Anal Fistula Treatment: When to Seek Surgical Intervention

Q: Anal Fistula Treatment: When to Seek Surgical Intervention

Answer： Without a personal examination, it is impossible to definitively determine whether it is a fistula; however, there is no doubt that the condition is anal pruritus. <br>In addition to medication and topical treatments, three important considerations should be noted for man

Treatment of anal fistula

Since the first half of last year, I have been experiencing significant itching in my private areas (genital and anal regions).
The itching in the genital area was more severe, so I consulted a gynecologist.
At that time, I didn't think much about it and didn't connect it to the anal itching.
Now, I regret not paying attention to the anal itching.
Initially, it wasn't as severe, but after three to four months, it worsened.
I couldn't resist scratching, especially at night when I couldn't sleep.
However, due to my busy work schedule, I didn't have time to see a doctor.
After leaving my job, I thought I would take a break to see if it would improve, but it fluctuated over the next three months.
During that time, I researched a lot online and learned about anal fistulas, and I felt my symptoms resembled that condition.
Finally, I went to a colorectal clinic with the determination to undergo surgery.
During my first visit, the doctor examined me and mentioned inflammation in two areas, diagnosing me with an internal fistula.
His explanation was somewhat vague.
He prescribed anti-inflammatory medication and advised me to adjust my lifestyle and eat more fruits and vegetables.
He suggested that if it didn't improve after some rest, I should see a dermatologist or go to a larger hospital for further examination.
He ended with, "You're still young." I followed his advice to adjust my routine and diet.
After three weeks, although I felt a bit better, I still wasn't comfortable, so I returned for a follow-up.
The doctor scolded me, saying that he only prescribed topical medication and that it shouldn't be that easy.
I wanted to ask him about my specific condition, but he said, "That's not important; it's just inflammation." He gave me another tube of anti-inflammatory ointment and reiterated the need to adjust my routine and diet, saying that if the itching persisted, I should go to a larger hospital for further examination.
After my second visit, I actively adjusted my routine and diet, and my condition has indeed improved.
Today, it has been ten days since my last follow-up, but I still often experience itching during or after bowel movements.
Even after applying the medication, it still itches initially and only becomes comfortable after a few minutes.
I would like to ask if continuing to adjust my routine could gradually alleviate my discomfort, or should I go to a larger hospital for examination and potential surgical treatment?

Ruì bǐ, 20~29 year old female. Ask Date: 2017/01/22

Dr. Ke Fangxu reply Surgery

Answer: Without a personal examination, it is impossible to definitively determine whether it is a fistula; however, there is no doubt that the condition is anal pruritus.
In addition to medication and topical treatments, three important considerations should be noted for managing anal itching: 1.
Do not scratch to avoid causing a wound infection.
2.
Temporarily avoid consuming spicy foods to prevent capsaicin from irritating the skin.
3.
Avoid using soap or body wash to clean the anal area to prevent excessive removal of the skin's natural oils.
If these measures are followed, improvement can generally be seen in about a week.
If there is no improvement, it is advisable to consult a colorectal specialist for further evaluation.

Reply Date: 2017/01/22

More Info

When it comes to understanding anal fistula treatment and determining when to seek surgical intervention, it is essential to first understand the nature of the condition. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. This condition often arises after an anal abscess, which is a collection of pus that can develop due to infection. Symptoms typically include pain, swelling, and discharge, which can lead to significant discomfort and impact daily life.

In your case, it seems that you have been experiencing persistent itching and discomfort in the anal area, which has progressively worsened over several months. Initially, you sought treatment for itching in the genital area, but as the symptoms persisted and worsened, you began to suspect that you might be dealing with an anal fistula. Your visit to the colorectal specialist confirmed inflammation and suggested that you might have an internal fistula.

The treatment approach for anal fistulas can vary significantly depending on the severity and complexity of the fistula. In many cases, conservative management, including dietary changes, topical medications, and lifestyle modifications, can help alleviate symptoms. However, if these measures do not provide relief, or if the fistula is causing significant discomfort or complications, surgical intervention may be necessary.

Here are some key considerations regarding when to seek surgical intervention for an anal fistula:
1. Persistent Symptoms: If you continue to experience symptoms such as itching, pain, or discharge despite conservative treatment, it may be time to consider surgical options. Fistulas often do not resolve on their own and may require surgical intervention to heal properly.

2. Impact on Quality of Life: If the symptoms are affecting your daily activities, sleep, or overall quality of life, it is essential to discuss surgical options with your healthcare provider. Surgery can provide a more definitive solution and improve your quality of life.

3. Infection or Complications: If you notice signs of infection, such as increased pain, fever, or worsening discharge, it is crucial to seek medical attention promptly. Infections can complicate the condition and may necessitate surgical drainage or intervention.

4. Failure of Conservative Treatment: If you have followed your doctor's advice regarding dietary changes and topical treatments but have not seen significant improvement, it may indicate that the fistula is more complex and requires surgical evaluation.

5. Specialist Referral: If your current healthcare provider is not able to provide a clear diagnosis or treatment plan, seeking a second opinion from a colorectal surgeon or a specialist in anal disorders may be beneficial. They can offer more targeted treatment options and discuss the potential need for surgery.

In conclusion, while lifestyle changes and conservative treatments can be effective for some individuals, they may not be sufficient for everyone. Given your ongoing symptoms and the fact that you have already sought medical advice, it may be prudent to consider a referral to a colorectal surgeon for further evaluation. They can assess the complexity of your fistula and discuss the potential benefits of surgical intervention, which can provide a more permanent solution to your discomfort. Remember, early intervention can often lead to better outcomes and a quicker return to normal activities.

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