home Adviсe Operation to remove a rectal fistula - “The actual operation to remove a rectal fistula and the rehabilitation period after it turned out to be not as scary as my imagination imagined”

Operation to remove a rectal fistula - “The actual operation to remove a rectal fistula and the rehabilitation period after it turned out to be not as scary as my imagination imagined”

Rectal fistula is a disease that does not represent great danger for the body. However, the disease is unpleasant, knocking the patient out of the usual rhythm of life. When an illness occurs, a hole (fistula) opens into a hollow organ or directly outward, through which pus and mucus emerge. Surgery will be required to remove the fistula. The cause of the problem is the development of fiber diseases.

If this happens, recovery after surgery takes important role. It is necessary to undergo all prescribed procedures and examinations so that the disease does not begin to progress again. About 80% of patients are men. Accelerate the development of fissure fistula anus, haemorrhoids. Another reason is prolonged diarrhea after surgery.

Rectal fistula (rectal fistula) has the following types:

Full, if there are 2 holes. One is open into the intestines, the second - into outer part, near the anus.
Incomplete, which open in one direction only. Can be internal or external. They develop mainly after removal of tumors, intestinal tuberculosis, or unprofessional biopsy. Damage to the walls of the gastrointestinal tract leads to the spread of intestinal bacteria into the perirectal cavity.

A person can diagnose the disease if they find pus or feel discomfort in the perianal area. The wounds sometimes secrete pus and cloudy blood. You have to constantly change bloody underwear, use moisture-absorbing products, and perform perineal hygiene. At strong discharge irritation occurs skin. Constant itching bad smell– the first symptoms of a fistula.

A straight fistula is quickly eliminated. Severe pain does not appear. Incomplete fistulas cause regular discomfort due to chronicity. With any sudden movement, the symptoms intensify. Blockage of the fistula canal threatens to increase the amount of pus. Exacerbations, abscesses, fever, intoxication due to the accumulation of pus are possible.

Symptoms

The following symptoms occur:

weakness, lack of sleep;
decreased concentration;
increased body temperature during certain periods (usually at night);
nervousness.

Recovery after surgery should be carried out under the supervision of a professional. With prolonged absence of treatment, incorrect methods used after surgery, serious changes are possible. The anus becomes deformed and scars form on the sphincter muscles.

Treatment of rectal fistulas

Before surgery, which is the main method of getting rid of rectal fistula, additional treatment may be prescribed. Antibiotics, painkillers, and healing substances are used. Medicines are taken to improve the condition, but most often such therapy does not bring significant relief.

Physiotherapy may be prescribed in preparation for surgery. The need for physiological procedures is to reduce the risk of complications after the surgeon’s actions.

Fistula should not be treated folk ways. The substances used may provide temporary relief. It is unlikely that anything will be done with their help, but time will be lost.

Remove rectal fistula is the only solution to the problem. Specialists do not provide treatment during remission. The fistula tracts close, pus stops oozing, and it is difficult to determine the location of the operation. The surgeon can remove part of the problem area, affecting a healthy part of the digestive system.

The type of fistula determines the method of removing the pathogen. The size of the diseased areas and the rate of pus discharge influence the methods used. The surgeon must correctly cut off the fistula, drain the purulent canals, if necessary, suture the sphincter, and close the damaged cavities.

The steps are different in each case. The use of general anesthesia is mandatory; the patient is under the supervision of a doctor for about 10 days.

Features of the postoperative period

Time is needed for complete healing of the damaged cavity and fistula tracts. The stages of the postoperative period are divided into inpatient and outpatient.

The first part of recovery is when the patient is placed in a hospital for observation. A tube is installed to remove gases, analgesics and antibiotics are prescribed. Bandaging is carried out several times a day.

Eating is allowed 12 hours after surgery, be sure to finely grind it. Frequent fluid intake is recommended. In 90% of cases, baths are prescribed, to which an antiseptic solution and ointments are added for pain relief. If necessary, laxatives and other required substances. In the hospital, the patient is detained for the time required for partial restoration of functions and wound healing.

Outpatient period

The fistula takes a long time to heal, and the discharge does not stop for 3 to 5 weeks. It is recommended not to stop taking sitz baths at the end of the outpatient period or leaving the hospital. Carry out morning and evening procedures with the addition of prescribed medicinal infusions, antiseptic drugs. The wound should be covered with sterile bandages and lubricated with disinfecting ointments. Baths are also taken after the next bowel movement.

A mandatory measure if the rectum is susceptible to disease is diet. The patient consumes the required amount of fluid to soften stool and fiber. Spicy foods and alcohol are excluded. It is not recommended to sit/stand for long periods of time. It is prohibited to perform heavy physical work, lifting any heavy objects.

Any violation of the regime provokes wound opening and prolonged healing. Recommendations are described by the attending physician - proctologist.
After some time (usually a day), the patient is allowed to drink water. After anesthesia, unusual sensations occur in the body, sometimes severe pain. For the first few days, the patient takes a course of painkillers.
After the first dressing they are removed. Dressing is a painful procedure for the patient. Locally acting drugs on the body are required. The attending physician controls the healing: the edges of the wound should not stick together, there should be no accumulation of suppuration or non-drainable pockets.
If the operation was complex, after a few days it becomes necessary to change the dressing under anesthesia. A deep treatment of the operation site is performed, and the ligature is tightened. To make the wound heal faster, baths with potassium permanganate or chamomile are performed.

Diet after removal of rectal fistula

After the operation, it is necessary to use not only medications that accelerate the healing of the resulting wound, but also other methods. Diet helps the body cope with the damage it receives. It is necessary to eat foods rich in vitamins, nutrients so that recovery goes faster. Food is divided into small portions and consumed evenly. Products should not have a negative effect on the stomach, contribute to flatulence or constipation.

It is advisable to avoid bowel movements for the first 20 hours after surgery. The patient must fast for several hours. After the second day you can eat food. Products are steamed or baked. Vegetables are consumed in any form. The following products are allowed to be consumed:

Bread made with coarse flour or wheat.
Baking, drying (not rich).
Soups with broth made from meat and vegetables. Be sure to be light, without adding numerous seasonings. You can eat cold dishes: beetroot soup, fruit or vegetable soups.

Lean meats. The product must be boiled or baked.
Fish, only sea fish. Definitely boiled or stewed.

