Concerns After Failed Fistula Imaging: What Should You Do Next?

After the outpatient visit, a suspected hernia was arranged for examination, but the wound could not be located for evaluation?

On May 1st, I noticed a large abscess on my buttocks that was painful and also bled.
The next day, I went to see a doctor who suspected it might be a fistula and advised me to schedule a fistulography.
On that day, the doctor made an incision and drained the pus.
I scheduled the imaging for May 6th and was instructed to fast for four hours beforehand.
When I arrived for the imaging, the doctor was unable to locate the incision site on my buttocks, which prevented the examination from being performed.
The doctor also asked if I had any ongoing bleeding or fever, to which I replied no, and then I was sent home.

However, I am still quite worried.
Although there is no pain and, as the doctor mentioned, the opening is not visible, I can still feel a small, slightly swollen area that is not very noticeable.
I would like to know what I should do next—should I return for another examination or wait for a potential recurrence before seeking further evaluation? Thank you.

Additionally, I would like to ask if the fistulography is very painful, as I am really afraid of pain.
I was actually relieved to hear that the imaging was not necessary at that moment, but I am concerned about missing any underlying issues.

Wang, 20~29 year old female. Ask Date: 2019/05/07

Dr. Ke Fangxu reply Surgery

After incision and drainage of an anal abscess, there is a 50% chance of complete healing without the formation of a fistula.
Personally, I do not recommend performing a fistulography at this stage, as the wound may not have healed or may still be unstable.
If the fistula can be clearly palpated, fistulography is not necessary.
I suggest monitoring the situation for a period of time before reassessing.

Reply Date: 2019/05/07

More Info

After experiencing a painful abscess and subsequent examination by your doctor, it seems you are understandably concerned about the possibility of a fistula and the implications of the failed imaging procedure. Let’s break down your situation and explore the next steps you can take.

Firstly, it’s important to understand what a fistula is. A fistula is an abnormal connection between two body parts, often resulting from an infection or inflammation. In your case, it appears that the abscess may have been a precursor to a fistula, which can occur in the anal region. The fact that your doctor was unable to locate the opening for the fistula during the imaging procedure could indicate that the fistula is not currently active or that it has closed up, which can happen after an abscess has been drained.

Given that you are no longer experiencing pain, bleeding, or fever, these are positive signs. However, the presence of a small lump that you can still feel may warrant further investigation. Here are some recommendations on what you should consider doing next:
1. Follow-Up Appointment: It would be prudent to schedule a follow-up appointment with your doctor. Even if the symptoms have subsided, the lump you can feel should be evaluated. Your doctor may want to perform a physical examination to assess the area more thoroughly.

2. Monitoring Symptoms: Keep an eye on any changes in your symptoms. If you notice any new symptoms such as increased pain, swelling, or discharge, it’s essential to contact your healthcare provider immediately. These could be signs of a recurrence or a new issue.

3. Imaging Options: If your doctor believes that imaging is still necessary, they may suggest alternative methods. While fistulography (the imaging you were scheduled for) is one option, other imaging techniques such as an MRI or ultrasound may provide additional information without the discomfort you fear.

4. Discussing Pain Management: If you are concerned about the pain associated with potential imaging procedures, discuss this with your doctor. They can provide you with information on what to expect and may offer pain management options to make the process more comfortable.

5. Surgical Consultation: If a fistula is confirmed or suspected, a surgical consultation may be necessary. A colorectal surgeon specializes in these types of conditions and can provide insights into treatment options, which may include surgical intervention if needed.

6. Lifestyle and Dietary Considerations: Maintaining a healthy diet and staying hydrated can help promote healing and prevent constipation, which can exacerbate anal issues. Consider incorporating fiber-rich foods and staying active.

In conclusion, while the absence of pain and other acute symptoms is reassuring, it’s essential to remain vigilant. Scheduling a follow-up appointment with your healthcare provider is the best course of action to ensure that any underlying issues are addressed promptly. Do not hesitate to voice your concerns about pain and anxiety regarding procedures; your comfort and understanding are vital in managing your health.

Similar Q&A

CT Imaging in Urology: Assessing Renal Hydronephrosis and Urinary Tract Issues

Hello, Director Du! Thank you very much for your consultations. Regarding the first question of case 178099, you may have misunderstood my intention. My question is: since my renal edema is caused by external pressure from a mass at the iliac artery compressing the ureter, during...

Dr. Du Shixi reply Urology
Hello: 1) There is a limit to CT scans; depending on the different models, it usually requires a few millimeters or more to make a judgment. If the scans are done at the same hospital, it is often possible to compare the images from two different times. 2) The urine test result f...

Understanding Renal Hydronephrosis: Treatment Options and Concerns

Dear Dr. Hsu, I underwent an abdominal ultrasound which revealed hydronephrosis in my right kidney, and I also had an intravenous pyelogram (IVP) performed. The report indicated congenital ureteral stenosis (with no stones or tumors present). The doctor mentioned that no treatme...

Dr. Xu Weikai reply Urology
Hello, there are many causes of hydronephrosis, with the most common being kidney stones and strictures. In your case, if it was only recently discovered and there are no symptoms, and if the swelling is mild, it is indeed sufficient to follow up with ultrasound every 1-3 months....

Understanding Urinary Tract Infections and Persistent Back Pain

Hello, I have already gone to a large hospital for examination due to concerns about bacteremia. After blood tests, urinalysis, X-rays, and kidney ultrasounds, the doctor said there were no significant issues. However, I still occasionally feel some discomfort near the urethral o...

Dr. Hong Yuanbin reply Internal Medicine
Hello, if these tests have been done, it will take some time to improve. It is recommended to drink plenty of water and get more rest. However, if you suddenly experience a fever or increased pain later on, you will need to return to a major hospital for a detailed examination. T...

Understanding Post-Bladder Removal: Common Concerns and Care Tips

Due to bladder cancer, the doctor recommended a cystectomy. After the surgery, it was found that the area where the urinary bag was attached was particularly swollen. The doctor mentioned that this is normal but did not explain why this occurs. This has caused some confusion and ...

Dr. Cai Zongyou reply Urology
Hello: In response to your question, the treatment of tumors is a very complex process, especially as it is necessary to establish a treatment plan tailored to your specific condition. This plan may vary depending on the stage of the tumor. Since your description lacks detail, I ...