Is It a Fistula? Symptoms and Treatment Options

Is it a fistula?

Hello Doctor, I have a small indentation on the right side of my buttocks that I was born with.
When I was younger, it was just itchy and didn't cause much discomfort.
However, in recent years, it has started to swell and ooze, with recurrent inflammation.
I have seen a traditional Chinese medicine practitioner, but it hasn't improved.
Which specialty should I consult? Should I see a general surgeon or a colorectal surgeon? Could this be a congenital fistula? Thank you, Doctor.

wendy, 30~39 year old female. Ask Date: 2017/12/14

Dr. Ke Fangxu reply Surgery

The term "congenital" refers to conditions that are present at birth, but it can also refer to conditions that are noticed later in life.
These two scenarios are quite different.
However, if there is inflammation with purulent discharge, it is best to start treatment with antibiotics to control the infection.
It is advisable to have a general surgeon or a colorectal surgeon examine the condition to confirm the diagnosis and determine the next steps in the treatment plan.

Reply Date: 2017/12/14

More Info

Based on your description, it sounds like you may be dealing with a condition known as a fistula, specifically a congenital fistula or possibly a pilonidal sinus, which is a small tunnel that can form under the skin, often in the area of the buttocks. This condition can lead to recurrent infections, inflammation, and the discharge of pus, which aligns with the symptoms you've been experiencing.

Symptoms of a Fistula
Fistulas can present with a variety of symptoms, including:
- Pain and Discomfort: You may experience pain in the affected area, especially during sitting or movement.

- Swelling and Redness: The area around the fistula may become swollen and red, indicating inflammation.

- Discharge: Pus or other fluids may drain from the opening of the fistula, which can be a sign of infection.

- Recurrent Infections: If the fistula becomes infected, you may experience fever, increased pain, and more significant swelling.

Treatment Options
The treatment for a fistula typically involves surgical intervention, especially if it is causing recurrent infections or significant discomfort. Here are some common treatment options:
1. Surgical Drainage: If there is an abscess associated with the fistula, the first step may be to drain the abscess to relieve pain and remove infected material.

2. Fistulotomy: This is a surgical procedure where the fistula tract is opened and laid flat to allow it to heal from the inside out. This is often the most effective treatment for anal fistulas.

3. Seton Placement: In some cases, a seton (a piece of surgical thread) may be placed in the fistula to help keep it open and allow for drainage while promoting healing.

4. Flap Surgery: For more complex fistulas, a flap of healthy tissue may be used to close the fistula and promote healing.

5. Medications: Antibiotics may be prescribed to treat any underlying infections, but they do not address the fistula itself.

Which Specialist to See?
Given your symptoms, it would be best to consult a colorectal surgeon or a general surgeon who specializes in treating conditions of the rectum and anus. They will be able to assess your condition accurately and recommend the most appropriate treatment plan.

Congenital Fistula
You mentioned the possibility of a congenital fistula. Congenital fistulas can occur due to abnormal development during fetal growth. If this is the case, surgical intervention is typically necessary to correct the issue and prevent further complications.

Conclusion
In summary, it is crucial to seek medical attention from a specialist who can provide a thorough evaluation and appropriate treatment for your symptoms. Early intervention can help prevent complications and improve your quality of life. If you have any further questions or concerns, do not hesitate to reach out to a healthcare professional.

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