Premium quality sausage, milk sausages.
Vegetable dishes, snacks. Greens are consumed processed or raw, pickled.
Porridges, which are a source useful components. Most often, try to eat buckwheat, which is rich in carbohydrates that fill the body with energy.
Baked and boiled pasta are healthy.
Green peas and bean curd.

Eggs should be consumed boiled, preferably as part of other dishes.
Low-fat dairy products.

There is a list of products prohibited for consumption in postoperative period. These include any dishes or components that increase blood flow to the pelvis. Prohibited categories include:

alcoholic beverages, preservatives, smoked products;
complex proteins and dishes based on them (goose, lamb, pork);
mushrooms, which are difficult to digest food;
products that enhance the process of gas formation in the esophagus can be consumed, but in limited quantities;
pastries, baked goods, cakes;
high fiber fruits, garlic, onions, spinach;
legumes, peas, beans, whole milk;
fried foods.

If you follow the rules of dietary nutrition, recovery will be significantly accelerated. Eating the right foods helps eliminate complications that occur when unwanted substances enter the body and slow down the healing process.

Prevention

As a preventive measure, so that the disease does not occur again, timely treatment of paraproctitis plays an important role. It is important to completely get rid of the factors leading to rectal injuries. Preventive methods combating rectal fistula:

Timely treatment diseases of the rectum. It is necessary to heal anal fissures and prevent the progression of hemorrhoids.
Timely relief from diseases whose symptom is itching. Avoid irritation of the skin around the anus. It is important to diagnose and eliminate colitis, diabetes, invasion and other similar diseases so that extraneous problems do not develop.
Proper nutrition. The digestive organs directly affect the occurrence of fistula. Constipation and diarrhea are the first digestive disorders leading to the development of pathology.
Being in a suitable temperature zone. Hypothermia of organs increases the likelihood of disease.
Hardening the body and personal hygiene.

If you follow these recommendations, the likelihood of a rectal fistula is significantly reduced, and its excision will not be required. If you notice symptoms of the disease, you should consult a doctor to diagnose disorders at an early stage.

A fistula is a pathological channel that connects a hollow organ and external environment or two hollow organs. Most often appearsfistula after surgery. Treatment of this formation is quite long and painful. That is why the patient must strictly adhere to the doctor’s instructions.

A fistula is a hollow neoplasm, which in its own way appearance reminds deep wound. In accordance with the characteristics of the development of neoplasms, they can be:

Lip-shaped. In this case, fusion of fistulas and skin, as well as muscle tissue, is observed. Removal of fistulas is carried out using a surgical method.
Full. It is characterized by the presence of two outputs, which provides the opportunity to combat the inflammatory process as effectively as possible.
Tubular. It is a fully formed canal from which there is a constant release of feces, pus and mucus.
Incomplete. The neoplasm is characterized by one exit, the location of which is abdomen. With this type of fistula, pathogenic microflora multiplies and inflammation worsens.
Granulating. With this type of fistula, granulation tissue is formed. With this pathological process, swelling and hyperemia are quite often observed.

About, what is a fistula after surgeryonly the doctor knows. After carrying out the appropriate diagnostics, the specialist will be able to determine the type of formation, which will have a positive effect on the treatment process.

Reasons for appearance

Postoperative fistulascan develop for a variety of reasons. Most often, pathology is observed against the background of an infectious process that enters the human body through sutures and wounds. After carrying out surgical intervention The human body can reject the thread, which is explained by intolerance to its components. Against this background appearspostoperative fistula. The development of neoplasms can be diagnosed in the presence of other provoking factors, which include:

High immune reactivity of the body;
Elderly age;
Chronic specific infection;
Hospital infection;
Oncological diseases.

If the human body receives vitamins and minerals in insufficient quantities, this leads to the formation of fistulas. Postoperative fistula, treatmentwhich is very long-lasting, appears when there is a metabolic disorder - diabetes mellitus, metabolic syndrome, obesity.

Before, how to treat a fistula after surgery, it is necessary to determine the cause of its occurrence. Therapy for pathology should be aimed at eliminating it.

Symptoms

Fistulas after surgerycharacterized by the presence of certain characteristics. Initially, a thickening appears on the skin around the size. When it is palpated, pain is observed. In some patients, the appearance of pronounced tubercles is diagnosed, which secretes the infiltrate. At the site of infection of the scar, redness of the skin may be observed.

The pathological process is often accompanied sharp increase body temperature. This is explained by the inflammatory process in the human body. It is impossible to bring the temperature down to normal. Fistulas are accompanied by a purulent process. At untimely treatment pathology, the size of the abscess increases significantly. Patients experience tightening of the fistula opening for a certain period. After this, inflammation develops.

Fistulas are characterized by the presence of certain signs. If they appear, patients are advised to immediately consult a doctor. Timely treatment of the disease will eliminate the possibility of side effects.

Features of therapy

Treatment of fistula after surgeryin most cases requires surgical intervention. Initially, the surgical field is treated with special antiseptic solutions, which will eliminate the possibility of infection. Surgery requires the use of local therapy. In order for the surgeon to find the course of the fistula as quickly as possible, a dye solution is injected into it.

The surgeon uses a scalpel to remove the fistula. All other actions of specialists are aimed at stopping bleeding. After this, it is recommended to wash the wound with a solution of antiseptic effect. Postoperative sutures are applied to the wound. In this case, it is recommended to use active drainage.

Treatment postoperative fistulas requires the use of not only surgery, but also appropriate medications. In most cases, patients are prescribed antibiotics and anti-inflammatory drugs:

Diclofenac;
Nimesila;
Dicloberla.

In order to speed up the wound healing process, the use of Troxevasin or Methyluracil ointment is recommended. It is also recommended to use drugs that have vegetable origin, - aloe, sea buckthorn oil etc.

That, How long does it take for a fistula to heal after surgery?, directly depends on the characteristics of the rehabilitation period. Patients are recommended to carry out daily hygiene procedures in the area of the operation. The patient is recommended to disinfect the sutures daily using special preparations. The patient's diet should be rich in fiber, which will eliminate the possibility of constipation. In the postoperative period, it is recommended to avoid heavy physical activity. From long work V sitting position must be abandoned for three months.

How it appears fistula after surgery, what is it?only the doctor knows. That is why, if tumors occur, it is necessary to seek help from a doctor who will determine the type of formation and prescribe rational therapy.

