Fistula Recurrence: Symptoms, Treatment, and When to Seek Surgery

Recurrence of anal fistula?

Hello doctor, I had anal fistula surgery in October 2016.
After healing for a year, I started to feel a hard lump during my menstrual periods.
When I returned to the doctor, he said to just take antibiotics.
Then, last year, I felt a hard lump again along with a feeling of heaviness during my menstrual period, so I went back to the doctor, who mentioned that there might be a recurrence but still advised me to take antibiotics.
Recently, I felt a lump about 1 cm in size, and it hurts when I sit down.
Does this mean I definitely need surgery? Due to the severe pandemic, I am hesitant to go to the hospital.
Should I just buy antibiotics myself? Can antibiotics make the fistula disappear? I only feel the hard lump and there is no pus coming out.

Lin, 30~39 year old female. Ask Date: 2021/05/30

Dr. Ke Fangxu reply Surgery

If the symptoms have persisted for such a long time without improvement, then antibiotic treatment may only address the symptoms rather than the underlying issue.
If the symptoms are not severe, it may be advisable to wait until the pandemic subsides before seeking medical attention.

Reply Date: 2021/05/30

More Info

Understanding the recurrence of anal fistulas can be quite complex, especially after previous surgical interventions. Based on your description, it seems you are experiencing symptoms that may indicate a recurrence of the fistula, which is not uncommon. Let’s break down the situation and discuss the symptoms, treatment options, and when it might be necessary to seek surgical intervention.

Symptoms of Fistula Recurrence
From your account, the symptoms you are experiencing include:
- The presence of a hard lump near the anal area.

- A feeling of heaviness or pressure (the "downward feeling").

- Pain when sitting, particularly when you touch the area.

These symptoms can suggest that the fistula may have recurred or that there is some form of inflammation or infection in the area. The hard lump you mentioned could be a sign of a fistula tract or a perianal abscess, which can occur if the original fistula did not heal properly or if new tissue has formed abnormally.

Treatment Options
1. Antibiotics: While antibiotics can help manage infections, they are not a definitive treatment for fistulas. They may temporarily alleviate symptoms if there is an associated infection, but they do not address the underlying fistula itself. It is important to note that taking antibiotics without a doctor's supervision can lead to resistance and other complications.

2. Observation: In some cases, if the symptoms are mild and there is no significant pain or drainage, a doctor may recommend monitoring the situation before deciding on further intervention.

3. Surgical Intervention: If the symptoms persist or worsen, surgical intervention is often necessary. Surgery is typically the most effective way to treat a recurrent fistula. The type of surgery may vary depending on the complexity of the fistula and its relation to surrounding structures. Common procedures include:
- Fistulotomy: This involves cutting open the fistula to allow it to heal from the inside out.

- Seton placement: A seton (a piece of thread or rubber) may be placed to help drain the fistula and promote healing.

- Advancement flap procedures: These are used for more complex fistulas and involve using surrounding tissue to close the fistula.

When to Seek Surgery
Given your symptoms, especially the pain and the presence of a hard lump, it is advisable to consult a healthcare provider. While the COVID-19 pandemic has made many hesitant to seek medical care, it is crucial to prioritize your health. Delaying treatment can lead to complications, such as abscess formation or chronic pain.

If you are unable to visit a hospital due to pandemic concerns, consider reaching out to your healthcare provider for a telemedicine consultation. They can assess your symptoms and guide you on the best course of action. If surgery is deemed necessary, they can discuss the safest way to proceed given the current health climate.

Conclusion
In summary, while antibiotics may provide temporary relief, they are not a cure for a fistula. Given your symptoms, it is likely that surgical intervention may be necessary. It is essential to consult with a healthcare professional to evaluate your condition properly. Do not attempt to self-medicate with antibiotics without professional guidance, as this could lead to further complications. Your health is paramount, and timely intervention can help prevent more severe issues down the line.

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