Anal Abscesses: Do They Lead to Fistulas?

Q: Anal Abscesses: Do They Lead to Fistulas?

Hello, in response to your questions： <br>1. <br>The severity of an anal abscess is determined by the extent of its spread. <br>If the wound diameter is only 2.5 cm, it should not be considered very severe. <br>However, it is indeed unusual for the wound not to have shrunk after

Can an anal abscess really develop into an anal fistula?

I underwent surgery for an anal abscess on September 18th, and I have the following questions for the physician:
1.
It has been almost two weeks since the surgery, and I am washing the wound twice daily and soaking it in medication three times a day.
However, the wound, which is approximately 2.5 cm in diameter and 2 cm deep, seems to show no signs of shrinking, which is concerning.
How should I manage this situation?
2.
Before the surgery, the hospital doctor mentioned that a fistula would form and that a second surgery would be necessary.
I requested that both the abscess and fistula issues be addressed at once, but he said it was not possible, as doing so could likely result in incontinence.
I had no choice but to trust him.
Is what this doctor said true?
3.
Today, I noticed that when I pass gas, it is released from both the anus and the wound simultaneously.
Does this indicate that a fistula has formed? Is it time to proceed with the fistula excision surgery?
4.
The hospital has scheduled my follow-up appointment for October 25th, which is still a month away.
Is it too late to wait until the follow-up to address these issues? Is there a risk of another abscess forming within this month? As a patient dealing with this type of anal condition, I feel very isolated and hope the physician can provide detailed answers to my questions.

Yue Er, 30~39 year old female. Ask Date: 2005/09/30

Dr. Ke Fangxu reply Surgery

Hello, in response to your questions:
1.
The severity of an anal abscess is determined by the extent of its spread.
If the wound diameter is only 2.5 cm, it should not be considered very severe.
However, it is indeed unusual for the wound not to have shrunk after two weeks post-discharge.
As long as there is no purulent discharge from the wound, it should be fine.
The perception that the wound is not shrinking may simply be due to daily observation.
2.
The probability of developing a fistula after healing from an anal abscess is about 50%.
These two conditions cannot be managed simultaneously.
If the wound heals well, it does not necessarily mean that an anal fistula will develop.
Additionally, during the drainage of an anal abscess, the wound cannot be kept clean, making it unsuitable for suturing at that time.
3.
If gas is escaping from the wound during flatulence, it indicates that there is a connection between the wound and the rectum, which defines a fistula.
However, if the wound is large enough to allow gas to escape, it suggests a significant opening, making it inappropriate for fistula surgery at this stage.
Furthermore, the location of the wound can provide additional insights; if it is a single wound located near the anus, it is best to wait for it to heal.
However, if the wound is situated some distance from the anus, the situation becomes more complicated.
4.
The follow-up appointment on October 25th does seem a bit lengthy.
Generally, we recommend weekly follow-ups to monitor the healing of the wound.
However, enhanced sitz baths remain the primary guideline.
If the wound is not swollen, painful, or discharging pus, there should not be any major issues, but regular follow-ups are still advisable.

Reply Date: 2005/09/30

More Info

Anal abscesses are a common condition that can lead to complications such as fistulas if not properly managed. It’s understandable to have concerns after undergoing surgery for an anal abscess, especially regarding the healing process and the potential for further complications. Let’s address your questions one by one.

1. Wound Healing Concerns: It’s not uncommon for surgical wounds, especially those related to anal abscesses, to take time to heal. The size of your wound (2.5 cm in diameter and 2 cm deep) suggests that it may take several weeks to months to fully heal, depending on various factors including your overall health, nutrition, and adherence to post-operative care. Daily cleaning and medication application are crucial, but if you notice no signs of improvement or if the wound appears to be worsening (increased redness, swelling, or discharge), it’s important to contact your healthcare provider sooner than your scheduled follow-up. They may want to assess the wound for any signs of infection or other complications.

2. Surgical Approach to Fistulas: The statement made by your surgeon regarding the potential for a fistula to develop and the risks associated with attempting to address both the abscess and the fistula in one surgery is valid. Performing both procedures simultaneously can increase the risk of complications, including incontinence. Fistulas often require a different surgical approach and may need to be addressed after the abscess has healed. This staged approach allows for better healing and reduces the risk of complications.

3. Signs of Fistula Formation: The observation that gas is escaping from both the anal canal and the surgical site could indicate the formation of a fistula. Fistulas can develop as a result of an abscess, particularly if the abscess was extensive or if there was significant tissue damage. However, not all cases of dual passage of gas or stool indicate a fistula; it’s essential to have this evaluated by your surgeon. If you suspect a fistula has formed, it’s crucial to inform your healthcare provider as soon as possible, even before your scheduled follow-up.

4. Timing of Follow-Up: Waiting until your scheduled follow-up on October 25th may be appropriate if you are not experiencing significant pain, fever, or other concerning symptoms. However, if you notice any changes in your condition, such as increased drainage, pain, or the dual passage of gas, you should seek medical attention sooner. Recurrence of an abscess is possible, especially if there is an underlying fistula that has not been addressed.

In summary, it’s essential to maintain open communication with your healthcare provider regarding your healing process. If you have any concerns or notice changes in your symptoms, do not hesitate to reach out for advice or an earlier appointment. Managing anal abscesses and potential fistulas can be complex, but with proper care and monitoring, you can navigate this recovery process more effectively. Remember, you are not alone in this, and seeking support from healthcare professionals is crucial for your recovery.

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