Anal Fistulas: Symptoms, Diagnosis, and Treatment Options

Q: Anal Fistulas: Symptoms, Diagnosis, and Treatment Options

Answer： Anal fistulas and inflammation of the hair follicle tissue in the buttocks can sometimes be difficult to distinguish. <br>The key is to determine whether there is a connection to the internal anal canal, which requires a physician's direct examination for accurate assessm

Issues related to anal fistulas?

Hello Dr.
Ke: I have had lumps on my buttocks since childhood, which usually resolve on their own.
Last year, a lump developed about five centimeters to the right of my anus, causing severe pain when standing due to skin tension.
I went to a traditional Chinese medicine clinic for drainage, but it still hasn't healed.
Each time it scabs over, it swells again after a few days (the frequency increases with late nights or prolonged sitting).
When it bursts and drains pus, it feels better, but recently a new external opening has appeared in the same area (not from the original site).
Last month, I visited a colorectal surgeon in traditional Chinese medicine, who examined me and said it was not an anal fistula, but rather a common sebaceous cyst.
He advised me to return for excision when it swells again.
However, I found that the symptoms I read online match my condition closely, so I would like to ask the doctor if I should seek another consultation.
Thank you, doctor.

Louis, 20~29 year old female. Ask Date: 2017/06/09

Dr. Ke Fangxu reply Surgery

Answer: Anal fistulas and inflammation of the hair follicle tissue in the buttocks can sometimes be difficult to distinguish.
The key is to determine whether there is a connection to the internal anal canal, which requires a physician's direct examination for accurate assessment.
If multiple physicians arrive at the same diagnosis, the accuracy is likely higher than information obtained from online searches.
If you still have concerns, it is also reasonable to seek a second opinion from another physician.

Reply Date: 2017/06/09

More Info

Understanding anal fistulas is crucial for effective diagnosis and treatment. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. They often develop as a result of an infection in the anal glands, leading to the formation of an abscess. Symptoms can vary but typically include pain, swelling, and discharge of pus or blood from the opening near the anus.
In your case, it sounds like you have been experiencing recurrent issues with swelling and pain in the anal area, which could suggest the presence of a fistula or another condition such as a pilonidal cyst or an abscess. The fact that you have had drainage procedures and that the area continues to swell and form new openings is concerning and warrants further investigation.

Symptoms of Anal Fistulas:
1. Pain and Discomfort: This is often the most prominent symptom, especially when sitting or during bowel movements.

2. Swelling and Redness: The area around the anus may appear swollen and red, indicating inflammation.

3. Discharge: Pus or blood may leak from the opening of the fistula, which can be intermittent.

4. Recurrent Abscesses: Many patients experience repeated abscess formation in the same area.

Diagnosis:
Diagnosis typically involves a thorough physical examination, including a digital rectal exam. In some cases, imaging studies such as an MRI or ultrasound may be necessary to assess the extent of the fistula and its relationship to surrounding structures. It’s important to differentiate between a fistula and other conditions like cysts or abscesses, as the treatment approaches can differ significantly.

Treatment Options:
1. Surgical Intervention: The most definitive treatment for an anal fistula is surgical. The goal is to remove the fistula while preserving the sphincter muscles to prevent incontinence. Common procedures include:
- Fistulotomy: This involves cutting open the fistula to allow it to heal from the inside out.

- Seton Placement: A seton (a piece of surgical thread) may be placed to help drain the fistula and promote healing over time.

- Flap Procedures: In complex cases, a flap of tissue may be used to close the fistula.

2. Antibiotics: While antibiotics may be prescribed to manage infections, they do not treat the fistula itself.

3. Lifestyle Modifications: Maintaining good hygiene, avoiding prolonged sitting, and managing bowel habits can help reduce symptoms.

Given your ongoing symptoms and the development of a new opening, it would be advisable to seek a second opinion or revisit a colorectal specialist. It’s essential to ensure that the correct diagnosis is made and that appropriate treatment is initiated. If the current physician has ruled out a fistula but your symptoms persist, further evaluation may be warranted to explore other potential causes or to confirm the diagnosis.

In conclusion, anal fistulas can be complex and require careful evaluation and management. If you are experiencing recurrent symptoms, do not hesitate to seek further medical advice to ensure that you receive the appropriate care. Your health and comfort are paramount, and addressing these issues sooner rather than later can lead to better outcomes.

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