Is It Hemorrhoid Infection or Fistula? Your Symptoms

Is it a hemorrhoid infection or a fistula?

Hello Doctor, I underwent a minimally invasive surgery for hemorrhoids last November, and both my internal and external hemorrhoids seemed to have healed.
However, there is still some residual tissue from the external hemorrhoid (without any symptoms).
In April of this year, I strained too hard during a bowel movement, which seemed to cause a recurrence of the external hemorrhoid, resulting in significant pain.
In a moment of desperation, I used a needle to puncture the external hemorrhoid tissue in hopes of draining it.
A week later, the external hemorrhoid began to swell frequently after bowel movements, and even developed pus and pain, which would spontaneously rupture after half a day, releasing pus and alleviating the pain.

Between April and now, I have seen three doctors at major hospitals, all of whom diagnosed it as a typical external hemorrhoid, and there were no issues found during the examination.
However, I still experience some pus-like discharge after each bowel movement (though it does not have a strong odor).
Starting in May, the symptoms gradually improved; the external hemorrhoid still occasionally discharges pus, but the frequency has decreased, swelling has reduced, and the amount of pus has significantly diminished.

In May, I consulted a fourth doctor who prescribed antibiotics and anti-inflammatory medication, which I am currently taking.
I would like to ask if the infection was caused by my puncturing the external hemorrhoid? Is there a possibility that this could develop into a fistula, or do my symptoms already indicate a fistula? All the doctors I consulted stated it is not a fistula, yet my symptoms feel very much like one.
Is it possible for the symptoms I described to heal with anti-inflammatory and antibiotic treatment? Thank you for your response.

pinggu, 20~29 year old female. Ask Date: 2018/06/01

Dr. Ke Fangxu reply Surgery

Based on your description, it does seem like a fistula, but it is essential for a physician to examine you in person to determine the cause.
It is likely related to a bacterial infection rather than your own actions.
If your symptoms do not recur after oral antibiotic treatment, you can continue to monitor the situation.
However, if the symptoms persist, surgical intervention may need to be considered.

Reply Date: 2018/06/01

More Info

It sounds like you are experiencing a complex situation with your external hemorrhoids and potential complications following your surgery. Based on your description, it is essential to differentiate between a simple external hemorrhoid issue and a possible anal fistula or infection.

Understanding Your Symptoms
1. External Hemorrhoids: These are swollen veins located around the anus. They can become painful, especially if they form a clot (thrombosed hemorrhoid) or become inflamed. Symptoms typically include pain, swelling, and sometimes bleeding during bowel movements.

2. Infection: The fact that you have experienced pus discharge and pain after attempting to relieve pressure by puncturing the hemorrhoid raises the possibility of an infection. If the external hemorrhoid becomes thrombosed or if there is a tear in the skin, bacteria can enter and cause an infection, leading to pus formation.

3. Fistula: An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. Symptoms can include persistent drainage, pain, and sometimes recurrent infections. The presence of pus and ongoing symptoms after your initial treatment raises the question of whether a fistula has developed, particularly if you notice a persistent opening or drainage.

What to Do Next
Given that you have already consulted multiple physicians and are currently on antibiotics and anti-inflammatory medication, here are some recommendations:
- Follow-Up Care: Continue to monitor your symptoms closely. If the pain, swelling, or discharge worsens, or if you develop a fever, it is crucial to seek immediate medical attention.
- Sitz Baths: Taking warm sitz baths can help relieve discomfort and promote healing. This can also help keep the area clean and reduce the risk of further infection.

- Dietary Adjustments: Ensure you are consuming a high-fiber diet to prevent straining during bowel movements. Adequate hydration is also essential to soften stools.

- Avoid Self-Treatment: While it may be tempting to attempt to relieve symptoms on your own, such as by puncturing or draining the area, this can lead to complications. Always consult with a healthcare professional for appropriate interventions.

- Consider Imaging or Further Evaluation: If symptoms persist despite treatment, or if there is any suspicion of a fistula, your physician may recommend imaging studies, such as an MRI or an endoscopic examination, to evaluate the area more thoroughly.

Conclusion
In summary, while your symptoms could be related to an infection of the external hemorrhoid, there is also a possibility of developing a fistula, especially given the history of drainage and pain. The antibiotics and anti-inflammatory medications you are taking may help resolve the infection, but if symptoms do not improve, further evaluation will be necessary. Always keep open communication with your healthcare providers and do not hesitate to seek a second opinion if you feel your concerns are not being adequately addressed. Your health and comfort are paramount, and appropriate management can lead to significant improvement in your condition.

Similar Q&A

How to Differentiate Between Fistula and Hemorrhoids Symptoms

Hello, doctor. Recently, I have been experiencing a small amount of foul-smelling liquid leaking from my anus. However, upon examining my anus with a mirror, I did not notice any signs of a fistula (there is no redness, swelling, heat, or pain; it just resembles the symptoms of a...

Dr. Zhang Shuhao reply Surgery
Anal fistulas and hemorrhoids can occur simultaneously, but the presence of foul-smelling discharge from the anus is not necessarily caused by a fistula. Fistulas typically form after inflammation and swelling, and there may be an external opening on the skin, often accompanied b...

Understanding Hemorrhoids: Symptoms, Diagnosis, and Treatment Options

I'm sorry to ask the doctor, but I have internal hemorrhoids. Two weeks ago, my stool was a bit hard, and I felt something unusual in my anus. There was a small amount of blood on the toilet paper. I used a suppository, which helped a bit, but then it became swollen again. I...

Dr. Ke Fangxu reply Surgery
Anal fistulas can indeed only be definitively treated through surgical intervention. However, based on your description, it seems more likely that you may be dealing with hemorrhoids. In addition to a lump, an anal fistula would also present a hard, tubular structure connecting t...

Understanding Anal Issues: Is It Hemorrhoids or a Fistula?

Hello doctor, this is a picture of my buttocks: https://ppt.cc/f18W9x. There is a growth on the skin that doesn't hurt, itch, or have any wounds; it's just an extra piece that has been there for a long time. Recently, I went to a dermatology clinic, and they suggested i...

Dr. Zhang Shuhao reply Surgery
The image does not appear to show hemorrhoids or a fistula; if there is no swelling or pain, it does not resemble an anal abscess either. Fistulas typically present with a hard lump, and there may sometimes be swelling, pain, and discharge. It is recommended to visit an outpatien...

Understanding Symptoms: Is It an Anal Fistula or Something Else?

Hello Dr. Ke: About two to three months ago, I experienced diarrhea, which, combined with my pre-existing internal hemorrhoids, led to an anal fissure with bleeding. For the past two to three months, I have been applying medication and improving my bowel habits, having regular bo...

Dr. Ke Fangxu reply Surgery
Chronic anal pain following long-term diarrhea is usually caused by anal fissures rather than fistulas. If the pain persists, it is important to consult a physician for diagnosis and treatment; otherwise, if a fistula is present, there may be complications due to infection. Howev...