Anal Fistulas and Abscesses: Symptoms and Treatment Options

Anal fistula? Anal abscess? The polyp is still present?

Hello Doctor, regarding the consultation case you submitted #180079, there are two symptoms.
I apologize for the lengthy description (I have already sought medical attention, and the doctor mentioned it could possibly be an anal sebaceous cyst or abscess? He indicated it resembles a cyst more).
Here is the image link: https://ibb.co/kJbqm9d (this is a post-treatment image, not before the consultation).
The two symptoms are as follows:
1.
In the area marked with a red circle (position 1 in the image), about four years ago, there was a small abscess under the skin near the anus (approximately the size of a one-dollar coin) that felt swollen and painful upon pressure.
Due to embarrassment, I delayed seeking medical attention...
After a week or two, it ruptured on its own, and the swelling and discomfort while walking disappeared.
Once the pain subsided, I ignored it.
However, consuming spicy or fried foods would easily cause it to swell again.
When it swelled larger after a few days, straining during bowel movements (which might cause it to rupture and bleed into the toilet) or pressing it while wiping could expel pus and blood, relieving the discomfort.
This symptom persisted for two to three years, evolving from a subcutaneous abscess to a superficial polyp (approximately the size of a red bean connected to a soybean-sized polyp before seeking medical attention).
2.
In the area marked with a red circle (position 2 in the image), a few months ago, another lump formed under the skin.
When I first noticed it, I could feel it while sitting.
Within a week, it had swollen to the size where I could insert my thumb into the subcutaneous abscess.
It was painful to sit, and while straining during bowel movements, there was no sensation, but retracting caused severe pain.
Coughing also induced pain and chills, which made my body shake (this caused me the most distress, prompting immediate medical attention).
"The surgery was performed under local anesthesia, and I saw a lot of pus and blood being released.
I didn’t notice any solid mass.
I was discharged the same day, and the wound was not sutured.
For several days post-surgery, the wound frequently discharged an unclear fluid (possibly pus?).
The doctor sent the pus and blood collected during surgery for examination to identify the infection source (I recall it being Escherichia coli), and I was prescribed antibiotics."
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I would like to ask the doctor two questions:
1.
Are these two symptoms indicative of an anal sebaceous cyst? An anal abscess? (I only noted the keywords from the doctor at that time and am not quite sure if they are the same or different.)
2.
Regarding the image, in the area marked with a red circle (the red bean-sized polyp remains, while the soybean-sized polyp connected to it was excised), it no longer swells the day after consuming fried or spicy foods as it used to, but I experience swelling occasionally (about 1-2 times in the past six months).
After a few days, I can still expel pus and blood by pressing it with tissue.
Does this require further follow-up treatment? (It has been about six months post-surgery, and it doesn’t seem to have increased in size.) (I have had several follow-up appointments post-surgery, during which I noticed it still...)

Dong, 30~39 year old female. Ask Date: 2022/03/29

Dr. Chen Ronghong reply Surgery

The most likely diagnosis for this lesion is an anal fistula.
If it is only incised and drained without excising the fistula, it is likely to recur easily.
Whether a complete surgical excision is necessary depends on the frequency and severity of the symptoms.
It is recommended to consult an experienced physician at a colorectal clinic for evaluation.

Reply Date: 2022/03/29

More Info

Understanding anal fistulas and abscesses is crucial for managing symptoms and determining appropriate treatment options. Based on your description, it seems you have experienced two distinct issues related to your anal region: a recurring abscess and possibly a fistula.

1. Differentiating Between Anal Fistulas and Abscesses:
- An anal abscess is a localized collection of pus that can occur due to infection in the anal glands. It often presents as a painful swelling near the anus, which may rupture and drain pus. Your experience of a painful lump that eventually burst and drained is characteristic of an anal abscess.

- An anal fistula, on the other hand, is a small tunnel that forms between the anal canal and the skin near the anus, often as a result of a previous abscess. If the abscess does not heal properly, it can lead to the formation of a fistula, which may cause persistent drainage, discomfort, and recurrent infections. The fact that you have had ongoing issues with drainage and discomfort, especially after consuming certain foods, suggests that you may have developed a fistula.

2. Symptoms and Treatment Options:
- The symptoms you describe, including pain during sitting, bowel movements, and the presence of pus or blood, are indicative of an anal fistula or a chronic abscess. The intermittent nature of your symptoms, particularly the recurrence after eating spicy or fatty foods, points to a potential underlying issue that may require further evaluation.

- Treatment for anal abscesses typically involves drainage of the pus, which you have already undergone. If a fistula is confirmed, surgical intervention is often necessary to ensure proper healing and to prevent recurrence. This may involve a fistulotomy, where the fistula tract is opened and allowed to heal from the inside out.

3. Follow-Up Care:
- Given that you have had surgery and are still experiencing symptoms, it is advisable to seek a follow-up consultation with your healthcare provider. They may perform a physical examination and possibly imaging studies to assess the status of the fistula or any residual abscess. If the fistula is still present, additional surgical treatment may be required.

- It is also important to monitor your diet and avoid foods that trigger your symptoms. Maintaining good hygiene and following your doctor's recommendations for wound care post-surgery can help prevent infections.

4. Conclusion:
- In summary, your symptoms suggest the presence of both an anal abscess and possibly a fistula. The recurrence of symptoms after certain dietary choices indicates that further evaluation is warranted. It is essential to consult with a colorectal specialist who can provide a thorough assessment and recommend the most appropriate treatment plan tailored to your condition. Early intervention can help prevent complications and improve your quality of life.
If you have any further questions or concerns, please do not hesitate to reach out to your healthcare provider for personalized advice and treatment options.

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