Paraproctitis - symptoms and treatment, surgery, fistula and prognosis. Paraproctitis after surgery Before and after paraproctitis surgery

It is possible to remove pus and close the fistula canals in the rectum only through surgery. Surgery for paraproctitis is performed with a laser, scalpel or collagen thread, depending on the location of the abscess and the acute or chronic course of the disease. A coloproctologist performs the manipulation. When performing an intervention during an acute inflammatory process, relapses are possible in the future.

Indications for surgery for paraproctitis

When inflammation begins in the tissue that surrounds the rectum, the patient is diagnosed with paraproctitis. The disease requires surgical treatment, since the accumulation of pus in the wound leads to the formation of fistula tracts, which in turn are followed by exudate leaking into the cavity and entering the blood. The purpose of the operation is to cleanse the mucous membranes of pus and remove tissues that have become inflamed. Interventions are carried out for the following types of paraproctitis:

spicy;
subacute;
chronic.

Acute paraproctitis requires urgent surgery, as it can be life-threatening for the patient. In case of subacute and chronic development of the disease, planned surgical intervention is recommended. After excision of the fistula during the peak of the inflammatory process, relapses are possible. The disease itself is divided into the following subtypes:

The types of disease depend on the location of the purulent foci.

Subcutaneous paraproctitis - located under the dermis in the anus.
Submucosal - the fistula is located next to the rectum, under the membrane of mucous tissue.
Ischiorectal - inflamed at the ischium.
Doctors remove pelvic-rectal or pelviorectal paraproctitis in the pelvic cavity.
Retrorectal can be found on the back side of the rectum.

What happens if you don't intervene?

The accumulation of pus in the rectum is fraught with the following consequences:

The exudate can go inside and spread through the surrounding tissues or get into other organs with the blood, which will lead to the growth of inflammation or the emergence of new ones.
The pus is sometimes contained in a capsule and frequent relapses of the disease occur.
The abscess comes out on its own, but the path along which it passed is not completely cleared. Infection constantly enters the wound, as a result of which the tissue is constantly re-inflamed.

Independent and complete release of nektrotic masses is possible, while the lesion heals and no longer bothers you. This outcome is possible only in 10% of patients, so to avoid unpleasant consequences, doctors recommend surgery. Timely intervention will protect against the development of:

If the patient is not operated on in a timely manner, sepsis may develop.

phlegmon;
thrombophlebitis;
thrombosis;
peritonitis;
sepsis;
melting of the walls of the rectum and bladder;
chronic paraproctitis.

What types are there?

Often interventions are carried out in 2 stages, depending on the amount of pus and the course of the disease. First, the wound is cleaned and the patient’s condition is alleviated, then the damaged mucous membranes are cut out and closed. Treatment of paraproctitis in children is the same as in adults. The patient may undergo the following procedures to remove damaged tissue:

Plastic surgery:
radical excision of the tract;
dissection of the fistula;
sphincterotomy or ligature method;
obliteration or laser coagulation;
sclerosis;
filling the wound with collagen threads.

It is impossible to treat paraproctitis only with conservative methods. After successful surgical treatment, up to 90% of patients manage to get rid of the disease forever.

Preparation

Before surgery, the patient undergoes anoscopy.

During preparation for surgery, the patient undergoes examinations to determine the exact location of pus in the rectum, as well as his health status - whether he can clean and remove the affected tissue. To do this you need to do:

probing the fistula;
anascopic examination;
sigmoidoscopy;
fistulography;
dye test;
Ultrasound with a rectal sensor;
take blood, urine and stool tests;
cardiogram;
consult an anesthesiologist.

Stages of the operation

Anesthesia for paraproctitis can be general or epidural - the patient remains conscious, but anesthesia makes the lower half of the body insensitive. The intervention lasts from 40 minutes to 2 hours. Depending on what operating technique will be used, the intervention is carried out in one stage or divided into two. If we are not talking about acute paraproctitis, doctors begin to prepare for the operation 1-2 weeks before it - the patient begins to take the necessary medications.

Laser therapy can be used for simple forms of the disease.

