Anal Fistulas: Symptoms, Treatment, and Timing for Surgery

Anal fistula

About two weeks ago, I discovered a raised lump near my anus.
It is pink in color and painful when pressed, roughly a little smaller than a coin.
At first, I didn't pay much attention to it, but after a few days, it started to ooze a little pus, so I went to see a doctor.
The doctor said it has developed into an anal fistula.
However, since I usually study away from home and don't have time for hospitalization and surgery, I would like to ask the doctor if delaying the surgery until winter break would be very serious.
I'm quite worried, as I've heard that recovery from surgery can be quite inconvenient.
I've attached a photo for the doctor to review: https://drive.google.com/file/d/1M3xhm0fFgD8a4ulkeGtFmpT1ahhQTqzL/view?usp=sharing.
Please let me know how serious it is.
Thank you, doctor.

Niming, 20~29 year old female. Ask Date: 2020/10/14

Dr. Ke Fangxu reply Surgery

Based on the image, it is indeed possible that it is an anal fistula; however, without a personal examination, it cannot be confirmed.
If there is no redness, swelling, pain, or discharge, it is less concerning.
You can start with oral medication for treatment and consider surgery during the winter break, which should not have a significant impact.

Reply Date: 2020/10/14

More Info

Understanding anal fistulas is crucial for managing symptoms and determining the appropriate treatment. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. It often arises from an infection in the anal glands, leading to the formation of an abscess that can drain pus. The symptoms you described—a painful, pinkish lump near the anus that has started to ooze—are consistent with this condition.

Symptoms of Anal Fistulas
The primary symptoms of an anal fistula include:
1. Pain and Discomfort: This is often the most distressing symptom. The pain can worsen during bowel movements or when sitting.

2. Swelling and Redness: The area around the anus may appear swollen and red, indicating inflammation.

3. Discharge: You may notice pus or blood draining from the fistula, which can lead to irritation of the surrounding skin.

4. Recurrent Abscesses: Many patients experience recurrent infections or abscesses in the same area.

Treatment Options
The standard treatment for an anal fistula is surgical intervention. The goal of surgery is to remove the fistula while preserving the surrounding sphincter muscles to maintain bowel control. There are several surgical techniques, including:
- Fistulotomy: This involves cutting open the fistula to allow it to heal from the inside out.

- Seton Placement: A seton (a piece of surgical thread) may be placed to help drain the fistula and promote healing over time.

- Flap Procedures: In more complex cases, tissue flaps may be used to close the fistula.

Timing for Surgery
Regarding your concern about delaying surgery until your winter break, it is essential to understand the potential risks involved. While it may be tempting to postpone the procedure due to your academic commitments, delaying treatment can lead to complications, including:
1. Increased Pain and Discomfort: The condition may worsen, leading to more severe pain and discomfort.

2. Worsening Infection: If the fistula becomes infected, it could lead to more significant complications, such as abscess formation.

3. Potential for Complicated Surgery: Delaying surgery may result in the fistula becoming more complex, making surgical repair more challenging and increasing recovery time.

Post-Surgery Considerations
You mentioned concerns about the inconvenience of surgery. It is true that recovery from anal fistula surgery can be uncomfortable. Common post-operative issues include:
- Pain Management: Pain is typically managed with medications, and your doctor will provide guidance on how to manage discomfort.

- Bowel Movements: You may experience changes in bowel habits, and it is essential to maintain a high-fiber diet and stay hydrated to prevent constipation.

- Follow-Up Care: Regular follow-up appointments are crucial to monitor healing and address any complications.

Conclusion
In summary, while it is understandable to want to delay surgery due to your studies, it is advisable to consult with your healthcare provider about the risks of postponing treatment. If the fistula is causing significant symptoms or has started to drain, it may be best to prioritize surgery sooner rather than later to avoid complications. Your health should always come first, and addressing this issue promptly can lead to a better outcome and improved quality of life.

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