Anal Fistula Symptoms and Management: Your Questions Answered

Inquire whether it is related to fistula issues?

Recently, I have been experiencing a painful sensation near the anus that feels like a skin tear (it's not very painful, but it affects my mood).
When I rinse with hot water, it feels like there is a painful wound similar to a skin tear.
I often feel something like a band of muscle pushing against my skin very close to the anus (I can often feel it when I touch it).
Today, I went to the hospital for an examination.
The doctor performed a digital rectal exam and mentioned that it resembles a fistula.
He felt a small hard lump but was uncertain if it was a skin fold and suggested using an anoscope for further examination.
After the anoscopy, he said he did not see any wounds and it should not be a fistula.
I then informed the doctor about the sensation of a band-like muscle pressing against my skin near the anus, and he advised me to come in quickly if it swells up next time.
I asked the doctor if a fistula could appear and disappear, and he replied affirmatively, which left me quite confused.
I would like to ask: 1.
Is it possible that this is a fistula, or are there specific symptoms that can definitively indicate a fistula? 2.
What should I pay attention to in this situation? 3.
I work in a job that involves frequent lifting, and I often have sweat around the anus.
How can I improve this condition? Thank you.

SF, 30~39 year old female. Ask Date: 2023/05/30

Dr. Ke Fangxu reply Surgery

1.
Is it necessary to personally examine the fistula to confirm that it generally needs to meet the three conditions of an internal opening, external opening, and the tract? However, it is not always guaranteed that all three can be identified.

2.
Maintain cleanliness and avoid excessive wiping; do not apply irritating ointments indiscriminately.

3.
Sweating during work is normal; wearing loose-fitting, breathable clothing can help keep the area ventilated and dry.

Reply Date: 2023/05/30

More Info

Understanding anal fistulas and their symptoms can be quite complex, especially when the symptoms are intermittent and not clearly defined. Based on your description, it sounds like you are experiencing discomfort around the anal area, which could potentially be related to an anal fistula, but it is important to consider other possibilities as well.

1. Could this be an anal fistula?
An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. Symptoms of an anal fistula can include:
- Pain or discomfort around the anus, especially during bowel movements.

- Swelling or redness around the anal area.

- Discharge of pus or blood from the opening near the anus.

- A feeling of a lump or hard area near the anus.

In your case, the intermittent nature of your symptoms and the fact that the doctor did not find a clear opening during the examination may suggest that it is not a classic anal fistula. However, it is possible for a fistula to be present without a visible opening, especially if it is in a stage of healing or if it is not actively draining.

2. What symptoms would definitively indicate a fistula?
While there is no single symptom that can definitively diagnose an anal fistula, the presence of persistent pain, swelling, and discharge is often indicative. If you notice:
- Persistent pain that worsens with bowel movements.

- A noticeable lump or swelling that becomes painful.

- Discharge of pus or blood, especially if it has a foul odor.

These symptoms warrant further investigation. If your symptoms worsen or new symptoms develop, it is crucial to seek medical attention promptly.

3. What should you be cautious about?
Given your symptoms, here are a few things to keep in mind:
- Hygiene: Maintain good hygiene in the anal area to prevent irritation and infection. After bowel movements, gently clean the area with mild soap and water, and consider using moist wipes.

- Diet: A high-fiber diet can help prevent constipation, which can exacerbate anal pain. Staying hydrated is also important.

- Avoid Straining: Straining during bowel movements can increase pressure in the anal area and worsen symptoms. If you experience constipation, consider using stool softeners or fiber supplements.

- Monitor Symptoms: Keep track of any changes in your symptoms, including the frequency and severity of pain, any discharge, and any changes in bowel habits.

4. Managing moisture and discomfort
Since you mentioned that your job involves lifting and moving, which may lead to sweating in the anal area, consider the following tips:
- Breathable Fabrics: Wear loose-fitting, breathable underwear made from natural fibers like cotton to help reduce moisture buildup.

- Stay Dry: After sweating, try to change into dry clothing as soon as possible. You can also use absorbent powders designed for moisture control in sensitive areas.

- Frequent Breaks: If possible, take breaks during your work to allow for airflow and reduce moisture accumulation.

Conclusion
While your symptoms may not definitively indicate an anal fistula, they warrant careful monitoring and possibly further evaluation. If symptoms persist or worsen, consider seeking a second opinion or requesting more specialized imaging studies, such as an MRI or an endoanal ultrasound, which can provide more detailed information about the anal canal and surrounding tissues. Always consult with your healthcare provider for personalized advice and treatment options based on your specific situation.

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