There is a category of diseases that do not seem to pose a big threat to health, but at the same time are extremely unpleasant, knocking the patient out of the normal rhythm of life. A typical representative of this group is a rectal fistula. Those who know about it first-hand will agree, having experienced all the “delights” of this disease for themselves.

What is a rectal fistula and why does it occur?

A fistula is a hole (fistula) that opens outwards or into a hollow organ, through which fluid (pus, mucous-bloody contents, etc.) comes out. The hole is connected to a cavity, most often of an inflammatory nature, using a passage lined with epithelium.

As for the rectal fistula, it is essentially a chronic purulent process (paraproctitis), which opened independently outward or into its lumen. This process is located in the pararectal (peri-rectal) fatty tissue and is a consequence of its various diseases:

The development of paraproctitis is facilitated by anal fissures and hemorrhoids, and they, in turn, occur in people suffering from constipation, physical inactivity and are frequent “companions” of alcohol lovers and adherents of non-traditional sexual orientation. More than 80% of patients are men.

Sometimes the reason may also be prolonged diarrhea after operations on the intestines, when irritation of the skin of the anus occurs, cracks, an inflammatory process - paraproctitis.

What types of fistulas are there?

There are 2 types of rectal fistulas:

complete, when there are two openings: one opens outward near the anus, the other into the intestinal lumen;
incomplete, opening only inward or outward; accordingly, they are divided into internal and external.

Incomplete internal fistulas more often occur as a result of tumor disintegration, intestinal tuberculosis, and even when a biopsy of the rectum is performed unprofessionally with deep damage to its wall and spread intestinal microflora on pararectal tissue.

Symptoms of the disease

If the disease occurs as a result of acute paraproctitis, the symptoms will be as follows. Severe pain in the anus, swelling, difficulty defecating, and increased body temperature appear. This can last from several days to 1.5-2 weeks, then relief comes. The abscess breaks through, the pus drains through an opening in the anal area or from the anus with feces. At the same time, relief comes - pain decreases, body temperature normalizes.

The pain gradually subsides, but another nuisance appears - discharge. They may have a nasty putrid smell, irritate the skin around the anus, causing itching, burning, and require frequent hygiene procedures.

When a fistula develops as a result of tuberculosis or intestinal tumor, pain syndrome develops gradually, and mucous membranes or bloody issues from the anus.

Advice: in case of any problem in the anal area, you should immediately contact a specialist. Delay can lead to complications requiring long-term treatment.

Examination and diagnosis

When a patient contacts a proctologist with these complaints, the examination begins, as a rule, with finger examination. It allows you to determine the width of the lumen, the presence of infiltrates, and pain. Next, rectoscopy is performed - examination lower section mirror. Then, after special preparation, the patient undergoes sigmoidoscopy - examination of the rectum and sigmoid colon. Infiltrates, tumors, polyps and fistula openings are determined.

If there is damage to tuberculosis, tumor, ulcerative colitis, the patient is prescribed an extensive examination - irrigoscopy, fibrocolonoscopy.

Colonoscopy is also performed for hemorrhoids, with the exception of cases of acute thrombosis of the hemorrhoidal veins, because hemorrhoids are often complicated by chronic paraproctitis, and in themselves cause bleeding and pain.

Research methods special for fistulas are also used: probing, dye injection test, fistulography, ultrasonography. When probing, a thin probe with a rounded end is inserted into the opening of the fistula and the fistula tract is carefully examined. Using a syringe, a solution of methylene blue is injected into the external fistula tract and rectoscopy is performed. If the blue enters the lumen, it means the fistula is complete.

Fistulography is an X-ray contrast study where a special device is inserted into the hole. contrast agent, then pictures are taken. From them one can judge the direction of the fistula tract and the location of the purulent cavity. This study must be carried out before surgery.

It is quite informative ultrasonography– ultrasonography, using local technology with the introduction of a rod sensor into the lumen of the rectum.

Treatment methods

Treatment for fistula is surgical. The main goal is to block the entry of bacteria into the cavity, clean it and excise (remove) the fistula tract. There are many technologies for excision surgery; their choice depends on the type of fistula - on the nature, shape and location of the purulent cavity.

The patient is given anesthesia, because interventions in the anal area are very painful, and novocaine infiltration does not give complete pain relief and can aggravate the course of the inflammatory process.

When the fistula is the result of tuberculosis or cancer, a direct or sigmoid colon, or left hemicolectomy - removal of the entire left side of the colon. Before and after surgery, anti-inflammatory treatment – antibiotic therapy – is mandatory.

Advice: You should not try to treat a fistula on your own using herbs and other folk remedies. This will lead to a waste of time, and the cause of the disease will not be eliminated.

Postoperative period

The postoperative period after removal of a rectal fistula has its own characteristics. It takes time for the cleaned cavity and fistula tracts to heal and fill them with scar tissue. This period is divided into 2 stages: inpatient and outpatient.

Stationary period

The first days when the patient is in the hospital, a gas tube is placed, analgesics and antibiotics are prescribed, and dressings are performed. From the 2nd day, food is allowed - gentle and easily digestible food in pureed form, drinking plenty of fluids. Sitz baths are prescribed with warm solution antiseptics, pain-relieving ointments, laxatives, and antibiotics if necessary. The length of hospital stay after the intervention can vary - from 3 to 10 days, depending on the scope of the operation.

Outpatient period

The healing process of a fistula is long, discharge can last up to 3-4 weeks. Warm sitz baths 1-2 times a day with decoctions are also recommended. medicinal herbs or special antiseptics, then closing the wound with sterile gauze and bactericidal ointments. Baths should be taken after each bowel movement.

The diet should contain enough fiber and liquid so that the stool is soft and does not injure the healing wound. It is necessary to exclude alcohol, spicy foods, long stay in a sitting position. You cannot do heavy work or lift weights exceeding 5 kg. All this contributes to blood stagnation and poor wound healing. It's just general recommendations, and the doctor gives individual ones to each patient.

Rectal fistulas are a serious pathology that leads to complications, relapses and even malignancy (transformation of cells into malignant ones). They only need qualified treatment from a proctologist.

vseoperacii.com

Fistulas (aka fistulas) of the rectum are channels formed from the surface of the skin to the rectum, accompanied by suppuration of the tissues adjacent to the intestine.