During the first stage of the operation, the fistula is opened and cleaned with an antiseptic, and a drain is installed to drain the remaining pus. Next, it is necessary to excise the tissue in which exudate previously accumulated and sutured the cavity. The most difficult options for surgery are considered to be for retrorectal, pelviorectal and ischiorectal paraproctitis. These are places that are difficult for doctors to access; incisions and opening of abscesses in this area are made from the inside of the rectal tract, with possible partial dissection of the sphincter ring. The easiest interventions are operations for subcutaneous and submucosal paraproctitis. For simple linear forms, laser treatment is performed. In the chronic form of the disease, when there are contraindications to surgery, sclerosis of the fistula tract is performed with iodine.

Paraproctitis is an inflammatory process in the rectal area. This disease is as common as hemorrhoids, colitis and others. Regardless of the severity and course of the disease, the patient requires a paraproctitis operation that is suitable for the patient.

This disease develops due to the appearance of infection in the mucous membrane of the rectum. According to statistics, more men suffer from paraproctitis than women.

Signs of the disease depend on the source of inflammation, its location and size. In addition, the symptoms for acute and chronic paraproctitis differ slightly. The acute course of the disease is characterized by pronounced aggressive signs, which decrease over time and the patient feels much better. After some time, the symptoms of the disease appear again.

With chronic paraproctitis, the signs of the disease appear less pronounced, and relief lasts for a longer period of time.

The main symptoms of paraproctitis:

general weakness and malaise;
the occurrence of pain in the sphincter and perineum, intensifying after bowel movement;
development of a fistula in the chronic course of the disease;
elevated temperature;
the appearance of headaches;
regular constipation;
urinary disturbance.

Detection of any signs of disease is a serious reason to consult a doctor. A qualified specialist must conduct an examination and prescribe treatment, preferably in the form of surgery. The type of operation depends on the course of the disease, the size and location of the abscess. Delay is fraught with the development of complications. If left untreated, tissue necrosis and fistula formation occur.

The cause of the development of the inflammatory process is often the penetration of infections into the rectal area. The main causative agents of the disease are Escherichia coli, staphylococcus or enterococcus, which quickly spread throughout the intestines and penetrate the folds of the anus.

Timely treatment of paraproctitis can guarantee complete relief from this disease. At an early stage of disease development, therapy without surgery is possible.

Another cause of the disease is transmission of infection through blood. Microtraumas and fissures in the anus also contribute to the development of the disease.

Often the development of paraproctitis is preceded by diseases such as hemorrhoids and chronic constipation.

Excessive alcohol consumption, weakened immunity and diabetes mellitus also contribute to the onset of the disease.

To confirm the diagnosis of “acute paraproctitis”, a comprehensive examination is carried out, after which the patient is admitted to a hospital, where he is prescribed the only possible treatment for removing ulcers and fistulas - surgery.

There are several types of operations for acute paraproctitis, which are selected based on the patient’s condition. They can be single-stage or multi-stage. Due to the fact that the muscles should be as relaxed as possible, all types of surgery are performed under general or epidural anesthesia.

Options for simultaneous surgical intervention in the acute stage of the disease:

Opening the abscess with subsequent drainage and excision of the sinus and purulent tract. This method is effective in cases of damage to the subcutaneous layer or in the case of localization of the passage inside the sphincter.
In case of intersphincteric pathology, the abscess is opened, drained and the anal sinus is excised.
For trans- and extrasphincteric paraproctitis, the abscess is cut to cleanse it of purulent masses and the crypt is excised.

Single-stage operations require highly qualified surgeons and are performed in rare cases. To carry out this kind of intervention, it is necessary to know the exact location of the abscess, the purulent course and other factors.

Contraindications for this type of surgery:

severe weakness of the body;
old age of the patient;
susceptibility of tissues to severe inflammation in the area of the operation;
the location of the affected anal sinus is not determined.

Multi-stage interventions occur in several stages. At the first stage, the abscess is opened and purulent masses are removed. After the tissue has healed over a period of about one week, the second stage is carried out, during which the affected anal sinus and glands are removed.

The difference between these operations is only the need for healing with the second method of intervention; otherwise, all measures for removing an abscess are identical.

