Ask the doc...
Dr. Uma Krishnaswamy, Consultant General Surgeon, Apollo Hospitals, Chennai, replies to this week’s queries.
I am 55 and have no ailments like diabetes or BP. A small abscess developed near the anus in September 2006 but subsided after taking metrogyl and cifron. There was a discharge of pus for a few days from both anus and the abscess. Again an abscess fo
rmed during the third week of January with a little discharge for four days. It subsided within a week with the same medication. I have clean bowel movement. Why is this recurring? What are the precautions to be taken? Satyam
Answer: You may have, in all probability, developed a fistula in ano. This is a connection between the lower rectum and anus to the skin around the anal region and is a common complication of abscesses in that area.
It is not a preventable problem and bowel movement does not influence its occurrence. When abscesses form in the anal region, a culture swab is taken to determine whether a fistula is a possibility. This allows the doctor to warn the patient that a fistula may form in the future.
Please note that there are no precautions to be taken except to keep the area washed and clean with plain tap water. Avoid repeated antibiotic use, as these cannot sterilise the infection. Fistulas do not heal on their own and there is no medication to heal them.
Your problem definitely needs to be seen by a surgeon to determine whether you have a fistula in ano or not. Please note that rarely recurrent abscess formation may occur from other causes too. Your surgeon will be able to determine this after examining you.
Once the examination is complete, your surgeon will indicate the nature of treatment, with reference to surgery. Most fistula in ano surgery is uncomplicated and easy to perform with good results.
I am 25 and suffer from irritable bowel syndrome. Is it possible to recover fully from this or can we just hold it at bay by taking precautions? Name withheld
Answer: Irritable bowel syndrome may be temporary and short-lived or long-standing. There is no way to predict which category you may fall under. The symptoms may vary in intensity causing mild, moderate or major inconvenience to you.
The symptoms can be kept in check with a number of precautions. These include a high fibre diet with plenty of vegetables and fruits. Avoid spicy food, excess coffee, tea, cola etc. Drink plenty of water.
Study your symptoms and check whether you have any specific foods that trigger or worsen your symptoms. Your doctor may prescribe simple medication to contain your symptoms
Individuals whose symptoms are triggered by stress may find stress reduction techniques useful. Irritable bowel syndrome does not cause any medical complications.
On the advice of my family physician, I took C.T. Scan Fistulogram. The study reveals “a low level fistulous tract communicating with the anal canal below the level of levator ani. There are no side branches/pooling of contrast. There is no evi
dence of any perianal or ischiorectal abscess. Rectum and anal canal otherwise appear normal”. Does this require surgical treatment? Does Fistula contribute to chronic constipation? I am 71 with normal B.P. and Blood Sugar levels. Kri
shnaswami
Answer: Fistula in ano definitely requires surgery and does not influence bowel movement.
As you seem to have a low and uncomplicated fistula in ano and you are apparently in good health, please ask your family physician to refer you to a surgeon. Fistula surgery is relatively minor and is usually very successful.
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