. Diseases of the rectum and anus: designed for students and practitioners of medicine. ed or allowed to rupture seldom healsspontaneously. On the contrary, it gradually shrinks up anddegenerates into the ordinary fistulous tract. There are sev-eral reasons why perirectal abscesses do not get well: (a) restis impossible owing to the acts of defecation and micturitionand the activity of the sphincters; (b) the venous circulationin this region is sluggish by virtue of the upright position as-sumed by man and the lack of proper support to the veins ofthis region; (c) the entrance of foul gases an
. Diseases of the rectum and anus: designed for students and practitioners of medicine. ed or allowed to rupture seldom healsspontaneously. On the contrary, it gradually shrinks up anddegenerates into the ordinary fistulous tract. There are sev-eral reasons why perirectal abscesses do not get well: (a) restis impossible owing to the acts of defecation and micturitionand the activity of the sphincters; (b) the venous circulationin this region is sluggish by virtue of the upright position as-sumed by man and the lack of proper support to the veins ofthis region; (c) the entrance of foul gases and feces into the ANORECTAL FISTULA 237 abscess-cavity when an opening into the rectum exists; (d)retention of pus when the openings are small; (e) when dueto local tuberculosis the destructive process is prone ratherto extend than to heal. Except when due to a pre-existing rectal disease,—suchas hemorrhoids, fissures, ulceration, polyps, stricture, proctitis,and malignancy,—fistula in ano usually occurs in persons witha debilitated constitution who have received an injury either. Fig. 65.—A, Complete External Fistula; B, Recto-vaginal Fistula. to the mucosa by the passage of hardened feces and foreignbodies or the introduction of instruments, or to the buttocksfrom external violence. In this class of cases suppuration isliable to occur as a sequel of irritation or slight bruising ofthe parts, owing to the ever-present bacteria, lowered resist-ance, and faulty blood-supply of the perirectal connective cysts (page 491) situated over the sacrum and coccyxare responsible for the majority of fistulas opening above 238 DISEASES OF THE EECTUM AND ANUS the anus in the posterior median Hne. Tuberculosis, beginningin the rectum or upon the skin, is a frequent cause of fistulain the ano-rectal region. Some authors contend that theformation of a sinus in these cases is not always precededby abscess: views not in harmony with those of the writer. VARIETIES OF FISTULA Th
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