Diagnosis: rectal fistula treatment without surgery:

Any treatment cannot be carried out without medical supervision and depends on the causes of the disease and the patient’s condition. To relieve infection and pain, anti-inflammatory drugs (antibiotics) and painkillers are prescribed. The doctor monitors the progress of treatment; if it does not produce results, surgery is prescribed.

Rectal fistula: treatment by surgery.

Surgery usually occurs under general anesthesia.

The surgeon excises the fistula itself and the tissues adjacent to it that are affected by the disease. The wound healing after surgery usually takes about a week. Surgery almost always results in complete deliverance from illness.

Complications that may threaten the patient: resumption of fistula and bleeding. The percentage of occurrence of these factors is small.

If a rectal fistula appears in an infant, surgery may be postponed until the age of one and a half years, if there are no complications and the general condition is normal.

In the postoperative period, you will have to consult a doctor again if you experience severe abdominal pain, elevated temperature, pain when urinating and other signs of infection, problems with retaining gas or feces, constipation.

Postoperative rehabilitation period:

Average, full recovery After excision of the fistula it takes several weeks. Usually the doctor prescribes a diet, which must be followed for the first few days until the wound heals. The diet is recommended in order to cause the patient to have no bowel movements, in order to avoid bacteria from entering the wound. The wound after removal of the fistula will heal much faster if you give it rest.

The operation to excise fistulas is not the easiest and, for your peace of mind, we recommend that you first discuss the details with your doctor. Find out in advance about preparatory measures and what awaits you after surgery. If your doctor thinks you will have pain in your anus, you will be prescribed pain medication for a few days.

After the fistula excision procedure, during the rehabilitation period it is usually allowed water procedures, taking a bath in a sitting position is recommended three times a day and after each visit to the restroom. Increased hygiene is prescribed to avoid infection from entering the healing tissue.

The patient can return to his usual daily routine after about three weeks from the operation. Counts healthy person after two months.

After surgery, relapse of the disease is sometimes observed, but such cases are extremely rare, however, this scenario should not be excluded.

Take a referral from your doctor for a re-examination to monitor the course of the postoperative period. As a rule, a secondary examination is performed after a few weeks, if no complications have been previously noticed.

medicalsan.ru

Types of direct fistulas

Fistulas of the direct passage are divided into:

full, with an open outlet;
incomplete, with a closed external opening;
internal, with access to the rectal cavity.

Most often, open, complete rectal fistulas occur. By at least, sick people seek medical help precisely in the case of the formation of an external hole. initial stage disease - an incomplete fistula, which goes deep into the thickness of the mucous membrane in the area of the anal sphincter. This cavity is gradually filled with mucous secretion with high concentration pathogenic microorganisms. As a result of the vital activity of this microflora, gradual melting of tissues occurs. This leads to the appearance of open fistula. Internal types are the most difficult to diagnose.

Symptoms of anal fistulas of the rectum

In development pathological process patients begin to experience some symptoms and signs that indicate the presence of an inflammatory process in this area. Among the symptoms of rectal fistula, the most characteristic are:

acute pulsating pain that intensifies while sitting;
irritation, swelling and redness of the skin around the anus;
release of purulent and bloody contents;
frequent constipation and pain during bowel movements;
During an exacerbation, body temperature may rise and symptoms of general intoxication may appear.

Visual examination and digital rectal examination are often sufficient for diagnosis. But in some cases additional clinical examinations to clarify the location and depth of the inflammatory end-to-end process. During a laboratory examination, it is important to identify:

sexually transmitted infections, they can often cause the development of a fistula in the rectal area;
chronic inflammatory diseases of the small and large intestines;
diverticulosis and Hirschsprung's disease;
oncological and benign tumors.

Computed tomography, X-ray examinations, sigmoidoscopy, and ultrasound examinations may be prescribed.

What treatment does rectal fistula require?

As noted above, treatment of a fistula in the rectal area is only possible through surgery. During the period of preparation for surgery, general anti-inflammatory therapy is performed. If the cause of this defect is not eliminated, there is a high probability of recurrence. pathological formation fistulas.

What kind of rectal fistula surgery will help eliminate completely?

There are several surgical options for direct fistulas. Among them, the most commonly used are:

excision of the fistula;
ligature technique;
patchwork technique;
use of fibrin glue;
biological plastic.

Excision of rectal fistula– the simplest surgical operation in its technique. Used in approximately 95 percent of sick people. The doctor simply excises the altered tissue of the fistula and stitches it together for complete fusion of its wall. Within 2 months, a connective tissue scar forms at the intervention site.

Ligature technique requires several surgical interventions. But at the same time, natural muscle and mucous tissue is preserved.

The technique of applying a flap is that during surgery, the surgeon takes a flap of skin from the area around the anus and uses this tissue to close the fistula cavity.

Using fibrin glue- This is not a surgical intervention. After preparing the patient, a composition is introduced into the cavity of the fistula, which stimulates rapid granulation of its walls and complete healing. Usually the effect lasts for 15–20 months, after which a repeat procedure is required.

Biological prosthetics on this moment is not successful enough. It is used only in cases of complicated fistulas, in which it is not possible to perform an operation to excise its walls.

After operation

After surgery for a rectal fistula, it is recommended to prescribe an anesthetic. Antibacterial agents broad spectrum of action are recommended for people with reduced levels immune defense. The risk of postoperative complications can be reduced by taking anti-inflammatory medications.

Typically the postoperative period is approximately 3 days. After this period, the sick person, provided there are no complications, can begin work if it does not involve heavy physical exertion. In the first six months after surgery, light work and constant exercise therapy are recommended.

In the first six weeks it is prescribed special diet, which does not impede the formation and passage of feces from the intestines. If necessary, herbal laxatives can be used. To protect the wound surface, use sterile gauze dressings. After each bowel movement, it is necessary to wash the wound surface with a solution of furacillin or hydrogen peroxide.

Urgent medical care may require a condition in which the following symptoms are noted:

extensive bleeding;
increased pain syndrome;
increased body temperature to 38 degrees Celsius or higher;
nausea and vomiting;
prolonged delay in bowel movement, accompanied by bloating;
difficulty urinating;
discharge of purulent contents;
development of scar tissue in excess.

pancreatit.info

What is a rectal fistula?

