Is This a Rectal Abscess? Your Symptoms and Diagnosis

Is this an anal fistula?

Hello doctor, recently I have developed a round lump located about 6-7 centimeters from the anal opening, within the subcutaneous tissue.
It is not visible externally.
After about two months, I noticed that the lump seems to have increased in size and is painful when pressed.
In addition to the round lump, I can also feel what seems to be a tubular structure connected to it.
I have already undergone excision and biopsy at a dermatology clinic, and I also visited a proctology clinic for a digital examination.
The examining doctor stated that it is not an anal fistula.
During the examination, the doctor inserted a finger into the rectum and pressed in various directions, asking if I felt significant pain, to which I replied no.
I would like to ask, does my lump resemble that of an external anal fistula? Does the examination indicate that my condition is not an abscess related to the external opening of an anal fistula?

Xiao Xin, 30~39 year old female. Ask Date: 2022/03/17

Dr. Zhang Shuhao reply Surgery

The diagnosis and treatment of anal fistulas require a certain level of clinical experience, and it can be challenging to determine the course of the fistula and the locations of the internal and external openings during acute inflammation.
If a mass is palpated, anti-inflammatory pain relief medications and antibiotics can be administered initially.
If an abscess has formed, drainage should be performed first, and only after the local inflammation has subsided can it be determined whether a fistula has developed.
If the fistula connects to the rectum, it is prone to recurrent episodes, and surgical excision is recommended.

Reply Date: 2022/03/17

More Info

Based on your description, it sounds like you are experiencing a subcutaneous lump located approximately 6-7 centimeters from the anal opening, which has been present for about two months and has increased in size. You also mentioned that it is painful when pressed, and you can feel a tubular structure connected to the round lump. Given these symptoms, it is understandable to be concerned about the possibility of a rectal abscess or a related condition.

A rectal abscess typically occurs when an infection develops in the anal glands, leading to the formation of pus. This can result in a painful, swollen area near the anus, which may feel warm to the touch. The presence of a tubular structure could suggest a fistula, which is an abnormal connection between the rectum and the skin, often resulting from a previous abscess. However, the fact that your doctor performed a digital rectal examination and did not find significant pain or tenderness during the examination may indicate that it is not an acute abscess or a fistula.

The examination by the colorectal specialist, along with the skin biopsy you mentioned, will provide more clarity. If the lump is indeed a rectal abscess, it would typically require drainage, and if it is a fistula, surgical intervention may be necessary. The biopsy will help determine the nature of the lump—whether it is an abscess, a cyst, or another type of lesion.

In terms of differential diagnoses, other possibilities could include a sebaceous cyst, a lipoma (a benign fatty tumor), or even a pilonidal cyst, which can occur in the sacrococcygeal area. Each of these conditions has distinct characteristics and treatment approaches.

It is important to follow up with your healthcare provider regarding the results of your biopsy and any further imaging studies that may be necessary. If the lump continues to grow, becomes increasingly painful, or if you develop systemic symptoms such as fever, it is crucial to seek medical attention promptly.

In summary, while your symptoms could be consistent with a rectal abscess, the findings from your physical examination and the results of your biopsy will ultimately guide the diagnosis. It is reassuring that your doctor did not find significant pain during the examination, which may suggest that the condition is not an acute infection. However, it is essential to await the biopsy results for a definitive diagnosis and appropriate management.

Similar Q&A

Is It an Anal Abscess? Symptoms and Treatment Explained

I would like to ask the doctor, about three days ago I started feeling swelling in my anus. At first, I thought it was hemorrhoids, and it hurts when I move or strain. Then, two days later, I noticed some yellow discharge. Could this symptom indicate an anal abscess? How should I...

Dr. Ke Fangxu reply Surgery
What issues can lead to a correct diagnosis of anal fissures, hemorrhoids, fistulas, abscesses, or pilonidal cysts only through a personal examination by a physician? It is advisable to consult a doctor to avoid delays in treatment that could worsen the condition.

Understanding Anal Abscess: Symptoms, Causes, and Treatment Options

Hello Doctor, In March, I discovered a lump near my anus, which is painful to the touch, but I have not experienced any fever or discharge. After researching, I suspect it might be an anal fistula. I consulted a colorectal specialist who performed a digital examination and said...

Dr. Yu Mingchang reply Surgery
Hello; when you have time, please take a look at the colorectal diagnosis from the Ministry of Health and Welfare Changhua Hospital. We care about you.

Understanding Abscesses Above the Anus: Treatment Options and Advice

Hello Doctor, I would like to ask you about the pain I have been experiencing above my anus for the past few days. There seems to be a small abscess-like formation. I had a similar situation about 10 years ago, but I did not see a doctor. It healed after the abscess burst and pus...

Dr. Lin Shaojie reply Surgery
Dear Dr. Chuang Ren-bin of the Tainan Hospital, Department of Surgery, Executive Yuan Health Department: Hello, Xiao Zhang: Based on your description, the most likely diagnosis is an anal abscess, which is 90% caused by the formation of an anal fistula. Neither the abscess nor ...

Understanding Anal Abscess: Symptoms, Causes, and Treatment Options

Hello Doctor, I started experiencing pain around my anus on November 30th, which has affected my daily life. On December 1st, I visited my family doctor who suspected it was hemorrhoids and prescribed antibiotics and an ointment. However, on the evening of December 2nd, I noticed...

Dr. Zhang Shuhao reply Surgery
The family medicine physician prescribed antibiotics and ointment, indicating that the doctor also suspects an anal abscess. If it ruptures on its own, it's fine; you can clean and disinfect the area and gently express the pus. Continue applying the ointment to the wound. Af...