Fistula or rectal fistula (fistulae ani et recti) –
serious pathology associated with the formation of purulent passages
through the connective tissue of the direct intestine. Output
fistulous tunnels may end in perioplasmic tissue.
These are incomplete internal fistulas. More often, the aisles are fully open and
open through the skin in the zone of the anus so-called full
Next, consider what the disease is, what are the main
symptoms and causes of its occurrence, as well as what is prescribed in
as a treatment for adult patients.
What is rectal fistula?
Rectal fistula is a chronic inflammatory process.
anal gland normally found in the area of the morganic crypts
(anal sinuses), which resulted in the rectal wall
a course is formed through which products are periodically released
inflammations (pus, mucus and ichor).
Fistula – chronic paraproctitis at which occurs
constant discharge of pus from the fistulous opening. Inside the course
covered with epithelium, which does not allow him to close up and on his own
ICD-10 disease code:
- K60.4 – Rectus fistula. Dermal (full).
- K60.5 – Anorectal fistula (between the anus and straight
In itself, the presence of a nidus of chronic infection is unfavorable.
affects the body as a whole, weakening the immune system. On the background
fistulas may develop proctitis, proctosigmoiditis. Among women
possible infection of the genital organs with the development of colpitis.
The occurrence of fistula associated with infection, penetrating into the shell
guts and surrounding tissue. Fatty tissue is inflamed first.
around the intestine (paraproctitis). At the same time begins to accumulate
The ulcers erupt over time, leaving tubules called
fistula. They may scar or continue to inflame and
In proctology, about 95% of rectal fistulas are outcome
acute paraproctitis. Infection, penetrating deep into the walls of the rectum
and the surrounding fiber, causes the formation of perirectal
abscess, which is opened, forming a fistula. Formation can
to be associated with the untimely approach of the patient to the proctologist,
non-radical surgery for paraproctitis.
The nature of the disease, in addition to the association with acute
paraproctitis, may also be postoperative or
posttraumatic. For example, women have fistulas when connecting
the vagina and rectum are predominantly formed as a result
birth injuries that may occur in particular due to ruptures
birth canal, with protracted labor or pelvic presentation
Rough forms can also trigger fistula formation.
carrying out gynecological manipulations.
Causes of fistula formation are as follows:
- untimely access to a doctor during development
- improper treatment;
- incorrect operation to remove an abscess,
accompanied only by opening and drainage of the abscess without
Appointment of properly selected antibiotic therapy.
The appearance of fistulous openings in the area of the anus may be associated with
- diverticulitis (inflammation of the inner lining of the thick
- rectal tuberculosis
- Crohn’s disease
All types of fistula have the same structure – entrance, channel and exit.
The inlet may be formed in different places, for example:
- near the anus;
- on the buttock;
- in the crotch;
- in the vagina or close to it (rectovestibular
- in the layers of subcutaneous tissue.
|Kinds свищей прямой кишки|
|Complete||In this type of fistula, the entrance is located in the wall of the rectum,
and the outlet is on the surface of the skin in the perineum or
anal area. Sometimes in the rectal area can form
immediately several inlets, which are further in the subcutaneous
Cellulose merge into one channel and form one outlet
on the skin. The main distinguishing feature of full fistulas is
that they go outside, on the surface of the body.
|Incomplete||Incomplete type. This adrectal fistula has only an entrance.
and the channel without exit, but this phenomenon, according to doctors temporary.
Gradually, an outlet will appear in the fistula anyway.
Depending on how the fistulous course is located relative to
to the anal sphincter, determine the intraspinal,
extrasfyncter and transsphincter fistula of the rectum.
- Intra spinal fistulae are the most simple
they are diagnosed within 25-30% of cases of the formation of such
formations. Their other designations are used in this
variant, namely – marginal or subcutaneous submucosal
fistula. Characterized by direct fistulous course, unexpressed
manifestation of the cicatricial process and slight prescription
- Transsfinkteralnye. Fistulous passages of such formations contain
purulent pockets, branching in adrectal tissue and cicatricial
changes caused by purulent fusion of tissues. Channels such
fistula pass on superficial, subcutaneous or deep portions
- Extrasphincter fistula of the rectum is the most complex species
affecting most of the sphincter, and at the same time having
streaks of various forms. The treatment is quite complicated with various
plastic forms, and even carried out in several stages.
Симптомы свища прямой кишки у взрослых
The manifestations of rectal fistula depend on the site of localization
fistula with purulent contents and a state of the immune system that
will determine the severity of manifestations of such
After undergoing paraproctitis in a patient:
- pains in the anus;
- there is a hole from which pus is released (its traces
will be noticeable on linen and / or clothes).
Sometimes, along with purulent discharge on the tissue, the ichor remains.
appearing due to damage to blood vessels. If the fistula is not
has an external exit, then the patient only has pain and / or
discharge from the lumen of the rectum or vagina.
Наличие неполных внутренних свищей вызывает у больных
feeling of presence of a foreign body in the anus. With
insufficient exit of infiltrate from the cavity of the fistula patients
- pain and discomfort in the anus area
- delayed stool and urination
- discharge from the rectum (pus, infiltrate, mucus)
- irritation and redness of the skin around the back
passage and part of the buttocks
- fever, chills.
