Anal Fistulas in Infants: Symptoms and Treatment Options

Anal fistula in infants

Hello Doctor: I would like to ask about my child.
When my child was a little over two months old, a small hole appeared between the perineum and the anus.
Gas is expelled when passing gas, and there is a small amount of seepage of stool.
In December of last year, we attempted to locate the fistula tract in the outpatient clinic using a fine needle catheter, but it was unsuccessful.
The doctor suggested further observation and prescribed an antibiotic ointment.
The seepage and the wound examined at that time improved by the end of March this year.
However, on May 28, I noticed a bubble cavity appearing above the previously examined healing opening, which looks red.
How should we address this situation?

Wen, 30~39 year old female. Ask Date: 2022/05/30

Dr. Zhang Shuhao reply Surgery

First, observe for symptoms similar to previous fistula, such as discharge or signs of redness and swelling.
It is recommended to consult a pediatric surgeon or a colorectal specialist for examination.
If it is a simple inflammation, medication can be used for treatment; however, if a fistula has formed, debridement or fistula surgery may be necessary.

Reply Date: 2022/05/30

More Info

Anal fistulas in infants can be a concerning condition for parents, especially when they notice unusual symptoms such as a small opening between the anus and the perineum, gas or stool leakage, and the presence of a red, swollen area. Understanding the symptoms and treatment options is crucial for managing this condition effectively.

Symptoms of Anal Fistulas in Infants
1. Visible Opening: The most apparent symptom is a small hole or opening located between the anus and the perineum. This can sometimes be mistaken for a normal anatomical feature, but if it is associated with other symptoms, it warrants further investigation.

2. Gas and Stool Leakage: Parents may notice that gas escapes through the opening, and there may be small amounts of stool that also leak out. This is indicative of a connection between the rectal area and the skin, which is characteristic of a fistula.

3. Swelling and Redness: The area around the fistula may appear red and swollen, which can indicate inflammation or infection. In your case, the appearance of a "bubble" or cavity above the previously healed area suggests that there may be ongoing issues that need to be addressed.

4. Discomfort or Pain: While infants may not express discomfort in the same way older children or adults do, signs of fussiness, crying during bowel movements, or difficulty feeding can be indirect indicators of pain.

Treatment Options
1. Observation: In many cases, especially if the symptoms are mild and the child is otherwise healthy, doctors may recommend a watchful waiting approach. This involves monitoring the condition to see if it resolves on its own, which can sometimes happen as the child grows.

2. Antibiotic Ointments: As you mentioned, your doctor prescribed antibiotic ointments to help manage any potential infection. This is a common approach to prevent complications and promote healing of the surrounding skin.

3. Surgical Intervention: If the fistula does not heal or if new symptoms arise, such as the development of a cavity or abscess, surgical intervention may be necessary. The surgery typically involves excising the fistula and any associated tissue to ensure proper healing. This is often done under general anesthesia, and the recovery process can vary depending on the complexity of the fistula.

4. Follow-Up Care: Regular follow-up appointments with a pediatric surgeon or gastroenterologist are essential to monitor the healing process and address any new developments. If you notice any changes, such as increased redness, swelling, or discharge, it's crucial to contact your healthcare provider promptly.

When to Seek Further Medical Attention
Given that you have observed a new bubble or cavity above the previously healed area, it is advisable to seek further medical evaluation. This could indicate that the fistula has not fully healed or that a new issue has developed. A pediatric surgeon may perform imaging studies or a physical examination to assess the situation accurately.

In summary, while anal fistulas can be concerning, many cases can be managed effectively with observation and appropriate medical care. However, any new symptoms or changes in your child's condition should prompt a visit to the healthcare provider to ensure that they receive the best possible care. Your vigilance in monitoring your child's symptoms is essential for their health and well-being.

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