In parallel, therapy is carried out with conservative methods of treatment in the form of injections, tablets and topical medications.

Untreated acute paraproctitis takes on a chronic form of the disease with the presence of a fistula in the soft tissues, which requires surgical treatment.

Surgery for chronic paraproctitis can be planned or emergency.

Planned treatment is most effective and shows more favorable results. In this case, preparation for surgery is required using anti-inflammatory and antibacterial drugs.

Removal of the fistula tract is the main goal of surgery, the implementation of which depends directly on the location of the fistula. It is possible to determine the exact location of fistulas using dyes or radiography.

For chronic paraproctitis, the following measures are taken:

excision or dissection of the fistula;
sphincter suturing;
ligature method;
using sealing tampons;
fistula obliteration with laser.

The choice of method directly depends on the location of the fistula and other factors influencing the course of the operation.

To speed up relief after surgery and achieve a quick recovery, the patient must follow some rules.

First of all, this is following the prescribed diet with the exception of fatty and spicy foods. The patient's diet should include fermented milk products, boiled meat and fish, and dairy-free porridge. Drinking regime is very important. You should drink at least 1.5 liters of clean water every day.
During the treatment period, alcohol and smoking are completely prohibited.
It is very important to follow the doctor’s recommendations and take medications in a timely manner, use rectal suppositories, use antibacterial ointments and regularly take baths with the addition of medicinal herbs.

If recovery results are good, the patient spends several days in the hospital. However, you should continue to do daily dressing changes at home.

If it is impossible to perform the dressing yourself, this procedure is carried out in the clinic until complete healing.

Refusal to timely remove paraproctitis or self-medication is fraught with many serious complications, such as:

increased inflammatory process and development of phlegmon;
acute peritonitis due to infection in the abdominal cavity;
sepsis;
development of chronic paraproctitis;
purulent lesion of the pelvic organs or purulent paraproctitis.

It is especially dangerous if purulent masses enter the pelvic organs, since if untimely medical care is not given, this can cause death.

Each person must take care of his own health. When the first signs of paraproctitis appear, you should contact a surgeon or proctologist and do not refuse surgical intervention. Timely surgery can save lives.

Operations for acute paraproctitis

Operations for acute and chronic paraproctitis are somewhat different. As a rule, surgery for acute proctitis is necessary based on vital signs and is carried out without preparation in two stages:

cleansing the purulent cavity;
excision of the passage from the cavity to the rectum.

The simplest way is to cleanse the crypts (a crypt is a depression on the surface of an organ) filled with pus in the subcutaneous or submucosal layer. During visual and rectoscopic examination, they are visible - around the anus you can see an abscess visible through the skin or feel a fluctuation.

With the high professionalism of the surgeon-paraproctologist, both stages are carried out on the same day. If the doctor is not confident in his abilities, then both stages are carried out with an interval of 1-2 weeks. During this time, the crypt is completely cleared and begins to heal, but the exit hole can still be detected.

If the operation for resection of the tract is not performed professionally enough immediately after opening the abscess, there is a high probability of recurrence of the pathology.

Description of the stages of the operation

The stage of opening and releasing pus from the abscess in the rectum is performed using epidural or local anesthesia, since surgical intervention requires the most relaxed anal sphincter. For subcutaneous paraproctitis, the surgeon makes an external semicircular incision around the anus in the place where the cavity is palpated or visualized. The doctor dissects all the bridges that divide the crypt cavity, cleans and rinses it with a disinfectant solution and drains it to release the exudate.
The second stage is the detection and resection of the duct that connects the pouch and the rectal cavity. Using a probe inserted into the crypt cavity, a duct and its exit into the intestine are detected. Then the passage is excised. No stitches are required. When the abscess is localized in the submucosal layer, access to it is made from the rectal cavity. The doctor inserts a rectal speculum into the intestine and finds a protrusion that forms a purulent cavity. A needle is inserted into it, and if pus appears during puncture, the abscess is opened, cleaned, and drainage is removed through the anus.

The most difficult type of surgical intervention is surgery for pus in the crypt, localized in the following area:

ischiorectal;
retrorectal;
pelvic-rectal.