Fistulas or fistulas of the rectum (fistulae ani et recti) are a serious pathology associated with the formation of purulent passages through the connective tissue of the rectum. The exit of the fistula tunnels may end in the peri-rectal tissue. This - incomplete internal fistulas. More often, the passages are completely open and open through the skin in the anus area, the so-called complete external fistulas.

Rectal fistulas usually result from a pararectal abscess of the rectum, which has a medical name - paraproctitis. Fistula tracts can be classified by location and degree of prevalence.

Complete fistulas are common. They have two holes on both sides: inlet and outlet. There are fistulas with several entrances. Incomplete fistulas with one entrance hole often turn into full ones due to the gradual dominance of microorganisms in them.

Infected tissue cells lose their tone and gradually collapse: there is a breakthrough of the fistula outward with access to the surface of the skin around the anus. The appearance of fistulous openings in the anal area may be associated with the following diseases:

diverticulitis (inflammation inner shell large intestine)
tuberculosis of the rectum
syphilis
chlamydia
Crohn's disease

How dangerous is rectal fistula, what consequences can there be?

Fistulas that long time were not treated and went to chronic form are fraught with many general complications: from purulent processes of blood poisoning to the possibility of developing carcinomas ( cancerous tumors) anal ducts. Untreated anal fistulas can lead to scarring, which can cause pain during bowel movements and passing gas.

How to identify a rectal fistula: symptoms

Complete external fistulas appear visually: on the skin around the anus and partially on the buttocks, one or more tissue compactions with an internal lumen are felt.

Through this passage, discharge of pus, mucus or infiltrate is observed. In places where the fistula emerges, the skin becomes moist, softened, and loses its natural turgor due to maceration. When palpating the rectum, a hole-fistula in the form of a funnel is discovered.

Availability incomplete internal fistulas causes in patients a feeling of the presence of a foreign body in the anus. If there is insufficient release of infiltrate from the fistula cavity, patients feel:

pain and discomfort in the anal area
retention of stool and urination
discharge from the rectum (pus, infiltrate, mucus)
irritation and redness of the skin around the anus and part of the buttocks
fever, chills

Rectal fistula in a child: causes

Diseases in the form of rectal fistulas are rare in childhood. This pathology most often manifested at the birth of a child and is a consequence of failure of intrauterine development of the fetus for any reason.
The disease may appear when Crohn's disease(a genetic disease that affects the entire gastrointestinal tract) or after an acute paraproctitis (purulent inflammation tissues adjacent to the rectum).
Before prescribing treatment, you should know the root cause of fistula formation. Congenital fistulas require surgical treatment, since the disease threatens the baby’s life. The operation consists of removing the source of inflammation and the surrounding epithelium captured by the pathological process.
If fistulas are detected in a baby in the first months of life, surgical intervention can be postponed for more late date- when the child reaches 18 months. This is possible only if the child’s condition is stable without the spread of infection, accompanied by an increase in temperature and deterioration of the baby’s condition.

Paraproctitis fistula after paraproctitis: causes of appearance

Paraproctitis is the main cause of rectal fistulas. Inflammation of the perirectal tissue of the rectum occurs with infection through anal glands and damaged mucous membrane.

The inflammatory process is transmitted through neighboring diseased organs. Most often, paraproctitis accompanies the following diseases:

nonspecific ulcerative colitis
Crohn's disease
inflammation of the prostate and urethra
inflammation of the female genital area
pelvic osteomyelitis

Anal fistulas can appear due to:

advanced paraproctitis
complications during operations for paraproctitis
unsuccessful surgical opening of paraproctitis
spontaneous opening of paraproctitis

Rectal fistula - treatment without surgery at home

IMPORTANT: Complaints of pain and discomfort in the rectal area are a reason to consult a proctologist.

Symptoms of a rectal fistula cause great discomfort in the patient’s life. It cannot be cured at home, it does not exist universal remedy for scarring fistula tunnels. At home, you can only alleviate the patient’s condition with the help of medications and traditional medicine: ointments, herbal lotions and preparations.
Folk recipes have been developed over time and have been tested on more than one generation of people. Ointments and poultices are removed painful sensations, clean and disinfect the skin, remove inflammation in the areas of fistula rupture.

Anal fistula - treatment at home

The use of medications at home is not a solution to the problem of rectal fistula. Painkillers, antispasmodic and anti-inflammatory medications relieve the symptoms of anal fistula only for a while.
Then the disease begins to worsen again, requiring an immediate visit to the doctor. After clarifying the diagnosis, an algorithm for treating the patient is built depending on the severity of the disease.
At the first stage, antibiotics are prescribed to suppress the infectious process and drugs that alleviate the patient’s condition - antispasmodics, painkillers and anti-inflammatory drugs. Subsequently, surgical intervention is required after a series of necessary tests and a complete examination.

For in-depth diagnosis of the disease, the following methods are used:

sphincterometry (assessment of the working condition of the anal sphincter)
irrigoscopy (examination of the intestines using X-rays)
computed tomography (layer-by-layer examination of the intestines using x-rays)
fistulography (fluoroscopic examination of fistula tracts using radiopaque agents)

Folk remedies for the treatment of rectal fistula

There are folk recipes for relieving the condition of a patient with external perforation of the fistula. Let's share some.

Lotion with St. John's wort herb

The procedure with the herb St. John's wort helps remove purulent contents from the opening of the fistula. Regular application of herbal compresses to the sore area relieves inflammation and irritation, helps cleanse the passage, and relieves itching and pain.

Three tablespoons of finely ground raw material - St. John's wort herb - are steamed with 200 ml of boiling water.
Insist on steam bath 5-7 minutes.
The steamed herb pulp is spread on a piece of linen cloth.
The lotion is applied warm to the inflamed area and covered with a piece of cellophane film.
The procedure is carried out daily until the pus is completely discharged.

Lotion with mumiyo and aloe juice

Cooking 3% water solution mumiyo: in 100 ml warm, cleaned or boiled water dissolve 3 g of mumiyo.
Add a tablespoon of juice from 3-year-old aloe leaves to the dilution.
A piece of gauze is generously moistened with the solution and applied to the purulent lesion.

Lotions from kombucha with plantain roots

Boil a tablespoon of plantain roots in 200 ml of water.
After cooling, add 200 ml of kombucha infusion to the broth.
A gauze napkin is moistened with the medicine, lightly wrung out and applied as a lotion to the exit of the fistula opening.

