Anal Fistulas: Symptoms, Risks, and Treatment Options

Determination of Anal Fistula

I apologize for the lengthy message, but I would like to seek your advice regarding a situation I have been experiencing.
About 4 to 6 years ago, while bathing, I accidentally scratched a small wound very close to my anus, about 1 to 2 centimeters away.
This wound has not healed over time, and occasionally, there is a little pus or blood.
When this happens, I feel a slight tightness in the area, but it has not affected my daily life for these past few years.

Initially, I thought the location of the wound, being near the anus and between my legs, was the reason it had not healed.
Recently, I came across the term "anal fistula." However, I remember that the wound was caused by a scratch rather than an anal abscess, and I did not experience fever.
The wound does not show any significant redness, swelling, heat, or pain, although it is slightly tender when pressed.
I have also learned that untreated anal fistulas can lead to anal cancer, and I have recently experienced mild rectal bleeding and itching around the anus, which has raised my concerns about whether this wound is indeed a fistula and if delaying treatment could lead to anal changes.
Therefore, I would like to ask if this could be an anal fistula, and whether I should urgently visit a hospital to confirm if it is a fistula.
Additionally, if it is a fistula, how urgent is the need for treatment? I understand that fistulas typically require surgery, and since this wound has been present for some time, I might not be able to schedule surgery until the second half of next year.
However, I am worried about the potential risk of developing anal cancer if the wound is left untreated.

Thank you for your assistance in clarifying these concerns.

Jin Jia, 20~29 year old female. Ask Date: 2022/12/28

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is unlikely to be related to cancer, but if you are concerned, you can visit the colorectal surgery clinic for confirmation.

Reply Date: 2022/12/28

More Info

Understanding anal fistulas is crucial for anyone experiencing symptoms related to the anal region, especially if there is a history of non-healing wounds. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. It often develops as a result of an infection in the anal glands, leading to the formation of an abscess. If the abscess does not heal properly, it can create a fistula.

Symptoms of Anal Fistulas
The symptoms you described, such as a persistent wound near the anus that has not healed, occasional discharge of pus or blood, and slight discomfort, are indeed consistent with an anal fistula. Other common symptoms may include:
- Pain or discomfort around the anus, especially during bowel movements.

- Swelling or redness in the area.

- Itching or irritation around the anus.

- Recurrent abscesses in the anal area.

- Discharge of pus or blood from the opening of the fistula.

Risks and Complications
While anal fistulas are not typically life-threatening, they can lead to complications if left untreated. Chronic inflammation and infection can occur, and in rare cases, there is a risk of developing anal cancer, especially if there are other risk factors present. The presence of blood in your stool, as you mentioned, is concerning and should not be ignored. It could indicate other underlying issues, such as hemorrhoids, diverticulosis, or even more serious conditions.

Treatment Options
The primary treatment for an anal fistula is surgical intervention. The goal of surgery is to remove the fistula while preserving the surrounding healthy tissue and minimizing damage to the anal sphincter. There are several surgical techniques, including:
- Fistulotomy: This is the most common procedure where the fistula tract is opened and allowed to heal from the inside out.

- Seton placement: A seton (a piece of surgical thread) is placed in the fistula to help drain it and promote healing.

- Flap procedures: In cases where the fistula is complex, a flap of tissue may be used to close the internal opening of the fistula.

Urgency of Treatment
Given that your wound has persisted for several years and you are now experiencing additional symptoms like blood in your stool and anal itching, it is advisable to seek medical attention promptly. While it may not be an emergency, delaying evaluation and treatment could lead to further complications. A healthcare provider can perform a thorough examination, possibly including imaging studies, to determine the exact nature of your condition.

Conclusion
In summary, based on your description, it is possible that you have an anal fistula, and the presence of blood in your stool warrants further investigation. It is essential to consult with a healthcare professional, preferably a colorectal surgeon, who can provide a definitive diagnosis and discuss appropriate treatment options. Early intervention can help prevent complications and improve your quality of life. Don’t hesitate to reach out to a medical professional for an evaluation; your health is paramount.

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