Precise localization of the abscess is difficult, since the crypts are located in the deep layers of tissue. They are detected during instrumental examination - using CT or MRI. The abscess is then opened using a percutaneous or intraintestinal approach. If the abscess is localized in the space outside the sphincter, then the approach to the cavity and resection of the canal is performed percutaneously.

If the inflamed crypt is located deep in the tissue behind the anal sphincter, then access is made from inside the rectum. In this case, partial dissection of the sphincter ring can be performed. The move is removed using a ligature.

With this method, a ligature thread is inserted into the fistula tract, the ends are brought out from the sphincter and from its outer side, and the thread is tied into a ring. The thread is tightened daily, gradually cutting the sphincter.

This method avoids the risk of relapse of the pathological process as a result of insufficiency of the fistula tract and incompetence of the anal sphincter. It is believed that in the intervals between tightening the ligature, the wound gradually scars and when the thread completely cuts through the anal sphincter, a thin scar is formed that does not affect the obturator function.

Operations for chronic paraproctitis

Chronic paraproctitis usually occurs as a result of self-resolution - spontaneous opening of an abscess, as well as as a result of an unsuccessful operation. There is a possibility that even after a successful surgical intervention, a relapse of the disease may occur.

Surgery for chronic paraproctitis is complicated by the fact that the fistula tracts may not be single and tortuous. The fistula tract may have 2 openings opening at both ends of the canal, or one. In order to determine the location of the tract, a dye is injected into the wound, and, if necessary, X-rays are taken with a radiopaque substance.

After establishing the location, quantity and type of the fistula tract, it is eliminated using the following methods:

dissection;
excision;
using ligation;
laser ablation;
filling with collagen thread.

In the first two cases, the operation is performed from the rectum itself with suturing of the wound, partial or complete. If the passages are located deeper, they are dissected using the ligature method or resection along the course with incomplete dissection of the sphincter.

If the fistula was opened into the intestinal cavity, then after its removal, plastic surgery is performed, covering the wound surface with a flap of mucous tissue or sealing the wound with collagen glue and applying a stapler suture.

Latest Treatment Methods

A method of clipping the internal fistula opening using a special clip with shape memory, which tightens the edges of the opening, is under research. The “clipOTIS” method in an effectiveness study allowed to completely cure 90% of patients with chronic paraproctitis.

If the tract is uncomplicated, then the operation can be performed using laser ablation, introducing a light guide into the fistula tract and “sealing” it using laser radiation. When conducting clinical studies on the effectiveness of laser ablation of the fistula, successful surgery was performed in 72% of cases, and when the fistula was closed with a flap, this percentage increased to 89%.

Filling the tract cavity with collagen thread is carried out if the tract is straight and uncomplicated. The xenograft is produced from freeze-dried pig intestinal tissue. The graft is replaced by the patient's own tissues 3 months after insertion into the canal. This method is called "Fistula plug" and has been used successfully for about 20 years.

The advantage of minimally invasive methods and percutaneous access is the preservation of the integrity and functions of the anal sphincter and a shorter rehabilitation period.

The result of the operation depends not only on the professionalism of the surgeon, but also on the postoperative period.

Therapy during rehabilitation

The main methods of therapeutic intervention during the patient’s rehabilitation period consist of drug treatment. To prevent infection of the wound surface and prevent relapse of the disease, antibiotic therapy is administered under the supervision of the attending physician.

During the postoperative period, the patient experiences severe pain caused by treatment and dressing. Therefore, the patient is prescribed analgesics.

After the intervention, the patient remains in the hospital for several days. During this period, defecation is not recommended to avoid introducing infection into the wound. To do this, the patient is kept on a slag-free diet with food that is quickly and completely digested.

A few days later the patient is given an enema. If healing occurs without complications, the patient is discharged home, where he independently continues to treat and dress the wound. The actions consist of washing the wound with disinfectant solutions, treating with hydrogen peroxide and applying a sterile napkin with regenerating ointment.

Treatment of paraproctitis after surgery consists mainly of preventing infection, which is achieved by maintaining hygiene of the urogenital area and preventing violations of the act of defecation.

