Anal Fistulas: Symptoms, Treatment Options, and Risks

Issues related to anal fistulas?

Dear Dr.
Ke,
Background: On June 12, I experienced discomfort and slight pain in the anal area.
By June 15, the pain and swelling became severe, making it difficult to walk, stand, sit, or sleep, and I felt a sense of heat (but no fever).
Note: In retrospect, the symptoms resembled those of an anal abscess.
At that time, I thought it was hemorrhoids and consulted a traditional Chinese medicine practitioner on June 20, taking herbal medicine, which led to gradual improvement by June 23.
Note: The severe pain and swelling lasted for about a week.
By July, I noticed a hard lump about the size of a 50 NT dollar coin next to the anus.
It fluctuated in size and was accompanied by slight pain and swelling.
I immediately went to the hospital and consulted a colorectal specialist.
After a physical examination, the doctor diagnosed it as an anal fistula, recommending surgical intervention for a cure.
I would like to ask you the following questions:
1.
Currently, I have a hard lump next to my anus, but there is no external opening of the fistula.
I am coexisting with the lesion, and it does not affect my work or daily life, nor does it cause pain.
Since I have a business trip abroad soon, I may not be able to properly care for myself post-surgery.
Is it possible to delay the surgery? If so, how long can it be postponed? Or do you recommend proceeding with the surgery as soon as possible? I am concerned that delaying treatment may lead to a complex fistula.
2.
If I choose not to have surgery, will I only be able to manage the lesion to prevent recurrence, or is there still a risk of the fistula worsening?
3.
What is the accuracy of the doctor's physical examination in diagnosing this condition, and is there a possibility of misdiagnosis? Note: I have only seen one doctor so far.
Thank you very much for taking the time to address my questions.
Wishing you well, and thank you again.

A Shui, 30~39 year old female. Ask Date: 2017/07/31

Dr. Ke Fangxu reply Surgery

1.
If you are planning to travel abroad soon, it is advisable to wait until you return to your home country to undergo surgery to avoid complications with the surgical site while overseas, where you may have limited access to help.
In the meantime, you can manage your symptoms with oral medications until you return for the surgery.

2.
Yes.

3.
If you are uncertain about this physician's diagnosis, you may seek a second opinion from another specialist.

Reply Date: 2017/07/31

More Info

Understanding anal fistulas is crucial for effective management and treatment. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus, often resulting from an infection or abscess. The symptoms can vary but typically include pain, swelling, and the presence of a hard lump near the anus, which may drain pus or blood.

Symptoms of Anal Fistulas
The symptoms you described, including discomfort, pain, and the presence of a hard lump, are common indicators of an anal fistula. Other symptoms may include:
- Persistent pain or discomfort around the anus
- Swelling or redness in the affected area
- Discharge of pus or blood from the lump
- Irritation of the skin around the anus
- Difficulty sitting or walking due to pain

Treatment Options
The primary treatment for anal fistulas is surgical intervention. The goal of surgery is to remove the fistula while preserving the function of the anal sphincter. There are several surgical options, including:
1. Fistulotomy: This is the most common procedure where the fistula tract is opened and allowed to heal from the inside out.

2. Seton placement: A seton (a piece of surgical thread) is placed in the fistula to help drain it and promote healing.

3. Fistula plug: A bioprosthetic plug may be used to close the fistula.

4. LIFT procedure: This involves lifting the fistula tract away from the anal sphincter and closing it.

Risks of Delaying Surgery
1. Complications: Delaying surgery may lead to complications, including the development of a more complex fistula or recurrent infections. Complex fistulas can involve multiple tracts and may require more extensive surgery.

2. Quality of Life: While you may not currently experience significant pain or disruption to your daily life, the presence of the fistula can lead to unpredictable symptoms, potentially affecting your quality of life.

3. Risk of Malignancy: Although rare, chronic anal fistulas can be associated with an increased risk of anal cancer.

Considerations for Delay
If you are considering delaying surgery due to upcoming travel, it is essential to discuss this with your healthcare provider. They can provide personalized advice based on the specifics of your condition. Generally, if the fistula is not causing significant symptoms and you are not at risk of complications, a short delay may be acceptable. However, it is crucial to monitor the situation closely.

Prognosis Without Surgery
If you choose not to undergo surgery, the fistula may not resolve on its own. While some patients may experience periods of remission, there is a risk of recurrence or worsening of the condition. Non-surgical management may include:
- Maintaining good hygiene
- Using sitz baths to relieve discomfort
- Taking pain relief medications as needed
- Monitoring for any changes in symptoms

Accuracy of Diagnosis
Regarding the accuracy of your diagnosis, a thorough examination by a qualified healthcare professional is essential. While physical examination is a critical component of diagnosing anal fistulas, imaging studies such as an MRI or endoanal ultrasound may be recommended for complex cases. If you have concerns about the accuracy of the diagnosis, seeking a second opinion from another colorectal specialist may provide additional reassurance.

Conclusion
In summary, while it may be tempting to delay surgery for an anal fistula, it is essential to weigh the risks and benefits carefully. Surgical intervention is typically the most effective treatment to prevent complications and improve quality of life. Regular follow-up with your healthcare provider is crucial to monitor the condition and make informed decisions about your treatment plan. Always prioritize open communication with your healthcare team to ensure the best outcomes for your health.

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