Anal fistula is a sequelae of peri-anorectal abscess, so peri-anorectal abscess is the root cause of anal fistula, or its pre-pathological changes. After the anorectal abscess spontaneously ruptured or incised, the reasons why it cannot heal and eventually form a fistula are: ①The primary internal ostium (anal sinus) continues to be infected, and the contaminants in the rectum continue to enter the infected lesion from the internal ostium, causing repeated infections. The root cause of the disease cannot be eliminated. ②The fistula usually passes between the anal sphincter. Due to the constant contraction and relaxation of the sphincter, it compresses the fistula, which affects the discharge of pus and tends to accumulate pus. ③There is a certain amount of pressure and gas in the rectum, which can often enter the fistula from the internal opening and discharge from the external opening. ④ The abscess is ruptured, the pus is drained, and the abscess cavity is gradually reduced, making the fistula wall fibrosis, hardening and bending and narrowing, so the drainage is not smooth and the healing cannot be achieved. ⑤Bacteria and dirt can also enter from the outer mouth, causing infection and inflammation, sometimes ulceration, and repeated attacks. Therefore, there is very little chance of anal fistula healing on its own. If treatment is delayed, frequent attacks can cause the disease to develop further and become multiple and complex anal fistulas.
One of the problems we should pay attention to in daily life is that diarrhea can easily cause anal fistula. This is because the anal crypt is a funnel-shaped organ with an upward opening. Usually, when the stool is discharged through the rectum and anal canal, the soft stool, especially containing The diarrhea-like feces with a lot of water can easily invade the anal crypts. Once the diarrhea-like stool is retained in the anal crypt, the bacteria in it will invade the anal duct and cause purulent inflammation. Especially when the body is weak, diarrhea is more dangerous.
Another issue that needs to be clarified is that the pathogen of anal fistula is mainly bacteria rather than tuberculosis, although there are also anal fistulas caused by tuberculosis. Before the Second World War, there was no specific medicine to eliminate tuberculosis. At that time, there were many tuberculosis patients. Intestinal tuberculosis caused inflammation of the anal crypts, which further evolved into anal fistulas, so many people thought that anal fistulas were tuberculosis. disease. In fact, not all anal fistulas are caused by tuberculosis bacteria. Today, when tuberculosis is no longer a terrible disease threatening human health, in 100 patients with anal fistulas, I am afraid that none of them carry tuberculosis. Therefore, anal fistula is a tuberculosis disease. The statement is wrong. Of course, in an era when tuberculosis cannot be treated, the proportion of patients suffering from tuberculosis anal fistula must be much higher than it is now, so it is not surprising that anal fistula was considered a tuberculosis disease at that time.
------Excerpt from "The Secret of Hemorrhoids" edited by Li Shenglong