Featured, Health

By Austin Ejenike

The unconventional sexual escapades which Africans emulate from the Caucasians/Western world in the name of “pleasurable sexual satisfaction”, anal sex/foreign body insertion (sex toys) could lead to complicated clinical condition called fistula”.

Some people often go to the extreme when indulging in such habits without adequate information or knowledge of the consequence of such obnoxious sexual practice.

Fistula is an abnormal connection or passageway that connects two organs or vessels that do not usually connect a clinical condition that is rare, but silently creeps into our society due to ignorance, and especially fistula, that which is sequel to obnoxious sexual practice.

It is important young men and women should pay more attention to sex education since anal sex and foreign body insertions are now posing major health issues in the country.

According to data from evidence based medical researches, these practices are becoming prevalent and deserve urgent medical intervention.

Fistula (a complicated clinical condition) is an abnormal opening that connects two or more organs or spaces inside or outside the body; a fistula is an abnormal connection or passageway that connects two organs that don’t usually connect. They can develop anywhere between an intestine and the skin, between the vagina and the rectum, and other places. A fistula can develop between the bowel and the skin, it can occur in various parts of the body. Fistula is not specific to a particular sex, except from that of ‘‘Obstetric Fistula’’ which is specific to females.

Types of fistula:

• Anal fistula: An infected tunnel between the skin and the anus.
• Arteriovenous fistula: An abnormal connection between an artery and a vein.
• Obstetric fistula: An abnormal connection between the rectum and the vagina.

The above listed are the most common “FISTULA”. There are other various forms of fistula.

Anal fistula being the focus is primarily caused by an anal abscess, although there are several other possible causes of the condition.

An abscess is a painful collection of pus in an area of the body. An anal abscess is commonly associated with bacterial infection of tissues of the anal canal, with consequent pus formation and collection secondary to injury and abrasions as may be encountered during anal sex, foreign body insertion that is usually devoid of adequate lubrication, then a small anal gland becomes infected with bacteria ‘due to tears in the anal canal’. It can be very painful and may develop into other medical conditions such as anal fistula.

An anal, or rectal, abscess occurs when a cavity in the anus becomes filled with pus. It causes extreme pain, fatigue, rectal discharge, and fever. In some cases, anal abscesses can result in painful anal fistula with chronic discharges. This occurs when the abscess doesn’t heal and breaks open on the surface of the skin chronically discharging anal abscesses, hardly heals spontaneously and are associated with excruciating pain requiring surgical intervention, which entails high capital to be able to undergo surgery, which many people cannot afford in our society

Anal abscess is by far the most common cause of anal fistula, and is responsible for causing approximately 80% of cases. Up to half of all patients with an anal abscess will develop an anal fistula.

Anal sex, foreign body insertion (sex toys) into the anus predisposes to the formation of anal abscesses due to abrasions, injuries and tears within the anal canal with consequent fecal bacterial infection. This is commonly seen in people with immune suppression as in HIV, AIDS, diabetes mellitus, prolonged use of antibiotics, cancer patients

Mainstay of managing abscesses is incision and drainage to let out the accumulated pus, followed by adequate use of antibiotics (medication to treat infections caused by bacteria). If an anal abscess bursts before it has been treated, it can sometimes cause an anal fistula to develop. A fistula may also occur if an abscess has not completely healed, or if the infected fluid has not been entirely drained away.

Approximately 30-50% of people with an anal abscess will develop an anal fistula. Around 80% of all anal fistulas develop from an infection in the anus.

The complications of anal fistula include but not limited to the following conditions that cause the intestines to become inflamed;

Crohn’s disease a chronic condition that causes inflammation of the lining of the digestive system

Diverticulitis infection of the small pouches that can stick out of the side of the large intestine (colon)

Crohn’s disease is a type of inflammatory bowel disease (IBD).

What causes an anal fistula?

An anal fistula usually develops after an anal abscess (a collection of pus) bursts, or when an abscess has not been completely treated.

A fistula can also be caused by conditions that affect the intestines, such as inflammatory bowel disease (IBD) or diverticulitis.

An anal fistula affects:

As many as 50% of people with Crohn’s disease

Up to 30% of people with HIV (a virus that attacks the body’s immune system)

Approximately 30-50% of people with an anal abscess (this is slightly more common in women than men)

Symptoms of an anal fistula:

Symptoms of an anal fistula include skin irritation around the anus, a throbbing pain, and a discharge of pus or blood when you have a bowel movement.

There are several common symptoms of an anal fistula.

Skin irritation around the anus (the opening where waste leaves the body)

A throbbing, constant pain that may be worse when you sit down, move around, have a bowel movement or cough

A discharge of pus or blood when you have a bowel movement read more information about rectal bleeding

If your fistula was caused by an abscess that you still have, you may have:

A high temperature of 38ºC (100.4ºF) or more

Fatigue

Malaise (generally feeling of being unwell)

If your fistula is caused by inflammation of the intestines (part of your digestive system) for example, because of a condition such as Crohn’s disease you may also have:

Abdominal pain

Diarrhea

Loss of appetite

Weight loss

Nausea (feeling sick)

Vomiting

Most anal fistulas require surgery because they rarely heal if they are not treated. Several surgical methods are available, depending on where the fistula is and whether it is classed as simple or complex.

You may be able to go home on the day of surgery. However, you may need to stay in hospital for a few days if the fistula is difficult to treat.

There is a risk of complications after anal fistula surgery, including:

Infection

Bowel incontinence

This medical condition is diagnosed by physical exam and certain test such as abdominopelvic ultrasound, rectal enema, Magnetic resonance imaging, etc. depending on the need.  The incidence of fistula in Nigeria is most commonly seen/predominant in sexually active individuals, who indulge in Anal Intercourse, mostly to the young girls and ladies due to the motive of making money and some due to early marriage and mostly some due to precocious puberty (a condition in which a child’s body begins changing into that of an adult at an early age) and in young MSM – men having sex with men who take part in homosexual act face this medical condition “fistula” also.

The most precise and appropriate treatment for fistula is specifically by surgery for more efficiency, and its management is dependent on the type of fistula a patient is affected with, which also entails proper hygiene maintenance.

In conclusion, anal fistula is an ever increasing hydra-headed public heath burden occurring commonly among the un-informed with reckless tendency to exploit alien sexual escapades as well as in under-aged pregnant girls, and some women, following prolonged labour, especially in facilities with untrained hands.

Public enlightenment and appropriate ante-natal care and safe timely delivery will reduce the incidence. Vesico-vaginal fistula is prevalent in Nigeria.

This is a public health issue of utmost concern calling for urgent proactive measures to curb the increasing health menace,

This article was reviewed by Dr. S. O. Ebede. Consultant Clinical Microbiologist/ Lecturer, Dept of Medical Microbiology, UNTH, Enugu.

_AUG 06, 2019 @18:24 GMT |

Tags: Emerging threat of Fistula - a Medical condition