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Anal Fistulas And Abscesses Removal In Singapore

Anal fistulas and abscesses are painful and can be challenging to treat. It is also known as a common complication of inflammatory bowel disease (IBD). It is a recurrent infection that causes discomfort and disability to the sufferer. Waiting too long can lead to more severe problems, like the spread of bacterial infection or the pus’s build-up causes the skin to swell. And unlike other diseases or illnesses, antibiotics are not very effective in treating abscesses.

If you have an abscess that needs treatment, it’s essential to see a specialist for anal abscess removal in Singapore right away.

Anal fistulas and abscesses

What Are Anal Fistulas And Abscesses

The inside of our anuses contains numerous glands that produce fluid. Sometimes, these glands get blocked or clogged, causing a build-up of bacteria. Over time, this can swell up and result in the tissue around the area becoming infected and filled with liquid. This is also known as an anal abscess. 

Generally, doctors recommend Singaporeans undergo an anal abscess removal in Singapore to prevent further complications and infections. If left untreated, the anal abscess can grow and eventually move towards the area near your anus, causing a collection of pus in the nearby tissue area and the formation of an anal fistula.

An anal fistula is a small tunnel that develops between the end of the rectum/anus and the skin near the anus.  Most of the time, an abscess will lead to a fistula forming. Anal fistulas can cause unpleasant symptoms, such as discomfort and skin irritation, and will not usually get better on their own. Surgery is recommended in almost all cases. Other less common causes of fistulas include Crohn’s disease, diverticular disease, TB and HIV. 

Prevention is better than cure, hence it is important to seek timely abscess removal in Singapore to reduce both infection and the risk of anal fistulas developing.

fistula classification

 

Symptoms And Signs Of An Anal Fistula Or Abscess

An anal abscess is common within active adults from 30 to 50 years old. It usually causes the skin condition to worsen, causing discomfort around the anus. Some of the common symptoms are:

• Skin irritation around the anus

• A constant, throbbing pain that may be worse when you move around

• Smelly discharge from near your anus

• Passing pus or blood when you pass motion.

• A “pimple” near the anus that does not go away.

• Swelling and redness around your anus and a high temperature (fever) if you also have an abscess

If you are worried or unsure of your current condition, do not hesitate to contact us to make an appointment and find out more about abscess removal in Singapore. Dr QM Leong is one of the experienced colorectal surgeons and has handled many cases of colorectal surgery, anal abscess and will be able to provide accurate diagnosis and proper treatment. 

Common Investigations For Anal Fistulas And Abscess

After a thorough history and physical examination which includes a rectal examination and proctoscopy, further tests such as a colonoscopy and MRI scan may be required.

The reason for the colonoscopy is to exclude TB, diverticular disease and Crohn’s disease. An MRI scan may be essential to evaluate the anatomy of the fistula tract. If the tract extends higher into the rectum and it involves the anal sphincter muscles, surgery can become more complicated.

How Is Anal Fistulas And Abscess Treated

Treatment of fistulas and abscesses is surgery as these conditions do not resolve with medication (antibiotics) or on their own. There are several options and the correct surgery depends mainly on the type of fistula (simple vs complicated and high vs low fistulas). 

Simple fistulas have a single opening internally and externally. Complicated fistulas may have multiple tracks with multiple openings (some involving muscle). Low fistulas have internal openings near the anus while high fistulas have internal openings deeper in the rectum, hence may involve sphincter muscle. 

The aim of surgery is to heal the fistula while avoiding damage to the sphincter muscles, which could potentially result in loss of bowel control (bowel incontinence). Almost all surgery is done under general anaesthesia.

Here are the main options:

Fistulotomy

The most common type of surgery for anal fistulas is a fistulotomy. This involves cutting along the whole length of the fistula to open it up so it heals as a flat scar.

A fistulotomy is the most effective treatment for many anal fistulas, it is usually only suitable for low simple fistulas that do not pass through much of the sphincter muscles, as the risk of incontinence is lowest. In cases where the risk of incontinence is considered too high, another procedure may be recommended instead.

Seton Techniques (Loose VS Cutting)

If your fistula passes through a significant portion of the anal sphincter muscle (high and complicated fistulas), the surgeon may initially recommend inserting a seton. A seton is a piece of surgical thread that’s left in the fistula for several weeks to keep it open. This allows it to drain and helps it heal, while avoiding the need to cut the sphincter muscles.

Loose setons allow fistulas to drain, but do not cure them. To cure a fistula, tighter setons may be used to cut through the fistula slowly. Hence the initial surgery may be to insert a loose seton to drain the infection, followed by a second surgery on a later date to convert the loose seton to a cutting seton.

Advancement Flap Procedure

An advancement flap procedure may be considered if your fistula passes through the anal sphincter muscles (high fistulas). This involves scraping out the fistula and covering the internal opening where it enters the bowel with a flap of tissue from the rectum. This has a lower success rate than a fistulotomy, but avoids the need to cut the anal sphincter muscles.

LIFT Procedure

The ligation of the intersphincteric fistula tract (LIFT) procedure is a treatment for fistulas that pass through the anal sphincter muscles, where a fistulotomy would be too risky.(High fistulas) During the treatment, a cut is made in the skin near the anus between the sphincter muscles and the sphincter muscles are moved apart. The fistula tract is identified and scraped out. The tract is then divided between two sutures and the initial cut is closed. This is a relatively new technique and has promising results.

Risks Of Anal Fistula Surgery

Like any type of treatment, treatment for anal fistulas carries a number of risks.

The main risks are:

• Infection – this may require a course of antibiotics

• Recurrence – the fistula can sometimes recur despite surgery

• Bowel Incontinence – this is a potential risk with most types of anal fistula treatment, although severe incontinence is rare and every effort will be made to prevent it.

Frequently Asked Questions About Abscess Removal In Singapore

The general cost breakdown for abscess removal in Singapore are as follows, for consultation, it will be $150 and for the procedure itself, it ranges from $2000 to $4300. Depending on your medical insurance coverage, the cost might differ as well. 

Anal abscess and fistula surgery can be performed as day surgery, however, in more complex cases, an overnight stay may be required.

The pain will subside once the pus has been drained, but you may still experience mild discomfort or pain within the anal area due to the incision for several days or weeks post-surgery.

Very small anal abscesses can sometimes resolve with antibiotics. Larger anal abscesses always require surgery to drain out the infection. Anal fistulas are the result of large anal abscesses that have become chronic and have an internal opening in the rectum and an external opening near the anus. All anal fistulas require surgery.

Most causes of anal abscesses are unknown. A theory called the cryptoglandular theory of perianal fistulas suggests their development from the anal glands, which originate from the intersphincteric plane and perforate the internal sphincter with their ducts. A connection forms between an opening at the level of the dentate line and another in the perianal area. There are some conditions that can predispose patients to have anal abscesses and complex fistulas. These include inflammatory bowel disease, tuberculosis, diabetes and HIV. Chronic complex fistulas have a higher risk of developing cancer.