Painful Red Swelling Near the Anus: Causes and Treatments

There is a red, swollen area next to the anus that is painful?

Anal issues, with a lump that appeared rapidly two days ago.
Eight years ago, I had an anal fistula and underwent surgical removal.
Over the past two years, I have occasionally experienced lumps near the anus that develop quickly (growing large in less than a day) and can be painful when pressed.
Initially, I consulted the physician who treated my fistula, and he said it was merely folliculitis, prescribing mupirocin ointment for me to apply.
After using it for about 3 to 4 days, it healed.
These lumps appear intermittently (ranging from a few months to a few weeks apart), initially being very swollen and painful for a day or two, and after applying mupirocin for a few days, they disappear, although I felt the initial effect of mupirocin was not significant.
Due to my overweight condition, I suffer from irritable bowel syndrome (frequent bowel movements, occasional diarrhea) and often sit for long periods.
I am very concerned that a fistula may be forming again, but I am also wondering if it is just a common case of folliculitis, as I frequently develop similar follicular lumps in my armpits.
Could you please advise whether I should continue using regular mupirocin or an ointment containing fusidic acid for the anal area, since my physician recommended applying fusidic acid ointment for my armpit folliculitis?

Hao tong, 20~29 year old female. Ask Date: 2021/10/26

Dr. Ke Fangxu reply Surgery

Fusidic acid ointments or similar medications are used to treat conditions that may involve the recurrence of abscesses or general folliculitis, but it is essential to consult a physician for an accurate diagnosis.

Reply Date: 2021/10/26

More Info

Understanding painful red swelling near the anus can be quite distressing, especially given your medical history of anal fistula and the recurring nature of the swelling. Based on your description, it seems that you are experiencing episodes of localized swelling and pain, which could be attributed to a few potential causes.

Possible Causes
1. Folliculitis: As your previous physician suggested, the swelling could indeed be due to folliculitis, which is an inflammation of the hair follicles. This condition can occur in areas where there is friction, moisture, or irritation, and it can lead to painful, swollen bumps that may resemble boils.

2. Abscess: Another possibility is the formation of an abscess, which is a collection of pus that can occur due to infection. Given your history of anal fistula, there is a chance that an abscess could form if there is a blockage or infection in the area.

3. Recurrence of Fistula: While you mentioned concerns about a recurrence of the fistula, it is important to note that the symptoms you describe may not necessarily indicate a new fistula. However, if you notice persistent swelling, pain, or discharge, it would be wise to consult a specialist.

4. Skin Conditions: Conditions such as hidradenitis suppurativa, which involves painful lumps and abscesses in areas with sweat glands, could also be a consideration, especially if you have similar issues in other areas like your armpits.

Treatment Options
1. Topical Antibiotics: You mentioned using mupirocin (紫菌素) in the past, which is effective for treating localized skin infections. If you are experiencing similar symptoms, continuing with mupirocin could be beneficial. However, if the swelling is particularly painful or if you notice signs of systemic infection (fever, chills), it may be necessary to seek oral antibiotics.

2. Fusidic Acid Cream: Fusidic acid is another topical antibiotic that can be effective against skin infections. If you have had success with it in the past for similar issues, it may be worth trying. However, it is essential to follow your physician's advice regarding which medication is most appropriate for your current symptoms.

3. Warm Compresses: Applying warm compresses to the affected area can help reduce pain and promote drainage if there is an abscess. This method can also soothe inflammation.

4. Hygiene and Care: Maintaining good hygiene in the anal area is crucial. Avoiding tight clothing and ensuring the area is clean and dry can help prevent further irritation and infection.

5. Diet and Lifestyle Modifications: Given your mention of irritable bowel syndrome (IBS) and being overweight, addressing these issues may also help reduce the frequency of flare-ups. A balanced diet, regular exercise, and staying hydrated can contribute to overall digestive health.

When to Seek Medical Attention
If the swelling persists, worsens, or is accompanied by fever, significant pain, or drainage of pus, it is essential to seek medical attention promptly. A healthcare professional may need to perform an examination and possibly imaging studies to rule out more serious conditions.

In conclusion, while it is possible that you are experiencing recurrent folliculitis or a similar condition, given your medical history, it is crucial to monitor your symptoms closely. If you have any doubts or if the condition does not improve with over-the-counter treatments, consulting a healthcare provider for a thorough evaluation would be the best course of action.

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