Fistula, Constipation, Fissure: Diagnosis, management, Complications

Fistula

An abnormal passage between two epithetical surface usually connecting the cavity of one organ with another or a cavity with the surface of the body.

Etiology:

1.     abscess

2.     inflammatory diseases

3.     Malignant tumers

4.     radiation therapy

5.     developmental defect

6.     Failure of embryonic  development.

7.     Acquired by surgical complication.

Anal Fistula is the most common among other types of fistulae. Abnormal tube like passage from skin near anus into anal canal. It results from the rupture or drainage of anal abscess.

Signs and symptoms:

itching and pain around the fistula opening Purulent drainage from the opening

Diagnosis:

1.     clinical signs and symptoms

2.     Rectal examination (A metal probe is used to identify the direction of fistula)

Management:

Fistulectomy, Fistulotomy.

Nursing management:

Monitor vital signs for signs of infection. Bowel rest to allow fistula to heal.

Daily asses the wound for sign of infection. Administer analgesics and antibiotics as ordered. Encourage frequent sitz bath.

Initially encourage fluid diet followed by a balanced diet

Complication:

Infection.

Constipation ( enema)

Constipation refers to an abnormal infrequency of defecation.

Causes:

1.     Medication (eg. Tranquillizers, anticholinergics, Anti-hypertensives, opioids, antacids)

2.     Hemorrhoids and or fissure

3.     Malignancy (bowel cancer )

4.     Diabetes mellitus, parkinsonism, multiple sclerosis

5.     Hypothyroidism

6.     Impaired mobility

7.     Unconscious patient

8.     poor dietary habits ( low fibre diet and / or inadequate fluid intake)

9.     Lack of exercises, and stress filled life.

Sign and symptoms:

1.     Abdominal distention

2.     Borborygmus (intestinal rumbling)

3.     Pain and pressure.

4.     Loss of appetite.

5.     Headache.

6.     Fatigue.

7.     Indigestion.

8.     Straining at defecation

9.     Passing of small, hard, dry stool.

Diagnosis:

1.     History

2.     Physical examination.

3.     Digital exploration of the rectum

Management:

Treatment based on underlying cause of constipations.

1.     Discontinuing abusive laxative use.

2.     Advice to Include high fiber diet and adequate fluid intake

3.     Routine exercise to strengthen abdominal muscles.

Complication:

Fecal impaction Hemorrhoids Fissures

Fissure

Fissure is a narrow shallow ulcer or a cleft resembling a crack usually seen in the lining of the anal and canal or below the anorectal line.

Etiology:

Constipated stool may tear anal lining.

Perinial straining during childbirth.

Signs and symptoms:

1.     Acute pain and irritation during and after defecation.

2.     passing of bright red blood with stool.

3.     Constipation

Diagnosis:

1.     Rectal examination done under anesthesia to prevent anal spasm.

2.     Stool examination for occult blood.

Management:

F. Jaundice:

Medical:

Promotion of regular, soft-bowel movements through stool softeners and rectal suppositories.

Local application of antiseptic solutions.

Surgical:

Fissurectomy.

Nursing management:

1. Assist the patient with warm sitz baths and local application of anesthetic ointment to reduce pain.

2. Instruct to take high-fibre foods fresh fruits vegetables green leafy vegetables etc and drink plenty of fluids to prevent constipation.