Subcutaneous Cysts vs. Anal Fistulas: Key Insights

Subcutaneous cyst or anal fistula?

Last year, I felt a bump near my vagina and anus that resembled a pimple.
Shortly after, it suddenly swelled up to the point where it felt connected to my anus.
I consulted a dermatologist, and after a physical examination, I was prescribed medication that reduced the swelling somewhat, but it did not completely resolve.
Due to pressure on the area, there were also wounds and some fluid or blood discharge, and it felt somewhat hard.
At the same time, my vagina felt inflamed and itchy.
On the last day of taking the dermatologist's medication, I visited a gynecologist for vaginal inflammation.
The gynecologist performed an internal examination and prescribed a suppository, oral medication, and topical treatment for the wounds.
The swelling decreased a bit more, but there still felt like a hard lump under the skin.
About two months later, the area swelled again, but not as large as before.
I applied the previous dermatologist's medication, which did not increase in size but also did not completely resolve.
A few weeks ago, after being bitten by fleas, I saw the dermatologist again and asked about the area.
The doctor examined it and suggested it might be a subcutaneous cyst or tumor, recommending that I go to a larger hospital for further evaluation.
No medication was prescribed, and now when I check, it seems to have disappeared again, resembling the initial pimple-like bump under the skin.
I would like to know if such subcutaneous cysts or tumors can shrink on their own.
I am very concerned that this could be an anal fistula; could that be a possibility? Since I can hardly feel it now, should I seek further medical attention? Thank you very much for taking the time to respond amidst your busy schedule.

Minimo, 30~39 year old female. Ask Date: 2016/05/25

Dr. Wu Yuxin reply Dermatology

A subcutaneous cyst is possible.
Without actually seeing the lesion, it is difficult to confirm.
If it is causing significant concern, please seek medical attention promptly.

Reply Date: 2016/05/25

More Info

Understanding the differences between subcutaneous cysts and anal fistulas is crucial for proper diagnosis and treatment. Based on your description, it seems you have been experiencing a recurring issue near the vaginal and anal area, which has raised concerns about the nature of the lump you felt.

Subcutaneous Cysts
Subcutaneous cysts, often referred to as epidermoid cysts or sebaceous cysts, are benign lumps that can occur anywhere on the body, including the genital and anal regions. They are typically filled with keratin and can vary in size. These cysts can become inflamed or infected, leading to swelling, redness, and sometimes drainage of pus or fluid. In many cases, they can resolve on their own, especially if they are small and not infected. However, if they become larger, painful, or recurrent, surgical removal may be necessary.

Anal Fistulas
On the other hand, anal fistulas are abnormal connections between the anal canal and the skin surrounding the anus. They often develop as a complication of an anal abscess, which is an accumulation of pus due to infection. Symptoms of an anal fistula can include persistent drainage, pain, swelling, and sometimes fever. Unlike cysts, fistulas typically require surgical intervention for proper treatment, as they do not resolve on their own.

Your Symptoms
From your description, it sounds like you initially noticed a small bump that became inflamed and painful, leading to some discharge. The fact that it has fluctuated in size and has been treated with topical and oral medications suggests that it may be more than just a simple cyst, especially given the location and the symptoms of itching and inflammation in the vaginal area.

The possibility of an anal fistula cannot be ruled out, particularly if there has been any history of abscess formation or if the lump is associated with drainage. However, the fact that the lump has diminished in size and is not currently causing significant symptoms is a positive sign.

Recommendations
1. Follow-Up Consultation: Given the complexity of your symptoms and the potential for both cysts and fistulas, it is advisable to seek a follow-up consultation with a specialist, such as a colorectal surgeon or a dermatologist with experience in this area. They can perform a thorough examination and possibly imaging studies to determine the exact nature of the lump.

2. Monitoring: If the lump is currently not causing discomfort and has reduced in size, you may choose to monitor it closely. However, if you notice any changes, such as increased pain, swelling, or discharge, you should seek medical attention promptly.

3. Avoid Self-Management: While it may be tempting to apply topical treatments or attempt to drain the cyst yourself, this can lead to complications such as infection or worsening of the condition. It is best to leave any procedures to qualified healthcare professionals.

4. Hygiene and Care: Maintaining good hygiene in the affected area can help prevent infections. Avoiding irritants and wearing breathable clothing may also be beneficial.

In conclusion, while subcutaneous cysts can sometimes resolve on their own, anal fistulas typically require medical intervention. Given your symptoms and the duration of the issue, a thorough evaluation by a healthcare professional is essential to ensure appropriate diagnosis and treatment.

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