Chronic paraproctitis - symptoms and treatment

Paraproctitis after surgery requires the most careful attention - both from the patient and from the doctor. The fact is that paraproctitis after surgery may not disappear completely, but may recur again and again. Therefore, the postoperative period of paraproctitis is very important.

Paraproctitis is an anal fistula or abscess of the anal area. Although it happens that paraproctitis goes away on its own, such cases are extremely rare; more often than not, it recurs again and again, and this can only be stopped surgically, that is, an operation is performed to excise the abscess or fistula. However, even after surgery, relapses occur, and in order to get rid of them, surgery has to be performed several times.

In addition, even after a successful operation, the patient does not feel well and cannot live a full life (work, actively relax, etc.). This fact is indicative of the postoperative period of paraproctitis. But you shouldn’t despair, but on the contrary, you need to tune in to a long but successful treatment, which should stop only when the patient is completely healthy. The main component of a successful postoperative period of paraproctitis is careful hygiene of the anal area and postoperative wound. Also, paraproctitis after surgery requires medication and dietary treatment.

Types of operations

Radical surgery for acute paraproctitis can be:

• One-step. First, the purulent sac is opened, its contents are removed, and the abscess is drained. Then the path of infection is eliminated (the affected intestinal crypt, anal sinus or gland is excised). All these manipulations are carried out during one operation, which is why it is called one-stage. This type of surgery is not suitable for every patient. Simultaneous surgery is contraindicated in the general serious condition of the patient, inflammation of the surrounding tissues and the impossibility of accurately identifying the affected crypt.
• Two-stage. The same manipulations are performed as in the previous case, but not in one go, but in two. First, the purulent sac is opened and its contents are removed. After the tissue has healed, a new operation is performed, which involves removing the connection between the purulent focus and the rectum. This is done 1-2 weeks after the first surgery.

A two-stage procedure is performed more often than a one-stage procedure, since in this case the risk of developing postoperative complications is reduced.

Paraproctitis. Effective treatment of a wound after opening a purulent focus

Surgeon E.V. Lozhnichenko shares his experience in the surgical treatment of paraproctitis using Stellanin ointment in the postoperative period. (polyclinic No. 3 of the National Health Institution "Road Clinical Hospital of JSC Russian Railways", Rostov-on-Don):

“A 19-year-old patient came in with acute pain; in her words, “it has been impossible to sit for three days” due to a huge “bump” that was hot to the touch in the anus. Upon examination, an acute purulent focus containing infiltrate was discovered, and a diagnosis of paraproctitis was made.”

After examination, the purulent lesion was opened, sanitized, packed with Stellanin-PEG ointment, dressings were carried out for a week once a day. After 8 days

the wound
has completely healed
. Photo 1. Examination of the patient at the time of contacting the surgeon Photo 2. 4th day of treatment with Stellanin-PEG ointment. Photo 3. Day 8, complete healing.

Stellanin is a universal remedy for treating all types of damage to the skin and soft tissues. The active substance of Stellanin-containing ointments is the substance 1,3-diethylbenzimidazolium triiodide, patented as an invention. Stellanin is a complex chemical compound - organic

part of the molecule affects the activity of the cell’s gene apparatus, powerfully activating regeneration processes in it.
At the same time, the inorganic
part of the molecule has a pronounced effect on the entire spectrum of pathogenic microorganisms.

Stellan eliminates wounds like bacteria

, as well as
mushrooms
, viruses, protozoa.
It is especially important that all pathogens
of wound infections
do not have
either natural or acquired resistance to Stellanin.
The high effectiveness of the drug
has been confirmed by leading Russian scientists:

«Already on the first day

Treatment of wounds with Stellanin-PEG ointment shows positive dynamics in the healing process, inflammation decreases...Young cells with a high level of metabolic processes appear in the wound.”
( From the Report approved by the director of the A.V. Vishnevsky Institute of Surgery, Academician of the Russian Academy of Medical Sciences V.D. Fedorov
).