Both constipation and diarrhea are dangerous for the patient's condition. Therefore, it is very important to follow a diet with sufficient intake of fermented milk products to normalize microflora and accelerate metabolic processes, baked apples rich in pectin, and a large amount (about 5 liters) of liquid.

To speed up healing, take sitz baths with a decoction of medicinal plants. It takes a long time to treat purulent wounds. Sometimes it takes more than a month from surgery to complete healing.

For simple superficial operations, the rehabilitation period is 1.5-2 weeks. Due to the secretion of ichor and possible insufficiency of the anal sphincter, the patient has to use diapers or pads for some time. If the operation is successful, the discharged fluid becomes less and less over time, and at the end of the rehabilitation period the flow stops.

If a patient is diagnosed with paraproctitis, surgery is inevitable. Surgery is the only effective treatment that eliminates unpleasant symptoms and contributes to the patient’s further recovery. In order for the recovery period after surgery to pass without complications, it is necessary to follow the doctor’s recommendations, follow the rules of personal hygiene and diet.

Collapse

Paraproctitis is considered a fairly common disease along with hemorrhoids and the formation of anal fissures. The disease develops due to an inflammatory process, which subsequently develops into a purulent abscess. The inflammation itself can be triggered by the penetration of infection into the intestines. Inflammation of the mucous membrane occurs due to the penetration of pathogenic microorganisms. Favorable conditions for this are created by the lack of proper treatment and hygiene. Inflammation can begin through neighboring organs that are affected by the inflammatory process.

Pain in the perineum

The main symptoms of the disease include:

increased body temperature;
chills, cold sweat and body tremors;
rapid onset of fatigue during daily activities;
general malaise and constant weakness;
pain in the perineum and anus, which intensifies after bowel movements;
With a subcutaneous abscess, blood and lymph accumulate. Touching the skin provokes painful sensations.

If the patient has the listed signs, there is every reason to believe that a purulent inflammatory process is developing in the anus. In the chronic course of the disease, it can develop.

There are some features of the operation for paraproctitis. The doctor chooses the specific method of surgical intervention based on the patient’s condition and the stage of the disease.

The operation is performed to identify the abscess, open it and eliminate the purulent mass, excision of infected depressions in the anal canal and purulent tubules. Removing an abscess is possible in several ways, but each of them involves opening the abscess and removing the purulent masses. Afterwards, for each specific case, additional manipulations are carried out aimed at preventing the spread of infection from the colon mucosa.

Carrying out the operation

After surgery, proper rehabilitation measures are an important condition for the patient’s recovery. The doctor should explain the importance of diet and moderate exercise to eliminate swelling and congestion. However, complete recovery and restoration of all functions can only be guaranteed if seeking medical help was timely. If treatment for the disease was started when it was already in an advanced state, there is a high probability that from an acute state, even after surgery, the disease will become chronic. The intensity of the symptoms will decrease, but some discomfort will still remain.

After surgery, the treatment of paraproctitis does not end; on the contrary, the rehabilitation period is of the same importance as surgical intervention.

When the anesthesia wears off, the patient feels pain in the area of the removed abscess with purulent masses. To reduce these sensations, painkillers and antispasmodics are prescribed. If the patient’s body temperature rises and their health deteriorates, doctors examine the suture and wounds for possible discharge, pus and inflammation. Local treatment is used with disinfectants, and antibacterial drugs are administered intramuscularly. Oral antibiotic tablets are also an option, but they may take longer to work.

After surgery, constant medical examination is required

The table shows the basic daily activities necessary for recovery.