Warm sitz baths with infusions of oak bark, chamomile and calendula flowers, and sage leaves help relieve inflammation and irritation of the skin around the anus.

Ointment for the treatment of rectal fistula

An ointment prepared with herbs helps clean the inflamed surface of the skin around the fistula opening, relieve swelling, remove redness and irritation. In general, the ointment has a beneficial effect and heals the fistula tunnel.

Plant components: oak bark, water pepper grass, toadflax flowers are used in equal proportions. 2 tablespoons herbal mixture finely grind, for this you can use an electric coffee grinder.
The herbal powder is poured with two tablespoons of melted fresh pork lard.
The ointment is kept in the oven at a minimum temperature of 3 hours.
Gauze swabs are soaked in ointment and applied to the inflammatory lesion for 5 hours, then the swab is replaced with a new one.

Surgery to remove rectal fistula: reviews

Surgical intervention is the main way to get rid of rectal fistulas

Rectal fistulas cannot heal on their own. Pathology is not amenable conservative treatment. Drug therapy and procedures in the form of baths, compresses and lotions relieve the patient’s suffering for a short time.

This should be taken into account in complicated forms of the disease, when the fistula passes through the muscle tissue of the anal sphincter, the so-called trans- and extrasphincteric fistulas.

IMPORTANT: Rectal fistulas are not prone to complete healing without surgical intervention.

Objectives of surgical treatment of rectal fistulas

Removal of the internal fistula opening.
Opening and removal of a pararectal abscess.
Excision of the fistula passage.
Application of minimal impact on the external sphincter of the anus to prevent loss of its functionality.
Postoperative conservative wound healing with minimal scarring.

The operation to remove an anal fistula is performed under general anesthesia. The wound after excision of the fistula usually heals quickly. On days 5-7, the patient is discharged if the healing process goes according to plan and without complications. In the first hours after surgery, pain in the wound area is possible.
After removal of the fistula, the patient is prescribed a complex of medications for internal and local use in the form of suppositories, ointments, wound-healing medications and anti-inflammatory tablets. The patient is under medical supervision until complete recovery.
In the postoperative period, it is important to perform hygiene procedures. It is allowed to take showers and sitz baths with herbal infusions of chamomile, calendula, sage, oak bark. Baths are recommended after each bowel movement.
Reviews from patients who have undergone such operations are mostly positive. As a rule, all patients tolerate the operation well and are completely cured. Approximately 2 weeks after surgery, the patient returns to his daily life, and complete recovery occurs around 6 weeks.
A small percentage of patients experience a relapse of the disease. Complications after surgery in the form of bleeding, slow wound healing and inflammatory processes also occur. Situations like this are quite rare. In such cases, additional treatment is prescribed.

Nutrition after removal of rectal fistula

It is possible to restore health after surgery within 2-3 weeks if you follow proper diet and perform the necessary hygiene procedures.
After the operation, a liquid diet is prescribed in the form of water, kefir, and a small portion of liquid rice cooked in water. This diet is recommended to make work easier intestinal tract without constipation and unnecessary stress. Besides, feces can serve as a source of infection and contaminate the postoperative wound surface.
Further work should be supported gastrointestinal tract in a gentle mode, without loading it. After rectal surgery, foods that irritate the intestinal tract are not recommended.

What you shouldn't eat:

fried foods
smoked meats
mushrooms
fatty and canned foods
spicy and salty foods
black bread
whole milk
vegetables and fruits that cause putrefactive processes and gas formation: radish, radish, peas, beans, beans, cabbage, spinach, sorrel, grapes, raisins
fresh baked goods
carbonated sweet drinks

liquid and pureed puree soups with vegetables and weak meat broths from white poultry meat
meatballs, cutlets, zrazy from vegetables, fish or meat, steamed
all kinds of liquid porridges: oatmeal, rice, buckwheat, wheat, corn with a small piece of butter
low-fat dairy products: kefir, fermented baked milk, cottage cheese, yogurt
bread in the form of dried toast, croutons

What is a rectal fistula, methods of relief, video:

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Anesthesia

It is necessary to eliminate pain after surgery within the next week. The pain is leveled out various drugs. It can be:

medications for intravenous administration;
gas anesthetics.

Local blockades are also used:

with epidural anesthesia, central blockade of the segment;
spinal anesthesia.

Rehabilitation after surgery sometimes includes pain management, which is controlled by the patient himself. In this case, a special electronic device for pumping liquids with some given by the doctor rapidly introduces the pharmaceutical into the body in one of two ways:

intravenous;
epidural.

In the event of a shortage of medicine from the established pumping, the patient has the right to increase the dose of medicine by pressing a special button on the device. The device is also capable of monitoring concentration medical product in the blood so as not to lead to an overdose. The process is controlled by medical staff, but the devices themselves can be placed on the shoulder and walked with them. Then, at the next meeting with the patient, the specialist looks at the amount of additional pain relief and adjusts the entire process according to the data received.

Adequate pain relief for the postoperative period provides improvement general condition, normalizes intestinal peristalsis, restores independent urination and makes it possible to perform a full dressing. In addition, good pain relief in the postoperative period allows one to avoid complications in elderly patients and in persons with concomitant pulmonary-cardiac diseases.

It is necessary to use painkillers to make the postoperative period easier

Dressings

Treatment of paraproctitis after surgery includes dressings. They are produced daily. The first dressing is performed 24 hours after surgery. 10–20 ml of Vishnevsky’s liquid ointment is injected into the rectum through a gas outlet tube and the tube is removed. Then the tampon inserted into the rectum, after abundant wetting with a solution of hydrogen peroxide, is also removed. The perineal skin around the wound is treated with 2% alcohol solution Yoda. Under a stream of hydrogen peroxide, tampons are gradually removed from the damaged perineum.

In cases of suturing a wound or moving the mucous membrane of the distal rectum, especially careful monitoring of the condition of the wound is necessary.