Studies conducted in the treatment of patients have shown that Stellanin

accelerates the germination of capillaries
by 2.4 times
increases the number of fibroblasts in the wound - the main cells involved in the restoration of damaged skin - by 7.5 times

Patient reviews
“I have 12 Oct.
there was surgical opening and drainage of the abscess - acute purulent ischiorectal paraproctitis.
Oct 18 discharged to day hospital. Despite the fact that I used Stellanin-PEG ointment only once a day, in the evening (during the morning dressing changes at the clinic, the nurse did not dare to use this ointment instead of the prescribed L), the wound quickly cleared after drainage and stopped hurting. When in the day hospital they replaced L-l with S-l (so that it would regenerate faster), in the evenings I replaced Stellanin-PEG with just Stellanin, as a result everything healed very quickly. (Karpov O., Tomsk)
“At the end of autumn I had surgery to treat acute inflammation of the muscles of the buttock

(under local anesthesia).
The doctor opened the abscess cavity above the site of inflammation, from where he removed about 40 ml of pus. In the next two weeks after surgery, the wound was treated with Stellanin-PEG ointment. The healing process was very fast and the wound was completely healed by mid-December (and without the formation of a chronic fistula, which occurs in 85% of such cases). And this despite the fact that I have diabetes, in which the healing of any wound, even a small one, is always a problem. (Filatova E.A., Rostov-on-Don)
Effects of the drug STELLANIN®:

1. CLEANS THE WOUND OF PURPENT CONTENTS
   – thanks to the hydrophilic auxiliary substance (polyethylene glycol) included in the Stellanin-PEG ointment, the wound is effectively cleansed of purulent contents.
2. ELIMINATES INFLAMMATION
   - prevents the synthesis of inflammatory mediators - prostaglandins.
   As a result of a decrease in the level of these mediators the inflammatory process stops
   
   pain and swelling
   are eliminated .
3. HAS HIGH ANTIBACTERIAL ACTIVITY
   against gram-positive and gram-negative bacteria, as well as aerobic and anaerobic microorganisms, fungi, and viruses.
4. STIMULATES SKIN REGENERATION
   – Stellanin repeatedly activates mitochondrial function and increases their size, activates the expression of genes for vascular growth factors VEGF-A and VEGF-B.
   This mechanism determines the direct effect of Stellanin on wound healing and
   the regeneration of healthy skin.

Features of application:

1. Stellanin-PEG
   ointment – ​​used to treat
   weeping
   wounds (in the presence of pus or exudate);
2. Stellanin
   ointment - used
   for clean (non-purulent)
   wounds.

What is the difference between Stellanin and Stellanin-PEG? >>> See detailed tips for use here >>>
1. Find out the price in pharmacies in your city:

order delivery using this service.

Stellanin both in large cities and in remote localities of Russia (more than
14,000 pharmacies
).
Ordering and delivery are free.
Payment for the drug itself is made
at the pharmacy
upon receipt of the goods.

2. List of pharmacies in your city that have Stellanin in stock

THE CLINICAL EFFECTIVENESS OF STELLANINE has been confirmed by specialists from leading scientific centers in Russia:

Indications

In the presence of purulent paraproctitis, surgery must be performed as soon as possible. The presence of the disease is indicated by the following symptoms:

• significant deterioration in general health, nausea, weakness, increased body temperature;
• discharge of pus from the anus;
• pain around the anus, in the anus, perineum, rectum, becoming more intense during defecation;
• the presence of a red lump on the buttock, next to the anus.

Opening paraproctitis is an emergency operation, since the patient’s condition is constantly deteriorating and the risk of further spread of the infection increases.

Carrying out the operation

Surgery is performed under general or epidural anesthesia. The general principle of the operation is as follows: the abscess is opened, its contents are removed, the abscess cavity is washed with antibacterial drugs, and drainage is carried out using ointment swabs. Then an antiseptic bandage is applied to the postoperative wound.

The nature of the incision depends on the type of paraproctitis (location of the abscess). The abscess can be:

• subcutaneous (located under the skin in the anus);
• ischiorectal;
• submucosal (located in the wall of the rectum, under the mucous membrane);
• pelvic-rectal.

For subcutaneous paraproctitis, an incision is made around the anus, for submucosal paraproctitis - from the side of the rectum. The most difficult thing is to “get close” to the ischiorectal or pelvic-rectal abscess. The incision can be made either through the skin or from the rectum. To select surgical tactics, magnetic resonance imaging or computed tomography of the pelvic region is performed.

Treatment

Complete relief from rectal fistula is guaranteed only by surgical intervention; conservative therapy in this case is absolutely ineffective.