Dressings	Daily dressings and treatment of sutures with antiseptic agents. During dressing, doctors assess the degree of wound healing and check for signs of inflammation.
The use of antibacterial ointments	After treating the seams with chlorhexidine, the wound should be lubricated with an antibacterial ointment, for example Levomekol. This ointment draws out pus and disinfects the wound. If the wound is not inflamed, treatment is carried out as a prophylaxis and to prevent suppuration. The use of antibacterial ointments helps prevent bacterial complications after surgery.
Application of regenerating agents	To speed up the healing and regeneration of damaged tissues, special ointments are used. Methyluracil ointment is well suited for these purposes. With faster healing of the sutures, the patient gets rid of the discomfort associated with the formation of crusts. Such ointments also prevent the formation of rough scars.
Medical examination of stitches	At a daily appointment, the doctor carefully examines the wound in order to promptly detect the first signs of inflammation and eliminate them. A medical examination is extremely important for the normal healing of postoperative sutures. At the appointment, the patient can inform the doctor about changes in his health and complain of severe pain in the anal area. Painkillers are prescribed to relieve pain.
Magnetic therapy and UV irradiation therapy	On the second or third day after surgery, provided that you feel well and the wounds are healing, a course of physiotherapy is prescribed. It is aimed at preventing the re-development of the inflammatory process, as well as accelerating the healing and tightening of wounds.

After the operation, the patient eats broths and mainly liquid foods to prevent the formation of excessively hard stool. The patient is also prescribed a course of mild laxatives and dietary nutrition to loosen the stool. Easy bowel movements will help avoid injury to tissues that have not yet healed.

After the patient is discharged from the hospital, it is necessary to continue dressing procedures at home. To do this, you will need the help of someone from your family. Until the sutures are completely healed, the patient is periodically examined by a doctor, and he must also attend the prescribed physiotherapy procedures.

Caring for and keeping a wound clean at home is not too difficult. As long as you use antiseptics and clean dressings, anyone can handle it.

Necessary materials for the dressing procedure

To bandage a patient at home you will need:

sterile bandage;
gauze;
liquid antiseptic;
antibacterial ointment;
gaskets

Constant dressing required

To clean the stitches and wounds, use a bandage folded in several layers. It is moistened with an antiseptic and the damaged tissue is wiped. It is not recommended to use cotton wool for these purposes, as its particles can remain on the wound and cause suppuration. After cleaning the wound with another piece of bandage or gauze, gently dry it with a blotting motion. When the seams are completely dry, a thin layer of antibacterial ointment is applied to them. A bandage is applied over the wound. Do not apply a bandage or gauze directly to the wound so as not to impede the outflow of fluid. To protect your underwear and not stain your clothes, you can use sanitary pads.

Patient hygiene

A slight inconvenience can be caused by hair growing over time. They can interfere with the treatment, so they must be regularly cut off or carefully shaved. Depilatory creams should not be used during this period, as they contain chemical additives that can irritate the mucous membranes and affected tissues.

After each act of defecation, the patient must clean the anus and surrounding tissues using antiseptic agents. The ideal option for cleansing and disinfecting the anus is sitz baths with soothing and disinfecting herbal infusions.

Sitz baths

After the operation, the presence of discharge from the wound or rectum with minor traces of blood is considered normal. If the bleeding is more severe and intense, you should immediately consult a doctor to prevent further complications.

It is important for the patient to understand that diet is an important component of the complex treatment of paraproctitis. During the rehabilitation period after surgery, dishes that are excessively seasoned with salt and pepper are excluded from the patient’s diet. Avoid highly acidic foods and fresh fruits. At first, the patient is allowed only baked apples in moderate quantities.

Porridge is good for the gastrointestinal tract

For a while, you should also forget about alcoholic drinks, sweet soda and unhealthy foods such as processed foods, chips, crackers and various sweets. To maximize the digestion process, you should consume more liquid food, follow a drinking regime, and include cereals and dishes rich in dietary fiber in your diet. By the way, drinking enough plain, clean water plays a big role in softening stool and eliminating problems with stool.

Predictions after surgery

Among the complaints of patients during the rehabilitation period, many noted the appearance of compactions and discharge from the sutures. These phenomena were accompanied by pain and discomfort. The appearance of even one of the listed unpleasant symptoms is a reason to contact a specialist. Often, to normalize the patient’s condition, conservative treatment methods, antibiotics and diet are prescribed. If these methods do not contribute to positive changes, the patient is referred for reoperation.

Another complaint of patients who have undergone surgery is the lack of tangible effect and positive changes in their well-being. In this case, you may need to repeat the operation, but not earlier than after 12 months.