With хронической форме заболевания, особенно в период обострения
The following set of symptoms is noted:
- fast fatiguability;
- nervous exhaustion;
- poor sleep;
- body temperature rises regularly;
- bowel gas incontinence;
- disorders in the sexual sphere.
Pathological changes in the physical
- deformed rear opening;
- scarring of sphincter muscle tissue appears;
- нарушение функционирования sphincter
During remission, the patient’s general condition is not changed, and
careful hygiene quality of life is not greatly affected.
However, the long course of rectum fistula and permanent
exacerbations of the disease can lead to:
- worsening sleep
- periodic temperature increase
- reduced working capacity
- reduce potency.
Depending on the stage and form of the disease, the symptoms alternate.
At the initial stage, the patient is interviewed, during
which revealed characteristic complaints for this pathology.
Diagnosing a fistula is usually straightforward, as
already on examination, the doctor finds one or more holes in the
anal area, with pressure on which purulent is separated
content. With пальцевом исследовании специалист может обнаружить
internal opening of fistula.
In addition to the examination and collection of anamnesis, the patient is prescribed tests:
- blood chemistry,
- general blood and urine analysis
- fecal occult blood test.
Instrumental methods for the diagnosis of rectum fistula:
- Rectoromanoscopy – endoscopic examination of the rectum with
using a tube inserted into the anus. This method allows
visualize the mucous membrane of the rectum, as well as hold
biopsy, in order to differentiate the rectal fistula from
tumors, in case of suspicion.
- In order to clarify the position of the rectum fistula and the presence
additional branches, carry out ultrasonography –
ultrasound of adrectal fiber.
- Fistulography – X-ray contrast study, when in
a hole is inserted a special contrast agent, then made
snapshots. According to them you can judge the direction of the fistula stroke and
the location of a purulent cavity. This research is required
It is important to understand that fistulas are not treated with medication.
drugs and traditional medicine. The only treatment
which allows for a complete cure of the disease –
Drug therapy is used solely to relieve
symptoms and as an adjuvant accelerating
The following pharmacological groups are recommended:
- fourth generation systemic antibiotics for taking
oral: metronidazole, amoxicillin;
- painkillers: Detralex, Hemoroidin, Phlebodia;
- healing drugs with anti-inflammatory properties
(externally): Levosin, Levomekol, Fuzimet.
- full course physiotherapy: electrophoresis,
Treatment свища является хирургическим. The main goal –
block the entry of bacteria into the cavity, its cleansing and excision
(remove) fistula stroke.
Operation удаления свища прямой кишки обычно назначается в
planned order. With обострении хронического парапроктита обычно
urgently open an abscess, and removal of the fistula is carried out in 1-2
of the week.
Contraindications to surgery:
- Severe general condition.
- Infectious diseases in the acute period.
- Decompensation of chronic diseases.
- Blood clotting disorder.
- Renal and hepatic failure.
Depending on the complexity of the fistula, the following may be performed.
operational methods interventions:
- excision throughout the fistula with or without wound closure
- excision with plastic internal fistulous openings;
- ligature method;
- laser burning of the fistula;
- Fabulous biomaterials filling.
Competently performed operation in a specialized hospital in
90% guarantee a complete cure. But, as with any operation,
There may be undesirable consequences:
- Bleeding during and after surgery.
- Damage to the urethra.
- Suppuration of postoperative wounds.
- Insolvency of the anal sphincter (fecal incontinence and
- Fistula recurrence (in 10-15% of cases).
Hospital stay after surgery:
- The first days when the patient is in the hospital, he is put
gas tube, analgesics, antibiotics,
dressings are carried out.
- From the 2nd day food is allowed – sparing and easily digestible food in
the wiped look, plentiful drink. Sessile baths are assigned with
warm antiseptic solution, anesthetic ointment, while
necessary laxatives, antibiotics.
- The duration of hospital stay after the intervention may
be different – from 3 to 10 days, depending on the volume
After discharge from the hospital, the patient must be especially
attentive to their own well-being and immediately
Seek medical attention if the following symptoms occur:
- Sharp rise in temperature
- Persistent abdominal pain
- Fecal incontinence, excessive gas formation
- Painful defecation or urination
- The appearance of the anus of purulent or bloody
Очень важно, что первые 2-3 дня после operations у больного не
there was a chair. This will ensure the wound is sterile.
healing. Subsequently, the diet expands, however
It is necessary to avoid constipation, which can provoke
seam divergence. Additional recommendations:
- Meals should be fractional, 6 times a day small.
- It is important to drink enough liquid, at least 2 liters of water in
day, so that the body recovers faster, as well as for
- Do not eat foods that irritate the intestines. To them
include carbonated and alcoholic beverages, chocolate in large
sharp spices and flavors, chips, fatty meats and
- Intrasphincter and low transsphincter fistula direct
intestines are usually amenable to permanent cure and do not entail
- Deep transsphincter and extrasphincter fistulas often
- Long-existing fistula, complicated by scarring of the wall
rectum and purulent flow, may be accompanied by secondary
Effective prevention of inflammatory process of the rectum
The following are the recommendations of a specialist:
- balanced and fortified food;
- the final rejection of all bad habits;
- timely treatment of chronic diseases of the digestive tract;
- moderate exercise on the body;
- rejection of emotional shocks and stress.
Rectum Fistula is a dangerous disease that can
bring discomfort to your unpleasant symptoms and cause
complications. With появлении первых признаков, обязательно обратитесь
for help to the proctologist.