The proctology department of the Yusupov Hospital uses laser welding of fistula tracts and their obliteration using special adhesives. Other progressive methods for eliminating fistulous tracts, which involve the absence of incisions in the rectal muscles, have been successfully used.

In addition, if necessary, surgical interventions are used to treat rectal fistula, during which the fistula tract is excised and primary sphincter repair is performed. Carrying out such operations is advisable in severe forms of pathology with a large number of branching fistulas and cavities along the fistula tracts. Radio wave surgery, electrical welding of tissues, laser coagulation, etc. can be used.

Thanks to an individual approach, complete recovery is achieved in the shortest possible time, minimal discomfort and preservation of patients’ ability to work.

Postoperative period

Complete healing of the postoperative wound occurs 3-4 weeks after surgery. If the procedure was completed without complications, the patient will be able to return to work in approximately 10 days. In the first days after surgery, the patient is recommended to stay in the hospital. He is prescribed painkillers and antibiotics, as well as a diet aimed at preventing stool disorders. Postoperative wound dressings are carried out daily. Stool retention can be observed in the first 2-3 days after surgery - this is not a deviation from the norm. However, if there is no stool for more than 3 days, the patient is given a cleansing enema.

At home, you need to continue changing the bandages. The wound is treated with an antibacterial agent and a sterile ointment bandage is applied to it (the doctor will recommend rinsing solutions and other medications).

Diet after paraproctitis

The diet is selected by the doctor. It is quite strict, without a hint of spicy, sour, salty or alcohol. Even fruits can be eaten with caution, and immediately after surgery, in general, only baked apples. The main components of the diet are:

• rice or semolina porridge with water;
• steam cutlets;
• boiled fish or boiled meat minced;
• protein omelet.

The condition of the operated patient improves in direct proportion to the amount of fluid, namely water, that he drinks per day. This should be at least 5 glasses. Since the postoperative period lasts a long time, the patient has certain questions from time to time. You should not consult about them with friends and people who themselves have been operated on for an anal abscess or fistula. Each person is individual, and only a doctor can accurately determine what is bothering the patient and give the correct recommendations.

The doctors of our clinic treat all patients very responsibly, but they pay double attention to people who underwent surgery here. Each person who is operated on and goes home receives detailed instructions on how to live in the next six months. In addition, all patients are encouraged to carefully write down any issues that arise at home. Thus, when meeting with the doctor again, they do not miss anything and receive the most comprehensive answer to each question. This helps not only physically, but also mentally.

Patients of our clinic feel protected, so they have no fears or nervous stress, which allows the body to recover twice as fast, and the person himself to be confident of a complete recovery.

How the procedure works

Surgery is the only effective way to treat acute paraproctitis. If the abscess is not eliminated, the following scenarios are possible:

• Self-healing. The purulent sac breaks through, its contents come out, and the wound heals. This outcome is likely only in 10-15% of cases, so the pathology cannot be left without treatment.
• The occurrence of chronic paraproctitis. There are two options for the progression of an acute disease into a chronic form. In the first case, the abscess breaks out on its own, but not all of its contents come out. A capsule is formed around the remaining part of the pathological focus. As a result, relapses of the disease occur. In another case, the pus comes out completely, but the path of its exit is regularly infected.
• Spread of purulent inflammation to surrounding tissues. The pus leaves the bag, but does not come out, but penetrates into nearby organs and blood. A serious condition may occur that threatens the patient's life.

Opening paraproctitis allows you to completely eliminate the pathological focus and avoid the following complications:

• fistula formation;
• blood poisoning;
• peritonitis;
• thrombosis of the pelvic veins;
• purulent melting of the genitourinary system.

After surgery, the patient may need physiotherapeutic procedures: ultraviolet or ultra-high-frequency irradiation, magnetic therapy - they speed up the healing process and relieve tissue inflammation.

Prices

* You can read more about the conditions here - Treatment on credit or in installments.
Sources:

1. Lakhin A.V. Acute paraproctitis / A.V. Lakhin, A.A. Lakhin // Coloproctology. — 2021. — No. 2 (64). — P. 24.
2. Mustafakulov I.B. Modern tactics of treatment of acute paraproctitis / I.B. Mustafakulov [and others] // Innovative development: the potential of science and modern education. — 2021. — Collection — pp. 252-255.