Anal Fistulas: Should You Consider Surgery or Manage Symptoms?

Regarding issues related to anal fistulas?

The current situation is that about a year and a half ago, I had an anal abscess, which caused severe pain and made it difficult to sit or stand.
After consulting with a physician, I took antibiotics, and after the abscess ruptured and drained blood and pus, the pain subsided.
Shortly thereafter, the wound seemed to heal, but about a month later, a small nodule appeared at the original site of the wound.
It is usually not painful or itchy, and I don't notice it unless I touch it.
Occasionally, after bowel movements, there is a small amount of blood on the toilet paper (similar to the amount from a popped pimple).
Overall, it does not affect my daily life.

In the past year, I have visited the hospital for several examinations, but the doctors have consistently diagnosed it as hemorrhoids and prescribed hemorrhoid ointment.
However, I felt something was off and sought a second opinion at a colorectal clinic, where the doctor informed me that this is an anal fistula, with a noticeable external opening (the doctor even mentioned that the hospital I originally visited was not reputable).

The doctor explained that patients with anal fistulas generally have two options: (1) surgical intervention for definitive treatment, or (2) managing it conservatively.
I would prefer to avoid surgery if possible, but I am concerned that leaving it untreated might lead to other complications (I have read online about complex fistulas, sepsis, etc., which are quite alarming).
Given my current condition of being asymptomatic, with only occasional slight bleeding that does not affect my life, can I continue to manage it conservatively? Or would you recommend early surgical intervention for definitive treatment? Thank you for taking the time to answer my question.
:)

Mr. Huang, 20~29 year old female. Ask Date: 2017/07/08

Dr. Ke Fangxu reply Surgery

I also believe that the first hospital is a scam.
For young people with simple fistulas, I recommend surgery as a better option; otherwise, there is a risk that it could develop into a complex fistula over the next 50 years.
If surgery is not desired, monitoring the condition is an option, but if symptoms such as discharge and swelling recur, I still recommend surgery to eliminate future complications.

Reply Date: 2017/07/08

More Info

Understanding anal fistulas and the decision-making process regarding surgery versus conservative management can be quite complex, especially when considering the potential implications for your health and quality of life.
From your description, it seems you have experienced an anal abscess that subsequently led to the formation of a fistula. An anal fistula is a small tunnel that forms between the end of the bowel and the skin near the anus, often as a result of an infection or abscess. The fact that you have had a history of severe pain and the subsequent development of a small bump at the site of the previous abscess suggests that the fistula may not have fully healed.

You mentioned that the bump is not painful and that you occasionally notice a small amount of blood on toilet paper after bowel movements. While these symptoms may not significantly impact your daily life, it is important to understand the potential risks associated with leaving an anal fistula untreated.
1. Potential Complications: Although your current symptoms are mild, untreated anal fistulas can lead to complications over time. These may include recurrent infections, increased drainage, or the development of more complex fistulas. In some cases, chronic inflammation can lead to scarring and changes in the surrounding tissue, which may complicate future treatment options.

2. Surgical Considerations: Surgical intervention is often recommended for anal fistulas, especially if they are symptomatic or if there is a risk of complications. The surgery typically involves cutting the fistula open to allow it to heal from the inside out, which can effectively eliminate the fistula and prevent future issues. While surgery carries risks, including pain and the potential for changes in bowel function, it can also provide a definitive solution to the problem.

3. Conservative Management: If you are currently asymptomatic and the fistula does not significantly affect your quality of life, some patients choose to manage their condition conservatively. This may include regular monitoring and maintaining good hygiene. However, it is crucial to have regular follow-ups with a healthcare provider to monitor for any changes or complications.

4. Making the Decision: Ultimately, the decision to pursue surgery or to manage the fistula conservatively should be made in consultation with a qualified healthcare provider, ideally a colorectal surgeon. They can assess the specific characteristics of your fistula, discuss the potential risks and benefits of surgery, and help you weigh these against your current symptoms and lifestyle.

In conclusion, while it may be tempting to avoid surgery, especially if you are currently asymptomatic, it is essential to consider the long-term implications of leaving an anal fistula untreated. Regular follow-up appointments and open communication with your healthcare provider will be key in making the best decision for your health. If you have any concerns or if your symptoms change, do not hesitate to seek medical advice.

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