Fistula Risks: When to Seek Medical Attention for Abscesses

Could there be an issue with a fistula?

Hello Doctor: I would like to ask about the issue of fistulas/abscesses.
On the morning of January 4th, I noticed a lump on the right side of my anus that was slightly painful.
That evening, due to a company year-end party, I sat at work for about two hours and found it increasingly uncomfortable (very painful).
Even at the restaurant, I tried to avoid sitting down (it was a buffet) and kept getting up to grab food or take photos.
After returning home and taking a shower, I felt the lump and noticed it was soft, but I didn't think much of it at the time.
The next day, on my day off, I touched it again upon waking and found that the lump had already burst.
I wiped it with tissue, and the pus had a bit of blood (and a foul smell), but I still didn't think much of it.
However, two days later, on January 7th, even though the lump had burst, there was no significant pain unless I pressed on it deliberately, and I could still feel a noticeable lump there.
Since the abscess had burst, it felt flat in the middle.
Years ago, I had a similar issue with a "boil" on my buttocks, which would come and go repeatedly, and each time it got larger and more painful until my family took me to see a doctor, where I learned that the lump had become infected.
I underwent surgery for drainage and was treated with oral antibiotics.
I'm wondering if this situation is similar to what I experienced years ago and if it could lead to a fistula.
Do I need to see a doctor? (I am a diabetic patient.)

Ling Er, 20~29 year old female. Ask Date: 2024/01/07

Dr. Zhang Shuhao reply Surgery

Based on the symptoms you described, it seems like an anal abscess.
During the acute phase, there will be swelling and pain, but once it ruptures and the pus drains out, the pain may alleviate.
You can start with warm sitz baths, and if there is pus in the wound, you can gently express it and then apply an ointment.
It is advisable to visit a colorectal clinic for evaluation, as it may not necessarily lead to the formation of a fistula (this depends on the size of the abscess and its distance from the anal opening).
Poor blood sugar control can increase the likelihood of recurrence.

Reply Date: 2024/01/07

More Info

When it comes to understanding the risks associated with fistulas and abscesses, especially in the context of your situation, it's crucial to recognize the potential complications and the importance of timely medical intervention.
From your description, it sounds like you experienced an abscess near the anal area, which can be quite painful and concerning. Abscesses are localized collections of pus that can occur due to infections, and they can lead to more serious conditions if not treated appropriately. The fact that you have a history of similar issues, such as the "疔仔" (which likely refers to a boil or skin abscess), raises the concern for recurrent infections and the potential development of a fistula.

A fistula is an abnormal connection between two body parts, often resulting from the drainage of an abscess that did not heal properly. In the case of anal abscesses, if the infection is not fully resolved, it can lead to the formation of a fistula, which can cause ongoing discomfort, drainage, and even systemic issues if the infection spreads.

Given your symptoms—specifically the painful swelling, the presence of pus, and the history of recurrent abscesses—it is advisable to seek medical attention. Here are some reasons why:
1. Infection Control: As a diabetic patient, your immune system may not respond as effectively to infections. This increases the risk of the infection spreading or worsening, which could lead to more severe complications.

2. Assessment of Fistula Formation: A healthcare professional can evaluate whether a fistula has formed. This typically involves a physical examination and possibly imaging studies. Early detection can prevent further complications.

3. Drainage and Treatment: If the abscess is still present or if it has formed a cavity, it may require drainage. This is often done in a sterile environment to prevent further infection and promote healing. Antibiotics may also be necessary to address any underlying infection.

4. Monitoring for Recurrence: Given your history of similar issues, a healthcare provider can offer guidance on how to manage and monitor for future occurrences. This may include lifestyle changes, dietary adjustments, or other preventive measures.

5. Diabetes Management: Proper management of your diabetes is crucial in preventing infections and promoting healing. Your healthcare provider can help ensure that your blood sugar levels are well-controlled, which is essential for recovery.

In summary, while it may be tempting to wait and see if the symptoms resolve on their own, the risks associated with untreated abscesses and the potential for fistula formation warrant a proactive approach. It is highly recommended that you consult with a healthcare professional as soon as possible to assess your condition and receive appropriate treatment. Early intervention can significantly improve outcomes and reduce the risk of complications.

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