Chronic paraproctitis (fistula of the rectum) is a chronic inflammatory process in the anal crypt, intersphincter space and pararectal tissue with the formation of a fistulous tract. The affected crypt is with all this the internal opening of the fistula. Also, fistulas of the rectum can be post-traumatic, postoperative (for example, after anterior resection of the rectum).
The vast majority of patients with rectal fistulas associate the onset of the disease with acute paraproctitis. Approximately 30% of patients with acute paraproctitis go to the doctor after a spontaneous opening of the abscess, as a result of which they often form a fistula of the rectum, another 30% of patients do not seek medical help at all until they have a fistula as a result of acute paraproctitis. Only the remaining 30% of patients with acute paraproctitis consult a doctor in a timely manner, but not all of them, for various reasons, undergo radical surgery.
Usually, the sick person is concerned about the presence of a fistulous opening (wound) on the skin in the anus, discharge of pus, ichor, because of which he is forced to wear a pad, do perineal washings or sitz baths 1-2 times every day. Sometimes the discharge is profuse, causing skin irritation, itching.
Diagnosis of chronic paraproctitis is not so difficult. Usually, patients themselves go to the doctor with complaints about the presence of a fistula in the perineum or purulent discharge from the anus. On external examination, if it is a complete fistula of the rectum, you can see the external opening. With an incomplete internal fistula, there is only an internal opening, there is no external opening on the skin.
The only radical method of treating rectal fistulas is surgical, i.e. the presence of a fistula is a direct indication for surgery. Of course, there are contraindications to radical surgery, mainly these are serious diseases of various organs and systems in the stage of decompensation. If it is possible to achieve an improvement in the condition after conservative treatment, then the operation becomes probable.