Anal Fistulas: Symptoms, Concerns, and Prevention Tips

Suspected anal fistula?

Hello, Doctor.
I apologize for interrupting you during your busy schedule.
I underwent anal fistula surgery on July 10 of this year, with the location being slightly to the right of the anal opening.
I am recovering well, with only scar tissue remaining and no discharge.
I initially thought I could relax, but a few days ago, I discovered a small, pimple-like lump on the left side of the anal opening (directly opposite the previous surgical site).
It is painful to touch, with no discharge or opening.
Currently, the surgical site on the right side remains just scar tissue without any issues.
I visited a colorectal surgeon at a medical center for an examination, and the doctor mentioned that it looks like a fistula but does not appear to be one since there is no opening, and we need to observe it further.
If it grows larger or discharges pus, I should return.
As of now, this small lump has not increased in size or discharged pus, but it remains there and is painful when touched or pressed.
I have many fears and questions, but since the doctor seemed very busy with many patients, I felt bad about continuing to interrupt him, so I am here to bother you instead.
I sincerely apologize.
1.
Doctor, could this small, pimple-like lump without discharge or an opening possibly be an anal fistula, or what other possibilities could there be?
2.
The doctor previously indicated that my fistula was a simple single tract.
If this left side is also a fistula, would it be a newly formed simple single tract, or could it also be a branch of a recurrent fistula from the right side (a complex fistula)? (Although the right side currently appears normal.) If that is the case, would it be what is referred to as a horseshoe fistula, requiring a large incision for surgery?
3.
I would like to ask how to prevent anal fistulas.
After my surgery, I have been making a real effort to live a regular life, eating plenty of fruits and vegetables, washing my anus with warm water after bowel movements, drying it with a clean towel, and exercising for a fixed 30 minutes every day to boost my immune system.
Yet, I still developed this small lump that may or may not be a fistula, which is quite discouraging.
Is there anything else I might be missing?
4.
Since the surgery, I have experienced some anal fissures due to harder stools, resulting in a small amount of blood.
I have consulted a doctor about this, and he said it was fine, prescribing stool softeners and a hemorrhoid suppository.
After a few days, the pain and bleeding stopped.
Is it possible that the fissure wound became infected with bacteria, leading to the new growth? What can I do to prevent bacterial invasion of the anal fissure? Is rinsing with warm water and using suppositories not enough?
Thank you very much for taking the time to read and respond to my numerous questions.
I apologize for the many inquiries, and I appreciate your help.

hen danxin de binghuan, 20~29 year old female. Ask Date: 2018/10/24

Dr. Ke Fangxu reply Surgery

1.
It is also possible that it is a benign subcutaneous tumor or a smaller external hemorrhoid at the anal opening.
Since I cannot perform a physical examination, I cannot provide a definitive answer, but I recommend continued observation.

2.
Of course, a newly formed fistula is also a possibility; however, it is generally unlikely to develop such a fistula in such a short time.
A fistula extending from the opposite side is also possible, and complex fistulas (such as the horseshoe type you mentioned) can occur.
However, if this were the case, it should have been detected during the previous surgery, as these types of fistulas typically involve significant surgical wounds.
3.
No, and it has not yet been confirmed whether this is a fistula.
4.
No, the anal area is not a sterile environment, so there is no need for excessive concern.
Current warm water rinsing and topical ointments are sufficient.

Reply Date: 2018/10/24

More Info

Understanding anal fistulas and their management is crucial for anyone who has undergone surgery for this condition. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus, often resulting from an infection or abscess. Your concerns about the new lump you discovered after your surgery are valid, and I will address your questions in detail.

1. Possibility of a New Fistula: The small, painful lump you described near the left side of your anus, which has no discharge or opening, could potentially be a new anal fistula, but it could also be a different condition such as a skin tag, abscess, or even a simple cyst. Fistulas typically have an opening that can drain pus or other fluids, so the absence of discharge is a positive sign. However, pain upon touching the area suggests that it may still be inflamed or infected. It’s essential to monitor this lump closely for any changes in size, pain level, or the appearance of discharge.

2. Nature of the Fistula: If it turns out to be a fistula, it could either be a new, simple fistula or a complex one that branches from the original site. A complex fistula may involve multiple tracts and could require more extensive surgical intervention. The term "horseshoe fistula" refers to a specific type of complex fistula that encircles the anal canal. If this is the case, the surgical approach may indeed be more invasive, potentially requiring a larger incision. Your surgeon will likely perform imaging studies, such as an MRI or ultrasound, to determine the exact nature of the fistula if it is confirmed.

3. Prevention of Anal Fistulas: You are already taking commendable steps to maintain a healthy lifestyle, including a balanced diet rich in fruits and vegetables, regular exercise, and proper hygiene practices. To further reduce the risk of developing new fistulas, consider the following:
- Maintain Soft Stools: Continue to take stool softeners or fiber supplements as prescribed to prevent constipation and straining during bowel movements, which can lead to fissures and subsequent infections.

- Hydration: Drink plenty of water to help keep your stools soft.

- Hygiene: After bowel movements, continue to wash the anal area gently with warm water and pat dry with a clean towel. Avoid using harsh soaps or wipes that can irritate the skin.

- Regular Check-ups: Keep up with follow-up appointments with your healthcare provider to monitor your recovery and address any concerns promptly.

4. Concerns About Infection: It is possible that the hard stools leading to anal fissures could create a pathway for bacteria to enter and cause infection, potentially leading to the formation of a new fistula. To minimize this risk, ensure that you are managing your bowel health effectively. In addition to the measures mentioned above, consider:
- Avoiding Straining: If you feel the urge to go, do not delay your bowel movements, as this can lead to harder stools.

- Using Barrier Creams: Applying a barrier cream or ointment around the anal area can help protect the skin from irritation and moisture.

- Monitoring Symptoms: If you notice any signs of infection, such as increased pain, swelling, or discharge, seek medical attention promptly.

In conclusion, while the appearance of a new lump can be concerning, it is essential to remain vigilant and maintain open communication with your healthcare provider. Regular monitoring and adherence to preventive measures can significantly reduce the risk of complications. If you have further questions or concerns, do not hesitate to reach out to your healthcare team for guidance. Your proactive approach to your health is commendable, and continuing to prioritize your well-being will serve you well in your recovery journey.

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