Anal Fistulas: Symptoms, Diagnosis, and Treatment Options

Anal fistula

I have occasionally experienced inflammation in my buttocks, resulting in a large lump that resembles a sebaceous cyst (which I am prone to developing).
Each time the inflammation occurs, it is in a different location, and it usually resolves on its own without any intervention.
As I grew older, I learned that this could potentially be an anal abscess, which may develop into an anal fistula.
I have not seen a doctor about this, but a few years ago, I had a particularly large inflammation that was more than five centimeters away from the anus and was painful for several days.
Eventually, it healed without further inflammation, but I now have a small, round area of purple pigmentation on the skin that feels like a depression when pressed, although the surface is flat and there is no opening.
In the past two years, a similar situation has occurred in a different location, but there has been no inflammation or pus discharge from the same site.
1.
Although there is no opening, the sensation of a depression when pressed—could this be an anal fistula, or is it still possible that it is a sebaceous cyst? (When I press on the pigmented area of the healed wound, I feel a depression, but I do not feel a tract leading to the anus, and there is no visible discharge.)
2.
If it is an anal fistula and has been present for several years, given the current situation where there is no inflammation or pus discharge from the same location, is surgery necessary? Can it coexist without surgery, and what problems might arise if surgery is not performed?
3.
What symptoms indicate that surgery is necessary?

Ms. Chen, 20~29 year old female. Ask Date: 2023/07/18

Dr. Zhang Shuhao reply Surgery

1.
An anal fistula originates from the anal glands, creating a channel from the epidermal wound to the anus.
A sebaceous cyst originates from the skin glands and, even if there are some subcutaneous spaces (feeling like there are holes when pressed), it will not connect to the anus.
2.
The likelihood of an anal fistula is low; it is more likely to be a subcutaneous fistula.
If there are no symptoms, surgery is not necessary.
3.
Symptoms include redness, swelling, heat, pain, purulent discharge, and a noticeable subcutaneous mass; in this case, medical evaluation is needed to determine if surgical removal is necessary.

Reply Date: 2023/07/18

More Info

Understanding anal fistulas, their symptoms, diagnosis, and treatment options is crucial for anyone experiencing related issues. 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 anal abscess, which is a collection of pus that can occur due to infection or inflammation in the anal glands.

Symptoms of Anal Fistulas
The symptoms of anal fistulas can vary, but common signs include:
1. Pain and Discomfort: Patients often experience pain around the anus, especially during bowel movements or when sitting.

2. Swelling and Inflammation: The area may become swollen and tender, resembling a lump or cyst.

3. Discharge: There may be pus or blood discharge from the opening of the fistula, which can lead to irritation of the surrounding skin.

4. Recurrent Abscesses: Many individuals with anal fistulas have a history of recurrent anal abscesses.

5. Skin Irritation: The skin around the anus may become irritated due to constant moisture from discharge.

Diagnosis
Diagnosis typically involves a physical examination by a healthcare provider, who may perform a digital rectal exam. In some cases, imaging studies such as an MRI or ultrasound may be necessary to assess the extent of the fistula and its relationship to surrounding structures.

Treatment Options
1. Conservative Management: If the fistula is asymptomatic and not causing significant issues, some providers may recommend a watchful waiting approach. However, this is generally not advisable for long-term management.

2. Surgical Intervention: Surgery is often the most effective treatment for anal fistulas. The goal is to remove the fistula while preserving the anal sphincter function. Common surgical procedures include:
- Fistulotomy: This involves cutting open the fistula to allow it to heal from the inside out.

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

- Fistula Plug: A bioprosthetic plug can be inserted to close the fistula.

- LIFT Procedure: This involves ligating the intersphincteric fistula tract.

Addressing Your Concerns
1. Presence of a "Dimple" or "Hole": The presence of a dimple or depression in the skin without an external opening could suggest a fistula, especially if it has been persistent. However, it could also be a result of a previous abscess or a pilonidal cyst. A healthcare provider should evaluate this to determine the exact nature of the lesion.

2. Need for Surgery: If the fistula has been present for several years without causing significant symptoms, some individuals may choose to live with it. However, untreated fistulas can lead to complications, including recurrent infections, abscess formation, and potential damage to the anal sphincter. Surgical intervention is generally recommended if there are recurrent symptoms or if the fistula is causing significant discomfort.

3. Symptoms Indicating Surgery: You should consider surgery if you experience:
- Persistent pain or discomfort.

- Recurrent abscesses or infections.

- Significant drainage or discharge.

- Changes in bowel habits or difficulty with bowel movements.

Conclusion
It is essential to consult a healthcare provider for a thorough evaluation and to discuss your symptoms and concerns. They can provide a definitive diagnosis and recommend the most appropriate treatment options based on your specific situation. Early intervention can prevent complications and improve your quality of life.

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