Anal Issues: Seeking the Right Specialist for Treatment

Anal issues

Hello Doctor,
In mid-May of this year, I developed a 0.2 cm raised white pus-filled bump at the anal opening, approximately 1 cm in size (it feels soft to the touch).
There seems to be a granular tissue-like substance in the center (fine texture).
The surrounding skin is not red or swollen, and there is no tenderness.
I consulted an A proctologist and took medication, but during the follow-up, the doctor mentioned that it could directly form an anal fistula and advised me to return for surgery once inflammation occurs (it has been a month since that visit).
After discussing with my family and worrying about the inconvenience of post-surgery care, I visited a B proctologist at a nearby large hospital two days later.
The B doctor examined me and said it did not appear to be a cyst but rather a bacterial infection, recommending electrosurgery for removal (treatment took place in early June).

Two weeks after the electrosurgery, I experienced stinging and burning sensations around the anal area.
Since Dr.
B was unavailable for consultation, I went to a C proctologist (clinic), who indicated that the irritation from applying ointment led to dermatitis.
After applying medication, my symptoms improved (it is almost healed now, but the skin remains slightly red).
Recently, I noticed small red dots on my buttocks (flat, bright red, the size of pinholes, located on the surrounding skin).
I consulted a dermatologist who diagnosed it as folliculitis.
After two weeks of treatment, new folliculitis lesions continued to appear, but the new ones are more acute, with tenderness, itching, and stinging sensations while sitting (the center is about 0.6 cm, somewhat firm, with redness, swelling, and softness around it, located in the crease of the buttocks).
Due to the multiple symptoms and the ongoing concern about the anal fistula, which specialist should I consult now—proctology or dermatology?
Thank you for your assistance!

Niming, 30~39 year old female. Ask Date: 2017/07/08

Dr. Ke Fangxu reply Surgery

Since there is concern about the possibility of an anal fistula, you should consult a colorectal surgeon.
It is advisable to wait until the skin issue has resolved before seeking an appointment to obtain a more accurate diagnosis.

Reply Date: 2017/07/08

More Info

It sounds like you are experiencing a complex and distressing situation with multiple anal and skin issues. Given the symptoms you've described, it's crucial to approach this matter systematically to ensure you receive the appropriate care.

First, let's break down your symptoms and the specialists involved:
1. Initial Symptoms: You mentioned a white bump near the anus that was soft and had a central component resembling granulation tissue. This could indicate a variety of conditions, including an abscess or a potential fistula, which is a connection between the anal canal and the skin.

2. Consultations: You initially consulted with a colorectal surgeon (Doctor A) who suspected a fistula and recommended surgery after inflammation. However, due to concerns about post-operative care, you sought a second opinion from another colorectal surgeon (Doctor B), who suggested that it might be a bacterial infection and opted for electrosurgery.

3. Post-Procedure Complications: After the electrosurgery, you experienced pain and burning in the surrounding skin, which led you to consult a third specialist (Doctor C) who diagnosed you with dermatitis likely caused by irritation from topical treatments.

4. Current Symptoms: Now, you are noticing red spots around the anal area, which have been diagnosed as folliculitis by a dermatologist. This condition can arise from irritation or infection of hair follicles, often exacerbated by friction or moisture.

Recommendations for Next Steps
Given the complexity of your symptoms and the involvement of multiple specialists, here are some recommendations:
1. Return to a Colorectal Surgeon: Since your initial concern was related to the anal area and potential fistula, it would be prudent to return to a colorectal surgeon. They can reassess your condition, especially considering the history of the bump and the potential for a fistula. They are best equipped to evaluate the structural issues related to your anal health.

2. Follow-Up with a Dermatologist: If the red spots and folliculitis persist, it may also be beneficial to follow up with a dermatologist. They can provide targeted treatment for the skin issues and help manage any secondary infections or irritations that may arise from your previous treatments.

3. Consider a Multidisciplinary Approach: Given the interplay between your skin and anal symptoms, a collaborative approach involving both a colorectal surgeon and a dermatologist might be beneficial. This way, both specialists can communicate and coordinate your care effectively.

4. Document Your Symptoms: Keep a detailed record of your symptoms, treatments, and any changes you notice. This information will be invaluable for your healthcare providers in diagnosing and treating your condition.

5. Discuss Concerns About Surgery: If surgery is recommended again, discuss your concerns about post-operative care with your surgeon. They may be able to provide solutions or support to ease your worries about recovery.

6. Seek Support: Dealing with chronic health issues can be emotionally taxing. Consider seeking support from a mental health professional or support groups where you can share your experiences and feelings.

Conclusion
Navigating health issues, especially those related to sensitive areas like the anal region, can be challenging and sometimes overwhelming. It’s essential to have a clear plan and to communicate openly with your healthcare providers. By returning to a colorectal surgeon and possibly involving a dermatologist, you can work towards a comprehensive treatment plan that addresses both your anal and skin concerns. Remember, your health and comfort are paramount, and seeking the right specialists is a critical step in your recovery journey.

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