Anorectal Diseases: Inflammation, Abscesses & Fistulae
By Markov • Jun 7th, 2009 • Category: Digestion & EliminationBefore getting into details on anorectal diseases, here’s an overview of a particular disease process. This process includes different disease names, all of which are caused by infection, inflammation and purulent discharge.
Western Medical Names (in Chinese): 肛隐窝炎 ——〉肛腺炎 ——〉肛周炎 ——〉肛门直肠周围脓肿 (tcm: 肛痈)——〉肛瘘 (tcm: 肛漏)
Western Medical Names (in English): Cryptitis ——〉Inflammation of Anal Sacs/Glands ——〉Perianal Inflammation ——〉Perianal Abscesses ——〉Anal Fistula
This progression is actually one infection following another, ultimately creating a fistula between the starting point of infection and the skin on the outside near the anal opening.
Anal Fistulae
Let’s start from the end point. We have a fistulae, a tunnel with one opening on the outside of the body near the anus, the other opening at the crypts (肛隐窝) on the pectinate line (齿状线) aka mucocutaneous junction.
The formation of anal fisulae (肛瘘) has to do with abscesses froming in the perianal area which, having nowhere to discharge, start creating their own discharge channel.
Perianal Abscesses:
These abscesses (痈肿) often occur in tissue spaces (间隙) surrounding the rectum and anal canal. These bacterial infections are often quick-acting and terribly painful. If the location of the abscess is deep and enters our blood circulation in a big way, there will be fever and other whole-body effects. Deep abscesses may also not show the usual signs of rubor, tumor, calor and dolor but that’s just because it is showing at the surface.
But, it can be slow acting too, especialy when layered with TB or Crohn’s Disease, the former being a slow-acting disease, the latter due to a compromised immune system.
Often, the patient comes in with high fever. Check for high WBC level and yes. Antibiotics are prescribed, but if they do not work, then we can suspect that a factory of festering bad guys is present somewhere in the body. Ask if the patient has any bowel related issues, and if he say that he has a drooping and bloated feeling in his anorectal area, then we have it. Do a DRE and try to feel for it. An MRI (磁共振) would help too.
Treatment with antibiotics is recommended for the usual bacteria incursions, with anti-TB medicines for TB. “Incise and drain” is an option if it is close to the surface. Otherwise, we still have surgery.
Anal Cryptitis (肛隐窝炎):
Inside of these recesses that line the pectinate line (齿状线) are mucus glands that secrete stuff to lubricate the anal canal. Theory says that infection of these recesses is the main cause of cryptitis. If a crypt is chronically infected, and especially if the infection is not able to escape these “pits,” it is highly likely that they lead to perianal abscesses.
Treatment using Chinese Medicine is possible here, especially if the symptoms are not yet whole-body symptoms like fever. The mistake is to ignore the signs and to wait until their appearance tells us that surgery is necessary. If no pus has been formed yet, we can use chinese medicine to disperse (消散) the pathogenic source. Use 止痛如神汤 for the pain (which we know is excruciating) and 凉血地黄汤 for any bleeding. Using 苦参汤 as warm wash (熏洗) or bath (坐浴) is also helpful.
If pus has already formed, or we can feel enlarge papillae (乳头肥大) or know that there is hidden fistula (瘘管) then surgery is necessary.
Summary:
Cryptitis causes perianorectal abscesses which causes anal fistulae. We can try to stem the infection/inflammation using traditional methods, but are lucky to have antibiotics and surgery as medical options these days.
Popularity: 28% [?]
[...] Read this article on anorectal inflammations, abscesses and fissures. [...]
I am a chinese from Malaysia who have anal fistula problem. The western medication would prescribe countless surgeries for this kind of ailment. I read about a certain Xian Han Shen Zai Hemorrhoid and Fistula hospital in Xian China. Do you know if a foreigner like me can go there to seek treatment. Any pointers where to find TCM for anal fistula around Malaysia or Singapore would be most helpful too. Thanks in advance.
Chinese herbal treatment can reaonably do the following:
analgesic
anti-inflammatory
astringent, dehydrant
anti-microbial
help with healing of wound and growth of flesh
Look at this article for more information, but the gist is that Chinese herbal treatments can help in treating external hemorrhoids, but with internal hemorrhoids, possibilities for treatment depend on the degree of prolapse. Varices can be dried off (and that is likely to be the treatment principle used at the Xian hospital you mentioned), but even if treated, how do with treat the prolapse using Chinese herbs? Here in Nanjing, surgery is the preferred option.
About your anal fistula (肛门瘘道), it is slightly more complicated. The problem is the formation of one or more tunnels aka fistulae that will present with inflammation whenever the root of inflammation – usually chronic infection of one or more crypts. Now, we can try to get rid of the root of infection, and this is possible with Chinese herbs. Treatment with herbal medication is easier if the place of infection is reachable for local placement of suppositories e.g. a crypt that causes superficial perianal abscess. Treatment is not so easy but also possible if it is deep abscesses we are talking about – oral antibiotics or intravenous medication is more suitable here.
Now, if the place that was once infected is kept clear of infection, then you can call that a cure. But is this cure permanent? The issue here is that a fistula/tunnel once formed will remain. And openings in the body like a fistula are prone to infection. This is why a more permanent form of treatment will include taking out the fistula too. This is probably why hospitals you’ve been to have recommended the surgical option.
I am not able to recommend places for treatment, but above you have information that you as an educated patient can use to make decisions regarding what treatment method to use.