The patient should remember that the operation is only half of the measures necessary for his recovery. In order for the rehabilitation period to end with the complete restoration of all body functions, you should follow medical recommendations, attend physical therapy and follow a diet.

Paraproctitis is a purulent inflammatory disease of the perirectal fatty tissue. Due to the intense blood circulation in the pelvic cavity, this process develops very rapidly.

According to the rules of treatment in surgery, any purulent cavity must be opened and emptied. However, at the very beginning of subcutaneous paraproctitis, surgical intervention can be avoided. To do this, first of all, you need to consult a doctor in time, at least before complications develop, and follow all his treatment instructions. In addition, there are good recipes for treating paraproctitis with folk remedies.

Paraproctitis – abscesses in the perirectal tissue

Etiology of the disease

Paraproctitis occurs due to the rapid growth of pathogenic microorganisms. For some reasons, flora that is normal for the internal environment of the body becomes pathogenic. Most often these are E. coli and staphylococcus. Infection with other bacteria (Klebsiella, Proteus) is possible. A person becomes infected with them from other people from the outside, and these harmful microbes can also move into the rectum from foci of chronic infection (carious teeth, inflamed tonsils, paranasal sinuses). Sometimes the disease develops against the background of severe immunodeficiency, this especially often happens with sepsis.

Even the tuberculosis bacillus, Treponema pallidum or chlamydia can be an etiological factor in the occurrence of paraproctitis.

Pathogenic bacteria are the cause of paraproctitis

Causes of inflammation

For acute paraproctitis to occur, specific conditions are required in which bacteria can multiply and, most importantly, the presence of an entrance gate. The penetration of microorganisms during paraproctitis is usually realized through:

fissures of the anal sphincter and rectum;
erosive and ulcerative processes of the rectal canal;
inflamed hemorrhoids;
rectal glands in the crypts;
wounds after injuries to the perianal area due to accidents, therapeutic, and diagnostic measures;
introduction of infection from internal foci of inflammation through the bloodstream and lymph.

Proctologists identify groups of people whose risk of developing paraproctitis is higher. The following are predisposed to inflammation in the rectal area:

people with chronic, indolent diseases of the gastrointestinal tract, in particular the rectum;
people who do not adhere to the principles of proper nutrition;
men, women and children of younger and adolescent age with congenital or acquired immunodeficiencies;
persons with diabetes mellitus, especially in the stage of decompensation;
adults with bad habits, smoking cigarettes and regularly drinking strong alcoholic drinks;
persons who neglect the rules of personal hygiene.

Important! Long-term untreated hemorrhoids and chronic inflammation of the nodes become one of the main routes of infection into the perirectal tissue.

Inflamed hemorrhoids are a gateway to infection

When can surgery be avoided?

Is it possible to treat a diagnosis such as paraproctitis without surgery? Yes, sometimes surgery can be avoided. The main thing is timely initiation of therapy. If alarming symptoms occur, you should immediately consult a doctor for advice.

Patients with chronic paraproctitis are able to quickly recognize signs of exacerbation, since this occurs frequently. Clinical manifestations are virtually no different from acute illness. The nature of the symptoms of paraproctitis, the time and intensity of their manifestation directly depends on the phase of the inflammatory process, and there are three of them:

infiltration phase;
phase of purulent inflammation;
process resolution phase.

Treatment of paraproctitis without surgery is possible in the infiltration phase, until pus has formed. Many effective methods are used: physiotherapy, laser, antibiotics and anti-inflammatory drugs. In the event of a purulent cavity, only surgical treatment with removal of the source of inflammation is possible. Only after this is conservative treatment of paraproctitis prescribed.

Diagnostics

Typically, diagnosing paraproctitis does not cause serious difficulties. An experienced proctologist surgeon carefully clarifies complaints and examines the anal area. Additionally, a digital examination of the rectum is performed, during which dense hot swelling, inflammation, sphincter fissures and hemorrhoids can be detected.

In case of chronic paraproctitis, an ultrasound examination is prescribed to clarify the localization of the fistulous tract and the spread of inflammation. It is possible to carry out fistulography - a special x-ray examination, when a radiopaque substance is injected into the opening of the fistula tract.