Mode

Active management of patients in the immediate postoperative period helps restore hemodynamics, breathing volume, normalizes urination, improves the wound healing process, and restores body tone. The regimen for the patient is selected depending on the type of pararectal disease:

The patient's regimen after surgery for acute perirectal abscess is active. After all types of surgical interventions, the patient is allowed to get out of bed on the second day. Restrictions may be due to the desire to avoid an early urge to defecate. Therefore, until 3-4 days after the operation, the patient is only allowed to get up and walk around the ward, wash, go to the toilet or dressing room;
The regimen of patients after surgery for chronic paraproctitis is generally active, but in detail it depends on the method of surgical intervention. Bed rest lasts from 1 to 7 days. Restrictions in the regimen may be due to the method of surgical intervention. When suturing the rectal sphincter, an early active regimen is not advisable. Patients who have undergone operations without sphincter suturing can be transferred to the general regimen from the second day.

After surgery, the patient is recommended bed rest

Diet

Recovery after surgery necessarily involves changes in diet. After surgery for a perirectal abscess, the diet should be limited in the first three days to slag-free foods, and in subsequent days to foods containing a minimum amount of slag-forming products. Allowed a large number of liquids, excluding the following drinks:

carbonated drinks;
juices;
compotes.

From day 4, the diet can be gradually expanded, achieving normalization of intestinal bowel movements. Prohibited for up to 3 months:

During the rehabilitation period, it is recommended to consume mainly liquid foods

Drug therapy

How to treat paraproctitis after surgery using pharmaceuticals is clear according to the indications. Antibiotics are used in the first 5 days - they help relieve the acute inflammatory process. Then, if antibiotic therapy is necessary, they take into account the culture data of the purulent discharge, the sensitivity of bacteria to antibiotics, and what the patient’s temperature is after the operation. There are reviews that in some cases, a compaction forms in the area where the operation was performed, and copious discharge from the wound. In these situations, antibiotics are usually prescribed, and in the worst case, the surgeon takes up his work again. The use of sedatives and tonics, cardiovascular and antihypertensive drugs, antiseptics and uroseptics are strictly regulated by the patient’s condition.

Postoperative management of patients during fistula removal

Postoperative management of patients depends on the following factors:

type of surgery undergone;
how does the fistula tract relate to the sphincter fibers;
how developed is the cicatricial process in the anus and along the fistulous tract;
the presence of cavities with pus in the perirectal spaces with fiber;
type of fistula.

Management of patients after surgery for intrasphincteric fistulas

Regardless of the type of operation, patients are on bed rest for the first 24 hours, the first dressing is changed the next day and then every day. Stool retention agents are not prescribed. From the 3rd day they give 30 ml of Vaseline oil 2 times a day and on the 4th day they give a cleansing enema. After this, patients are transferred to a more extensive diet. Before dressing, patients take a general bath or an ascending bidet shower. The dressings are applied with a 10% NaCl solution for 3–4 days, and then with Vishnevsky ointment. Usually, by day 5–6, the wound in the area of the anal canal and perineum is covered with well-defined granulation tissue. On days 7–8, patients are discharged for outpatient follow-up treatment.

Management of patients after surgery for transphincteric fistulas

Dressings begin 24 hours after surgery to remove paraproctitis. You need to stay in bed for the first 24 hours, and for those who have undergone excision of the fistula, when suturing the bottom of the wound or doing partial suturing and draining the cavity with pus, another additional day. Drugs that delay defecation are not prescribed. The first stool is induced by a counter enema on the 4th day after the preliminary administration of Vaseline oil. Further management of this group of patients does not have any special features. Patients are usually discharged home after 10–12 days.

Fistula removal is a procedure performed surgically.

Management of patients after surgery for extrasphincteric fistulas

The nature of management in this case is related to the complexity of the fistula. After excision of the fistula, which accompanies suturing the stump in the perineal wound and dosed-type posterior sphincterotomy, the duration of bed rest is 6–7 days. At this stage, patients receive stool fixatives; from 6–7 days, patients should use vaseline oil 30 ml 2 times a day; if you have the urge to defecate, you need a cleansing enema. The act of defecation precedes the transfer to a general regimen and expansion of the patient’s diet.

Dressings begin 24 hours after the surgeon’s work, then every day. From day 3, tight tampons are not inserted into the intestine. Patients are discharged on days 20–22. The damage to the anus is completely healed by this time. When the fistula is excised with suturing of the sphincter, bed rest is observed for 5 or 6 days, during which time they give stool fixatives. After this period, Vaseline oil is prescribed and, if the urge to defecate appears, a cleansing enema is given. Stitches on wounds skin surface removed on day 8–9. Patients can be discharged 16–18 days after the surgeon's work. If the fistula has been excised and plastic movement of the mucous membrane of the distal rectum has been performed, then 6–7 days of bed rest is indicated. During this time, defecation is delayed with obstipation. On days 5-6, the use of petroleum jelly is indicated; if there is a urge to defecate, a cleansing enema is given. After the first bowel movement, postoperative management is typical. Every day, during dressings, the viability of the displaced mucosal flap is monitored. The length of hospital stay is 16–18 days.

After excision of the fistula with a ligature

In this case, bed rest is observed for 3 days; drugs that delay bowel movements are not prescribed. From day 4, Vaseline oil is prescribed and, if there is a urge to defecate, an enema is given for cleansing. When dressings, it is necessary to monitor the condition of the ligature passed through internal hole: as it loosens, it is pulled in such a way as to tightly cover the bridge of tissues underneath it. Usually, by 11–12 days, the tissue bridge under the ligature erupts on its own. By days 22–25, patients can be discharged for outpatient follow-up treatment.

At the first symptoms of paraproctitis, you should consult a doctor

Dressings for wounds of the anal canal and perineum

When treating wounds of the perineum and anus, it is necessary to take into account the stage of the wound process. During the hydration stage, dressings should be performed with a 10% NaCl solution. During the period of delimitation of inflammation, and especially with the onset of the appearance of young granulation tissue, for dressing use 5–10% emulsion ointment of propolis and interferon. This differentiated wound management technique should be especially observed for deep and extensive wounds that penetrate beyond the intestinal wall into the perirectal tissue. In other cases, it remains to use any antiseptic ointment.

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Symptoms of rectal fistula

Constant sharp pain in the anus. Redness and hardness in the anal area.
Discharge of pus from the anus.
Pain during bowel movements, discomfort when walking or coughing.
General weakness, fever.

Causes of rectal fistula

Proctological diseases (paraproctitis, hemorrhoids, anal fissure etc.)
Infectious processes (sepsis, infections, sore throat, etc.)
Wrong diet
Weight lifting
Mechanical injuries of the anal canal
Stool disorder (diarrhea, constipation)
Inflammatory diseases of the colon (ulcerative colitis, etc.)

