Anal Abscess: Recovery, Fistula Risks, and Symptoms

Q: Anal Abscess: Recovery, Fistula Risks, and Symptoms

Dear Xiao Ru：<br>1. <br>After the incision of an anal abscess, it is essential to take sitz baths to prevent the development of cellulitis or incomplete drainage. <br>There is no need to manually squeeze the area. <br>If you diligently take sitz baths, the wound can generally hea

Anal abscess

Hello, Doctor: On July 8, I developed a swelling near my anus, and the doctor diagnosed it as an anal abscess and performed an incision and drainage.
Currently, the wound is not painful, approximately 0.5 cm in size, and there is no discharge or bleeding.
I have the following questions:
1.
When will the wound heal? Should I take sitz baths? Is it necessary to manually express any pus? (I'm concerned about cleanliness since there has been no discharge.)
2.
Is it certain that a fistula will form? What is the likelihood? Do I need to return for a follow-up appointment?
3.
How can I determine if I have a fistula?
4.
Additionally, eight years ago, after giving birth, I noticed a small swelling just below the area that has now become swollen.
I felt a round lump, which has caused discomfort when sleeping or after eating spicy food, but applying topical ointments or hemorrhoid medication seemed to help.
It usually does not hurt and does not affect my bowel movements (as it is about 1 cm from the anus).
Could this be hemorrhoids? Is it related to the fistula? (There has been no pus or other discharge in the past.)
5.
There is also a piece of tissue at the anal opening that hangs down, which is completely painless and does not affect bowel movements.
What could this be?
I apologize for asking so many questions, but I would greatly appreciate your thorough assistance in addressing my concerns.
Thank you! Thank you! Thank you! Thank you! Thank you! Thank you!

Xiao Ru, 30~39 year old female. Ask Date: 2008/07/11

Dr. Ke Fangxu reply Surgery

Dear Xiao Ru:
1.
After the incision of an anal abscess, it is essential to take sitz baths to prevent the development of cellulitis or incomplete drainage.
There is no need to manually squeeze the area.
If you diligently take sitz baths, the wound can generally heal in about a week.
2.
The probability of developing a fistula after drainage of an anal abscess is approximately 50%.
If symptoms recur post-surgery or if the wound does not heal, you should seek further medical evaluation.
3.
A fistula typically presents with a skin opening that may be painful, bleed, or discharge pus.
If you palpate between this opening and the anus, you should be able to feel a hard tubular structure beneath the skin, which is a common manifestation.
4.
Based on your description, this appears to be an external hemorrhoid.
If the external hemorrhoid is not painful and does not bleed, surgical treatment is generally not recommended, and it is unrelated to a fistula.
5.
Is this protruding from inside the anus? If so, it could be a prolapsed internal hemorrhoid or rectal mucosal prolapse.
If it is located at the anal opening, it may be another external hemorrhoid or a viral wart (commonly referred to as a cauliflower wart).
To accurately determine the issue, a physical examination is necessary.
Generally, as long as there are no symptoms or it does not continue to grow, no specific treatment is required.

Reply Date: 2008/07/11

More Info

Understanding anal abscesses and their potential complications, such as fistulas, is crucial for effective recovery and management. Based on your situation, here are detailed answers to your questions regarding recovery, the risk of fistula formation, and symptoms to watch for.

1. Wound Healing and Care: After an incision and drainage of an anal abscess, the healing time can vary. Generally, the wound may take about 1 to 3 weeks to heal, depending on its size and your overall health. It is advisable to keep the area clean and dry. Sitz baths (sitting in warm water) can be beneficial as they help soothe the area, promote blood flow, and may aid in healing. However, avoid squeezing or trying to express any remaining pus, as this can introduce bacteria and lead to further complications. If there is no drainage, it is likely that the abscess has been adequately drained.

2. Risk of Fistula Formation: Not all anal abscesses lead to fistula formation, but there is a risk, especially if the abscess was extensive or if it was not completely drained. The likelihood of developing a fistula can be influenced by factors such as the size of the abscess and the presence of underlying conditions (like Crohn's disease). Regular follow-up with your healthcare provider is essential to monitor for any signs of fistula development.

3. Self-Assessment for Fistula: Signs that may indicate the presence of a fistula include persistent drainage from the anal area, pain, or discomfort that does not resolve, or the formation of a small opening near the anus that may leak pus or stool. If you notice any of these symptoms, it is important to consult your doctor for further evaluation.

4. Previous Issues and Possible Hemorrhoids: The round mass you felt near the anal area could potentially be a hemorrhoid, especially if it has been present for a while and does not cause significant pain. Hemorrhoids can sometimes be mistaken for other conditions, including anal abscesses or fistulas. Since you mentioned that it has not caused significant issues in the past, it may not be directly related to the abscess. However, it is advisable to have it evaluated by a healthcare professional to rule out any complications.

5. Other Growths: The fleshy growth you described at the anal opening could be a skin tag or another type of benign growth. These are often harmless and can occur after trauma or irritation. If it is not causing pain or affecting bowel movements, it may not require treatment, but it is still wise to have it assessed by a doctor.

In summary, while your recovery seems to be progressing well, it is essential to maintain communication with your healthcare provider. Regular check-ups will help ensure that any potential complications, such as fistula formation, are addressed promptly. If you experience any new symptoms or changes, do not hesitate to seek medical advice. Your health and comfort are paramount, and addressing these concerns with a professional will provide you with the best care possible.

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