Conservative treatment methods

Drug therapy is an equally important component in eliminating paraproctitis. Conservative treatment can also be used in isolation, especially when surgery is contraindicated (in case of severe concomitant diseases in the stage of decompensation, especially if the patient is an elderly person or a small child).

First of all, antibacterial drugs are prescribed for paraproctitis. Most often, doctors use the following medications:

Amikacin;
Gentamicin;
Ceftriaxone;
Cefipime;
Metronidazole.

Medicines for the treatment of paraproctitis are prescribed in different forms: in the form of tablets, injection solutions and even suppositories. Antibiotics have anti-inflammatory properties, reduce swelling and tissue infiltration. The administration of antibacterial agents prevents the disease from becoming chronic and the formation of fistula tracts. Body temperature decreases, general symptoms of intoxication decrease.

During the remission phase of paraproctitis, when the fistula canal is closed, surgery is not performed; however, constant treatment and certain measures are required. Proctologists prescribe special rectal suppositories with an antiseptic effect, which reduce inflammation and pain. They are used twice a day, always after hygiene procedures.

The most popular drugs for the treatment of paraproctitis:

Relief;
Proctosan;
Posterisan;
Olestesin;
Ultraproct;
Ichthyol candles.

The most popular suppositories for paraproctitis

Special ointments and creams are also used for treatment, which are applied directly to the area of inflammation or delivered using a cotton swab, which is left for 3-4 hours.

Proctosedyl;
Locacorten-N;
Levomekol;
Levosin;
Vishnevsky ointment.

Attention! Without surgical treatment and removal of purulent masses, the capsule of the purulent cavity may burst, then the contents will spread to the surrounding tissues or enter the bloodstream. The result of advanced disease can be severe inflammation and septic complications.

Folk remedies

Recipes for the treatment of paraproctitis, which are used by traditional healers, have long proven themselves to be quite effective. People who have such a disease think for a long time about what methods to choose and how to cure paraproctitis at home.

It is worth remembering that folk treatment can only alleviate the symptoms of paraproctitis, reduce inflammation, and will help cure the disease only if it is subcutaneous in the initial stage.

Treatment of paraproctitis using alternative medicine methods includes the use of therapeutic enemas, the effect of which is aimed at suppressing the growth of pathogenic flora, reducing inflammation, and cleansing the intestines of feces. It is good to do them before using medicinal suppositories and ointments to enhance the effect of the latter.

Such enemas are usually small in volume - 100-200 milliliters. Microclysters are made from infusions of medicinal herbs. To do this, add 1-2 tablespoons of dry raw materials to a glass of hot water and leave for 3-4 hours.

The most popular use of the following herbs in the treatment of paraproctitis:

chamomile;
sequences;
sage;
calendula;
yarrow.

Baths and lotions are widely used at home. The simplest recipe for a sitz bath for paraproctitis is to add 2-3 tablespoons of salt or soda to the water. Take this bath for half an hour. You can add infusions of medicinal herbs: oregano or oak bark.

Recipes are used with mumiyo, which must first be dissolved, and even with wood ash and stone oil. These remedies relieve patients of pain, reduce swelling and prevent the spread of inflammation to healthy tissue.

Medicinal herbs used for inflammation

Nutrition rules

To prevent and treat paraproctitis, you need to make sure that the food you eat is natural, light, balanced in the composition of proteins, fats and carbohydrates and includes essential vitamins and microelements.

It is important to follow a diet; it is recommended to eat at approximately the same time. It is better to exclude fried, smoked foods, sweet carbonated drinks, confectionery and, of course, alcohol. It is important to consume a sufficient amount of fermented milk products: homemade yoghurts, kefir and curds. This diet helps restore normal microflora and regular bowel movements.

It is definitely worth remembering during treatment about the drinking regime; it is advisable to drink 1.5-2 liters of clean water per day.

If you take a responsible attitude towards your health, it is possible to cure paraproctitis without surgery. It is important to closely monitor the condition of the anal area throughout the entire treatment period and, if the condition worsens, promptly consult a doctor.

Video on the topic of the article: