Anal Abscesses and Fistulas: What You Need to Know

Anal abscess and anal fistula?

Hello, Dr.
Ke.
Last May, I underwent surgery for an anal abscess drainage (in the operating room).
Half a month later, I had a drainage procedure for a perineal abscess in the outpatient clinic.
The wound from the outpatient drainage has not healed, and I have made multiple trips to the hospital during this time.
The doctor indicated that it might be related to my individual constitution and advised me not to worry too much.
After examinations, it was believed that I was recovering well.
By around September, I noticed that the wound from the drainage had healed.
In November of the same year, I felt that the area around the perineal wound was hard to the touch, and pressing on it caused some pain, although it was not significant.
I continued to take warm sitz baths during this period.
In December, I began to feel something was off because the area around the healed wound started to become painful (which was not the case before; it only hurt when sitting down).
I also felt that the skin in that area was a bit tight (suspecting it might be swollen; family members looked at it and said it appeared normal).
I maintained my routine of warm sitz baths (twice a day).
Due to work commitments, I have been unable to schedule an appointment at a large hospital until the end of April, as I suspect it might be a fistula.
I would like to ask the doctor, if I wait until the end of April, is there a significant chance that it could develop into a complex fistula?

Niming, 30~39 year old female. Ask Date: 2018/01/28

Dr. Ke Fangxu reply Surgery

Based on your description, it does seem possible that a complex anal fistula may have formed due to repeated infections.
There shouldn't be significant changes within just a few months, but if there are episodes of swelling, pain, or inflammation during this time, it is important to consult a physician for evaluation and treatment.

Reply Date: 2018/01/28

More Info

Understanding anal abscesses and fistulas is crucial for anyone who has experienced these conditions, especially after surgical interventions. An anal abscess is a localized collection of pus that occurs in the tissue surrounding the anus, often resulting from an infection of the anal glands. If not adequately treated, an abscess can lead to the formation of a fistula, which is an abnormal connection between the anal canal and the skin surrounding the anus.

In your case, it seems you had an anal abscess that required drainage, and subsequently, you experienced complications with the healing process. It is not uncommon for wounds in the perianal area to take time to heal, and factors such as individual healing capacity, the presence of infection, and the complexity of the abscess can all influence recovery.

The symptoms you describe, such as the hardness around the incision site, tenderness upon pressure, and the sensation of tightness, could indicate several possibilities. One concern is the development of a fistula, which can occur if the abscess does not heal properly. Fistulas can be classified as simple or complex, with complex fistulas often involving multiple tracts and being more challenging to treat.

Regarding your concern about waiting until late April for a consultation, it is essential to understand that while some anal fistulas can remain stable for a time, delaying evaluation and treatment can lead to complications. If a fistula develops, it may become more complex over time, potentially leading to increased pain, infection, and further complications such as abscess formation in new areas.

In terms of management, the standard approach for a suspected anal fistula typically involves a thorough examination, which may include imaging studies such as an MRI or endoanal ultrasound to assess the anatomy of the fistula and surrounding tissues. Treatment usually involves surgical intervention to properly address the fistula and promote healing.
In the meantime, continuing with warm sitz baths can help alleviate discomfort and promote hygiene in the area. Maintaining a high-fiber diet and staying hydrated can also help prevent constipation, which can exacerbate anal pain and complicate healing.

If you notice any worsening symptoms, such as increased pain, fever, or drainage from the wound, it is crucial to seek medical attention sooner rather than later. Early intervention can prevent complications and lead to better outcomes.

In summary, while it is possible that your condition may remain stable until your appointment, there is a risk that it could progress to a more complex fistula. It is advisable to remain vigilant about your symptoms and seek care if you experience significant changes. Your health and comfort are paramount, and timely evaluation by a specialist can provide you with the best options for treatment and recovery.

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