistulas are characterized by a straight channel, which has an external opening directly adjacent to the anal sphincter. The inner hole goes into one of the anal crypts. Intrasfincter fistula of the rectum is diagnosed in 30-35% of the total number of patients suffering from proctologic problems. In 100% of patients with anal fistulas, the history of rectal fistula shows how recurrent.

Transsfinkteralnye fistulas are characterized by the location of the canal in the subcutaneous or superficial layer, less often in the deep layers of the sphincter. Strokes, as a rule, are multiple, with purulent pockets, accompanied by scarring of surrounding tissues. Transsfinkteralnye are also called stroke ficciform fistulas, they are a typical clinical form of chronic, neglected paraproctitis.

External or extrasphinctic fistulas, as if bypassing, round the anus, folding the inner output into the crypts. This type of fistula is a typical consequence of acute paraproctitis, which has several degrees of complexity: 

• Narrow opening inside, straight running, fistula without scars and infiltrates, without pus. 
• The inner hole is cicatrized without inflammation and pus. 
• The inner hole is not scarred, since a purulent process develops in the cellulose. 
• The hole inside widens, cicatrizes, has infiltrates, purulent "pockets".

Fistulas of the rectum: symptoms

The fistula can not be asymptomatic, since the patient, as a rule, already has a proctologic history of the rectum fistula as a result of it.

The fistulous course starts to disturb the patient with an itch, secretions containing a purulent suprathin. Independent treatment of the fistula by alternative means at this stage only aggravates the patient's condition, there is a strong irritation in the anus zone, painful sensations, the body temperature can rise. The disease is wavy, remission is possible, and then a relapse of the fistula of the rectum.

[5]

Chronic paraproctitis

The appearance of the fistula is a small-sized wound that has seals at the edges. In the chronic course of the process, serous-purulent discharge is meager, but constant. They have a characteristic unpleasant odor and have irritating properties in relation to the tissues of the anus. If there is not enough drainage, the pus begins to accumulate in the fistulous passage, there is a aching pain, intensifying during defecation. After emptying the pain subsides, the outflow of exudate from the fistula is activated.

[6], [7], [8], [9]

Exacerbation of the process

With exacerbation and formation of an abscess in the cellulitis, the temperature rises, the pains become intense, radiating to the pelvic area, into the lower abdominal part of the body, into the rectum. Stools and urination are disturbed, there is swelling, most often in the legs. Improvement is possible from the time of opening the abscess, when the inflammation subsides, but after a while, a fistula of the rectum can be relapsed.

[10], [11], [12], [13], [14], [15]

Fistula of the rectum: treatment

The fistula of the rectum is directly related to the presence of the infection and the conditions of its spread in the rectum. Therefore, the fistula of the rectum is largely neutralized and neutralized. During surgery, both fistula (fistula) and inflamed anal crypt are removed, which is a constant source of infection of surrounding tissues. Thus, if chronic paraproctitis is confirmed, the fistula exhibits characteristic symptoms and signs, removal of the fistula of the rectum is inevitable. In the presence of serious contraindications, excision of the fistula of the rectum is postponed until the moment of improvement, and is carried out in a planned manner.

How to treat the fistula of the rectum - a question that worries the patient, but not an experienced proctologist. There is a standard scheme of surgical intervention for chronic paraproctitis. The term of a radical operation depends on the clinical course of the disease. If the process is in an aggravation stage, there are infiltrates, abscesses, they are opened, they eliminate inflammation with the help of conservative antibacterial therapy, both internal and external, and then excision of the fistula of the rectum is performed. The operation is usually tried not to be postponed for a long time, since a relapse of the fistula of the rectum is possible, and a new exacerbation can provoke the formation of scars on the walls of the anal opening. The operation is postponed only in the case of persistent remission, when the fistula's orifices are closed.

The type of operations for the fistula of the rectum: 

• The fistula is dissected into the lumen of the rectum. This type of operation, with all the advantages, has significant disadvantages: a wound over the fistula can overgrow too quickly, in addition, during surgery, the outer part of the sphincter 
• Gabriel's operation is excision of the fistula of the rectum. The operation consists in the following actions: a special solution is injected into the fistula, a probe is passed through the fistula's passage, after which the fistula is cut off, and the canal is removed. Also, the skin covering the fistula and all inflammation-affected tissues is excised. 
• Excision of the fistula of the rectum with subsequent drainage. 
• Excision of the fistula followed by suture of the sphincter. 
• Excision of the fistula with the use of ligature technique (for high, extrasfinctorial fistulas). Ligature (thread) is introduced with the help of the clamp of Billroth, is grasped by another clamp and is removed outward from the gut. 
• Excision of the fistula of the rectum by the plastic method: dissecting the fistula, draining the purulent leakage, anesthetizing the tissue and cutting off the flap of the mucocutaneous tissue, moving it, closing the hole of the fistula.

The prognosis of surgical treatment of fistulas is favorable, as a rule, operations lead not only to stable remission, but also to complete cure.

Fistula of rectum after operation

How to cure a fistula of a rectum after operation. Fistula of the rectum as treated after surgery is necessary under the supervision of a doctor, at least for one or two days. The patient is prescribed conservative treatment, which includes taking painkillers (especially before defecation) - ketones, ketarol, zlodiar, antibacterial drugs that relieve inflammation. Also shown are the recumbent baths in warm water, in which dissolve antiseptic agents - nitrofural (furacillin) or manganese. The healing of a postoperative wound occurs within a month, the duration of tissue regeneration depends on the volume of the operation and compliance with all medical prescriptions. After the operation, physical exertion, weight lifting and any physical activity are excluded.

[16], [17], [18], [19]

Treatment of the fistula of the rectum by alternative means

Fistula of the rectum does not imply treatment by alternative means, however, there are situations when it is necessary to quickly relieve the patient's condition, and before the operation is still far away. Anti-inflammatory effect can have broths, infusions from medicinal herbs, which are used in the form of compresses, microclysters or rectal trays. Calendula, aloe, St. John's wort, plantain, oak bark and sage have proved successful. You can also use own ointments with the addition of honey or propolis. The use of honey is possible not only externally, it should be consumed inside, mixed with the crushed leaves of aloe, the leaves are often replaced with aloe juice (the proportion is 1/1). Fistula of the rectum after the operation is also well treated with alternative prescriptions. Accelerate the healing of tissues lotion from decoction of chamomile or decoction of marigold. Brew grass in this way: 2 tablespoons dry herbs pour a liter of boiled water, allow to pour for 5 minutes, cool to an acceptable temperature. Tampons soaked in such a decoction are applied to an already healing wound, the tampon can be kept for no more than an hour, then it should be changed to fresh.

Pay attention, treatment of the fistula of the rectum by alternative means can in no case become an alternative to medical or surgical treatment, since it is not highly effective and threatens with the recurrence of the formation of new fistulas.