Anal Skin Issues: Pimples vs. Abscesses Explained

Unable to distinguish between acne and an anal abscess (has sought medical attention)?

Hello, Dr.
Ke.
Last week, perhaps due to prolonged sitting, I developed a bump near my anus that resembles a pimple.
The location is not very close to the anus, but it is also not far, approximately at a distance where stool would not come into contact during bowel movements.
Later, this bump released a small amount of fluid similar to tissue fluid, but it did not produce pus.
On the evening of March 26 (Friday), I visited a nearby clinic where the doctor specializes in colorectal medicine.
After a digital rectal examination, he told me there was no fistula and advised me to not worry, suggesting I treat it as just a pimple on my buttocks.
He also mentioned that if it ruptured, it would be fine.
That night, after taking a warm bath, the bump indeed ruptured and released some pus.
As of today, it has almost completely stopped hurting, although there is still a slight protrusion, but there is no redness or swelling.
However, I do not consider my anal health to be good; in the past, I have had abscesses closer to the anal opening, and now this area often has a hard black spot.
Sometimes, when I sit for extended periods at work, it takes on a pimple-like appearance, which makes me quite worried.
However, each time I visit the doctor, they examine me and say it is not an anal fistula.
Therefore, I have the following questions for the doctor:
1.
Does this protrusion resemble an anal abscess or fistula? (I have attached a picture below)
2.
If this bump had an abscess that later ruptured and released pus, why did the clinic doctor not classify it as an anal abscess? In general, how can patients differentiate between an abscess, a fistula, or other skin conditions (such as folliculitis)?
3.
If it is neither an abscess nor a fistula, why does this area frequently develop pimple-like bumps? Are there any methods to improve this condition?
I apologize for the many questions, but even though the clinic doctor told me not to worry, I am still very concerned because my anal health is not great, and I am extremely afraid of developing a fistula.
I hope to receive a second opinion and would appreciate your assistance in answering these questions.
Attached image (bump near the anus): https://ibb.co/NrvZC04

Xiao Bai, 20~29 year old female. Ask Date: 2021/03/29

Dr. Ke Fangxu reply Surgery

1.
If so many professional physicians believe it is not a fistula, I cannot simply overturn their diagnosis based on a unclear photograph.
The key elements for diagnosing a fistula, aside from the external opening, include palpating a firm tract, which cannot be achieved through online consultations.

2.
The extent and depth of an anal abscess are greater, while folliculitis is limited to the surrounding follicular tissue.
Even experienced physicians can sometimes misdiagnose, and the general public cannot diagnose this on their own.
3.
Oily skin and individuals with compromised immune systems are more likely to experience this phenomenon; sometimes it is simply a matter of constitution and cannot be completely cured.

Reply Date: 2021/03/29

More Info

When it comes to anal skin issues, distinguishing between conditions like pimples, abscesses, and fistulas can be quite challenging. Your description suggests that you experienced a localized bump near the anal area, which later released some fluid and pus. Let's break down your concerns and provide clarity on the possible conditions.

1. Pimples vs. Abscesses: A pimple is typically a small, raised bump on the skin that can be filled with pus or fluid, often resulting from clogged pores or hair follicles. An abscess, on the other hand, is a collection of pus that forms due to infection, leading to swelling and pain. The fact that your bump released pus indicates that it may have been an abscess, especially since it was painful initially and then resolved after drainage. However, the absence of significant pain and inflammation afterward suggests it might have been a superficial infection rather than a deep-seated abscess.

2. Fistulas: A fistula is an abnormal connection between two body parts, often resulting from an infection or abscess that has not healed properly. Your doctor’s assessment that there is no fistula is reassuring, especially since you mentioned that they performed a digital examination and found no signs of one. The presence of a hard black dot and recurring bumps could suggest a condition like folliculitis (inflammation of hair follicles) or even a sebaceous cyst, which can occur in the anal region due to blocked glands.

3. Self-Diagnosis: It can be difficult for patients to self-diagnose these conditions accurately. Generally, if a bump is painful, swollen, and warm to the touch, it may indicate an abscess. If it persists or drains fluid without significant pain, it could be a cyst or a benign skin condition. If you notice recurrent bumps, it might be worth considering factors such as hygiene, skin care products, or even dietary influences that could contribute to skin irritation or infection.

4. Management and Prevention: To manage and prevent future occurrences, consider the following:
- Hygiene: Maintain good hygiene in the anal area. Gentle cleansing with mild soap and water can help prevent infections.

- Avoid Irritants: Be cautious with products that may irritate the skin, such as harsh soaps or scented wipes.

- Diet and Hydration: A balanced diet and adequate hydration can improve skin health. Foods rich in omega-3 fatty acids, antioxidants, and vitamins can support skin integrity.

- Clothing Choices: Wear breathable, loose-fitting clothing to reduce friction and moisture buildup in the anal area.

- Consult a Specialist: If the bumps continue to recur or if you experience any new symptoms, it’s advisable to consult a dermatologist or a colorectal specialist for a thorough evaluation.

In conclusion, while your initial assessment by the doctor was reassuring, it’s understandable to have lingering concerns, especially with a history of anal skin issues. Monitoring your symptoms and maintaining good hygiene practices can help manage your condition effectively. If you notice any changes or if the bumps become painful again, seeking further medical advice is always a prudent choice.

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