Disorders of the Gastrointestinal System, 2nd Edition
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● Puncture wounds from, for example, ingested fish bones as they are eliminated from the body. ● Preexisting lesions. ● Anal sex. ● Sexually transmitted infections. ● Systemic illnesses such as ulcerative colitis, diabetes, tuberculosis, and Crohn’s disease. ● Immunodeficiency because of such disorders as HIV or treatment of cancers. As the production of pus increases, a fistula may develop in the soft tissues be - neath the anal sphincters’ muscle fibers. This occurs in 30%–70% of those with an anorectal abscess (Bleday, 2022). Anorec- tal abscesses have an average age peak incidence of 40 and a rate of up to 44% recurrence or persistence. Such abscesses are twice as common in men than women (Bleday, 2022). Following are the characteristic signs and symptoms of an anorectal abscess (Bleday, 2022): ● Rectal pain that is often described as throbbing, burning, cutting, or tearing. ● Pus or mucous discharge from the rectum. ● Pain with bowel movements. ● A small amount of rectal bleeding that is not mixed with stool. ● Pain with palpation. An anorectal abscess can be detected upon rectal examination. Sometimes the abscess drains by forming a fistula. If so, the pain typically subsides, and intense itching or irritation occurs (Vogel, 2021). Lab work can also be done if severe in- fection or sepsis is suspected or to deter- mine underlying disease processes, but this is not typically initiated in uncompli- cated cases (Hebra, 2022). Upon digital
rectal exam, a palpable indurated tract may be noted, and pus may be evident on the examiner’s gloved finger. It may be necessary to perform a proctosigmoidos- copy to rule out other diseases or compli- cated cases (Hebra, 2022). An anorectal abscess must be surgically incised to promote drainage of infected material. Antibiotics alone are generally not effective and will only allow the infec- tion to worsen or fistulas to form before the inevitable surgical intervention. Some resultant fistulas resolve independently, and some need ongoing treatment or surgical intervention, known as a fistulot - omy, to remove the fistula and granulated tissue (Champagne, 2021). Fissures and anal irritation are treated with the W.ASH regimen (Lo, 2022). ● W : Warm water from sitz baths, showers, or cleaning with warm washcloths after bowel movements. ● A : Analgesics. Nurses need to be aware of several con- siderations. They should teach patients the importance of perianal cleanliness. This may be an embarrassing topic for some patients. Nurses should be tactful and objective while providing information about perianal hygiene. Nurses should also teach patients to be alert to the signs and symptoms of abscesses and fistulas and to seek prompt medical attention. Patients may suppress the urge to have a bowel movement because of fear of pain, leading to constipation and fecal impac- tion, resulting in even more pain. Nurs- es should teach the importance of a diet that consists of adequate fluid intake and ● S : Stool softeners. ● H : High-fiber diet.
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