Anal fistula (perirectal abscess)
What is the disease? It is an infection of the rectum and anus. What is the cause? Between the rectum and anus When the body's resistance is weakened and diarrhea occurs, diarrheal stool enters this small cavity, and the E. coli in the stool causes an infection in the glandular tissue called the anal gland that connects to this small cavity. Infection of the glandular tissue causes pus to spread to the rectum and anus, resulting in a perianal abscess (Figure 16). When the accumulated pus is drained by either naturally rupturing or being incised, a tube is formed that connects the rectum and anus, with the small depression on the dentate line as its entrance and the infected area of the anal gland as the source of the pus. In this way, once a pus tube is formed (i.e., anal fistula), it connects to the anus and, because there is an entrance for pus (the source of pus), it will not heal naturally. How symptoms manifest When perianal abscess occurs and pus accumulates, the temperature rises from 39°C to over 40°C in severe cases. If it breaks on the outside or inside the anus and an exit is made, pus will come out and symptoms such as swelling, pain, and fever will disappear. When an exit for pus is made, pus will be discharged from there and soil your underwear. Just when you think the exit has been closed and it has healed, pus will accumulate again, break, and come out again, and the cycle will repeat. Treatment methodsIn the case of perianal abscess, the pus is drained as soon as possible by incising the skin around the anus or the mucous membrane inside the rectum and anus, and the accumulated pus is drained out. After the incision is made and a sufficient exit for the pus is created, antibiotics and painkillers are administered. After that, the patient will be observed for a while in the outpatient clinic, and if a fistula forms, surgery will be performed (in rare cases, the abscess may disappear with antibiotics, resulting in a recovery). The surgical method is basically to cut open the pus tube and remove the entrance and source of the pus. However, this surgical method Therefore, depending on the type of fistula, we may perform sphincter-preserving surgery to remove the entrance and source of the fistula while leaving the sphincter intact as much as possible. What to do if you notice an illnessIf you have a perianal abscess, you should see a doctor as soon as possible and have it incised and drained. Do not endure it or try to make do with over-the-counter painkillers. This will cause the pus to spread, and the disease will progress and become more complicated. As a first aid measure until you can see a doctor, cool the anal area. Do not warm it up by bathing it. Warming the area will temporarily relieve pain, but it will cause the area to become infected later. Anal fistulas can only be cured by surgery, so surgery is the basic treatment. If you cannot see a doctor immediately or cannot be hospitalized for surgery, be careful not to have diarrhea. Diarrhea is the cause of anal fistulas and worsens the symptoms, so avoid alcohol, excessive drinking, and overeating. Washing the anal area with warm water and keeping it clean will also help relieve the symptoms caused by anal fistula, even if it does not cure the fistula. Junichi Iwadare "> Figure 16. Occurrence of perianal abscess (anal fistula) Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia |
どんな病気か 直腸、肛門部の感染症です。昔は 原因は何か 直腸と肛門の境の 体の抵抗力が弱っていて下痢をした場合などに、この小さなくぼみに下痢便が入り込むと、便のなかの大腸菌がこの小さなくぼみに連絡する肛門腺という腺組織に感染を引き起こします。その腺組織の感染が原因となって、うみが直腸・肛門周囲に広がっていき、肛門周囲膿瘍となります（図16）。 たまったうみが自然に破れるか切開されるかして排膿されると、結果として歯状線の小さなくぼみを入り口とし、肛門腺の感染部をうみの元とする、直腸・肛門と交通のある管が形成されます。 このように、一度うみの管ができあがると（つまり痔瘻になると）、それは肛門と交通し、なおかつうみの入り口（うみの元）があるために、自然には治りません。 症状の現れ方 肛門周囲膿瘍になってうみがたまると、39℃からひどい時は40℃以上の発熱となります。うみがたまった部分が 表に破けたり、肛門のなかに破けて出口ができればうみが出て、腫脹、痛み、発熱などの症状はなくなります。うみの出口ができると、そこから排膿して下着が汚れたりします。出口がふさがって治ったかと思っていると、またうみがたまって破け、うみが出るということを繰り返します。 治療の方法肛門周囲膿瘍では、一刻も早く切開して排膿します。肛門の周囲の皮膚、もしくは直腸肛門内の粘膜に切開を加え、たまったうみを外に出します。切開し、十分にうみの出口をつくったところで抗生剤、鎮痛薬を投与します。 その後、外来でしばらく経過を観察し、痔瘻を形成するようなら手術を行います（まれに抗生剤で膿瘍が消退し、治る場合もある）。 手術の方法は、基本的にはうみの管を切り開いてうみの入り口、うみの元を切除するというものです。しかし、この手術の仕方では そのため痔瘻のタイプによっては、括約筋をなるべく残しながら痔瘻のうみの入り口、うみの元を除去する括約筋温存手術を行います。 病気に気づいたらどうする肛門周囲膿瘍では一刻も早く医師を受診し、切開排膿を受けることです。我慢していたり、市販の鎮痛薬などでごまかしていてはいけません。うみを広げ、病気を進展させ複雑にしてしまいます。 医師を受診するまでの応急処置としては肛門部を冷やすことです。入浴したりして温めてはいけません。温めるのは一時的に痛みを緩和させますが、あとでかえって化膿を進める結果になります。 痔瘻は手術でなければ治らないので、基本的には手術になります。すぐに受診できなかったり手術のための入院ができない時は、下痢をしないように注意します。下痢は痔瘻の原因であり、症状を悪化させるので、アルコール、暴飲、暴食を避けます。 肛門部を温湯で洗い清潔にしておくことも、痔瘻を治さないまでも痔瘻により生じる症状の緩解に役立ちます。 岩垂 純一 "> 図16 肛門周囲膿瘍（痔瘻）の発生 出典 法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について 情報 |
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