Diagnosis of rectal fistula

Deltaclinic specialists carry out a thorough diagnosis of rectal fistula already at the initial appointment. A visit to our doctor will take you no more than 30 minutes, during which the doctor will analyze your complaints and, through a visual examination, determine the location and structure of the fistula. Further laboratory and instrumental examinations will be carried out using high-tech equipment from Deltaclinic. You may be assigned:

blood tests (general and sugar);
anoscopy, colonoscopy, sigmoidoscopy;
Ultrasound of the perianal area;
fistulography.

Based on this examination, the doctor will select the best treatment option for you.

Innovation! Treatment of rectal fistula with radio waves

Deltaclinic practices the most effective and safest methods existing in modern medicine. treatment of rectal fistula - radio wave surgery.

This method allows you to successfully treat all types of rectal fistula: complete, incomplete, internal fistulas, transphincteric, intrasphincteric and extrasphincteric.

Operation using radio waves has a number of advantages compared to traditional method treatment with a scalpel. It is gentle and low-traumatic, therefore:

Does not require hospitalization
Conducted under local anesthesia
Healing and rehabilitation happen very quickly
The recovery period after surgery is only 2 days (with classic surgical treatment, patients spend 2–3 weeks in the hospital). Therefore, we recommend that radio wave treatment of a fistula be carried out on weekends so that our patient can go to work on Monday.
After operation there is no pain
AND no scars remain
Unlike classical method surgical intervention, after which slow healing is accompanied constant pain, dysfunction of the sphincter and often the formation of a scar, when excision of a rectal fistula with a radio wave, recovery is quick, painless and without the formation of scars.
After removal of rectal fistula at Deltaclinic there are no relapses!

The specialists of our clinic accompany their patients after surgery until complete recovery, select the optimal rehabilitation therapy and inform about all time restrictions that will need to be observed for some time after the procedure.

Important! Rectal fistula folk remedies no cure! Self-medication only aggravates the patient's condition. Don’t waste precious time, turn to DeltaClinic specialists for help. Remember: any disease is best treated at an early stage!

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What happens to patients with paraproctitis immediately after surgery? What can you do and what can't you do? First of all, you need to follow all the instructions and recommendations of the doctor and nurse. The anesthesia wears off shortly after waking up. In area postoperative wound Possible pain and discomfort. If these sensations are strong, then various painkillers are prescribed.

Eating and drinking are allowed several hours after surgery. Food should be light and gentle. You should not eat gas-forming foods, fried, highly salty or sweet, or spicy.

After surgery for paraproctitis, a bandage is applied to the wound, which is removed the next day. This may cause discomfort.

The stool is usually restored after 2-3 days, otherwise a cleansing enema is prescribed. The length of stay in the hospital can vary from several days to a week or even more, it all depends on the complexity of the surgical operation performed, the condition of the sick person, and his well-being.

So, the main points in the case of acute process will be:

1. Every day the wound is bandaged using antiseptics (chlorhexidine, dioxidine, betadine, iodopirone, etc.) and antibacterial ointments (levomekol, fusimet), as well as methyluracil to accelerate tissue regeneration. Moreover, during each dressing, the doctor checks the correctness of healing, as if “opening” the wound so that regeneration occurs from the bottom. This event may cause discomfort, in which case painkillers will be prescribed.

2. Physiotherapeutic procedures(after consultation with a physiotherapist):

ultraviolet irradiation
ultra-high frequencies 40-70 W
microwaves 20-60 W

The most suitable procedure is selected, carried out in the hospital every day for 10 minutes, the total duration is from 5 days to 2 weeks, sometimes more.

These measures are carried out as a treatment for acute paraproctitis after surgery, both radical (single-stage) and after the first stage of a multi-stage intervention.

Chronic paraproctitis after surgery

Usually, surgical treatment for the chronic course of this disease is carried out as planned, so patients most often feel better in the postoperative period, complications are less common. Treatment after surgery is similar to those measures that are necessary in the case of acute paraproctitis:

Daily dressings with antiseptics and local antibacterial drugs.
The use of systemic antibiotics according to indications: if there is severe postoperative inflammation in the wound, after plastic surgery for a rectal fistula.
Use of laxatives and prescription of diet according to indications: also after plastic surgery. The diet is aimed at softening the stool: lactic acid products, dried fruits, limiting vegetables and raw fruits.

After discharge from the hospital, treatment of paraproctitis after surgery continues. Firstly, the sick person, alone or with an assistant, will need to continue bandaging. The doctor will show you the technique in the hospital before discharge. Sometimes, if it is impossible to perform dressings at home, you can go to the clinic to see a surgeon.

Wound care at home is not difficult: it does not require complete sterility. For dressing you need a bandage or gauze folded in several layers, an antiseptic (hydrogen peroxide, chlorhexidine - can be purchased at any pharmacy), and antibacterial ointments(Levomekol is usually found in every home). Gently clean the wound with an antiseptic solution using gauze, then dry and treat with ointment. There is no need to put a bandage or gauze in the wound itself, so as not to interfere with the outflow from it; a bandage should be applied on top of the wound.

Growing hair should be carefully trimmed or shaved. After bowel movements, you should do sitz baths or simply wash the surgical incision with antiseptics. If the discharge from the incision is very bothersome, you can use pads to protect your underwear.

Bloody discharge from a wound or rectum after surgery for paraproctitis is normal. If bleeding occurs, you should contact your doctor immediately.

Treatment of paraproctitis after surgery: non-healing wound

First of all, you need to understand that the postoperative period (that is, the period until complete healing) in the case of paraproctitis is at least 3 weeks. Sometimes, depending on the complexity and volume of the operation, this period may take longer. Dressings usually take 3-4 weeks. Even when doing dressings at home, you need to periodically undergo checks with a surgeon, preferably a proctologist.

If you are concerned that the wound is not healing during treatment after surgery for paraproctitis, you should definitely inform your doctor about this. Sometimes it happens that paraproctitis, especially chronic, with the presence of a fistula, cannot be cured. Then upon palpation it will be determined that there is an overgrowing fistula. In this case, repeated surgery is necessary, but usually not earlier than a year later. In some cases non-healing wound may be associated with bacterial complications. In such a situation, antibiotics are prescribed locally and systemically (in tablets or injections).

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