Anal Fistulas: Diagnosis and Symptoms Explained

Q: Anal Fistulas: Diagnosis and Symptoms Explained

Hello Mr. <br>Huang： An anal fistula is one of the complications that can occur after the drainage of an anal abscess. <br>A common symptom is the presence of a small, non-healing opening near the anus, which may intermittently cause swelling, pain, bleeding, or discharge of pus.

Question about anal fistula?

Doctor, six months ago I had an abscess on the right side of my anus that was drained in the outpatient clinic.
Recently, during a follow-up visit, the doctor said that an anal fistula has formed.
I have seen three doctors: one said it is a fistula and mentioned there is discharge (I am not sure if it is due to the hot weather and sweating), another said it should be a fistula but did not palpate the fistula tract and could not find the fistula opening, and the third said a fistula has not yet formed since there was no palpation of a fibrotic fistula tract and nothing was found when using a needle.
Could you please explain the criteria for diagnosing an anal fistula? P.S.
Over the past six months, I have not experienced significant discomfort in the anal area, but I do feel some pain in my buttocks after long periods of driving, and occasionally it feels a bit moist.

Mr. Huang, 30~39 year old female. Ask Date: 2010/07/18

Dr. Ke Fangxu reply Surgery

Hello Mr.
Huang: An anal fistula is one of the complications that can occur after the drainage of an anal abscess.
A common symptom is the presence of a small, non-healing opening near the anus, which may intermittently cause swelling, pain, bleeding, or discharge of pus.
Chronic fistulas may become fibrotic, allowing a hard cord to be palpated extending from the wound to the anus.
However, patients who are more obese or have recently undergone abscess drainage may find it more difficult to feel the so-called fistula tract.
Diagnosis primarily relies on clinical physical examination, although some may undergo fistulography; however, this is typically reserved for complex fistulas and is not commonly performed on general patients.
If the symptoms are not severe, oral antibiotics may be used for treatment.
If symptoms do not improve over time, the likelihood of an anal fistula forming remains high, and surgical treatment is more likely to provide a definitive cure.

Reply Date: 2010/07/18

More Info

Understanding anal fistulas is crucial for anyone experiencing symptoms related to the anal region, especially after a history of abscesses. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. It often develops as a complication of an anal abscess, which is a collection of pus that can occur due to infection.

Diagnosis of Anal Fistulas
The diagnosis of an anal fistula typically involves a combination of clinical examination and imaging studies. Here are some key points regarding the diagnosis:
1. Clinical Examination: A thorough physical examination by a healthcare provider is essential. The doctor may perform a digital rectal exam to assess for any abnormalities. They will look for signs of a fistula, such as external openings or discharge.

2. Symptoms: Common symptoms of an anal fistula include:
- Persistent drainage of pus or blood from the anus.

- Pain or discomfort around the anal area, especially when sitting or during bowel movements.

- Swelling or redness around the anus.

- Occasional fever if there is an associated infection.

3. Imaging Studies: If the physical examination is inconclusive, imaging studies such as an MRI or endoanal ultrasound may be utilized to visualize the fistula and its tract. These studies can help determine the complexity of the fistula and guide treatment.

Conditions for Fistula Diagnosis
For a diagnosis of an anal fistula to be made, certain conditions must be met:
- Presence of an External Opening: A fistula typically has an external opening on the skin near the anus. This is where pus or other fluids may drain.

- Discharge: The presence of discharge (which may be pus or blood) is a strong indicator of a fistula. However, it is important to differentiate this from other conditions that may cause similar symptoms.

- Fistula Tract: The healthcare provider may attempt to palpate the fistula tract. If it is present, it may feel like a firm cord under the skin. However, in some cases, the tract may not be easily palpable, especially if it is small or not well-formed.

Your Situation
In your case, it seems that you have experienced an anal abscess that has led to concerns about a possible fistula. The varying opinions from different doctors regarding the presence of a fistula can be confusing. Here are some considerations based on your description:
- No Significant Symptoms: The fact that you have not experienced significant discomfort, aside from occasional pain after prolonged sitting, is a positive sign. Many fistulas can be asymptomatic, but they may still require monitoring or treatment.

- Discharge and Moisture: The occasional wetness you feel could be related to sweat or discharge from a fistula. If there is any persistent drainage, it would be advisable to keep track of it and report it to your healthcare provider.

- Follow-Up: Given the uncertainty regarding the presence of a fistula, it may be beneficial to follow up with a colorectal specialist who can perform a more detailed examination and possibly imaging studies to clarify the situation.

Conclusion
Anal fistulas can be complex, and their diagnosis often requires careful evaluation. If you suspect you have a fistula, or if you have been diagnosed with one, it is essential to maintain open communication with your healthcare provider. They can guide you through the necessary steps for diagnosis and treatment, ensuring that any complications are addressed promptly. If symptoms worsen or new symptoms arise, seek medical attention as soon as possible.

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