How to Differentiate Between Folliculitis and Anal Fistula?

How can one distinguish between folliculitis and an anal fistula?

Hello Doctor: Recently, I've experienced occasional itching in the anal area.
I applied a common anti-inflammatory ointment for minor injuries, but the next day, my buttocks became red and swollen.
Later, I noticed two small, pimple-like bumps on the left side of the anal area, positioned at the 8 o'clock location.
They are very small but quite painful, and they appear to have pus, although the pus hasn't increased in size or drained.
The swelling and pain are affecting the muscles in the genital area; urination is smooth, but there is a sensation of pain in the muscles.
I do not have any issues with constipation and have regular bowel movements.
Could those two bumps simply be folliculitis, or could it be a more serious anal fistula? Since I am currently abroad, I am unsure if I should return to Taiwan for a medical examination.
If it is just folliculitis, can I use a common acne treatment? The acne medication contains a 2.5% benzoyl peroxide formula, which provides the effectiveness of a 10% benzoyl peroxide formula with less irritation.
If I do not see a doctor and do not take anti-inflammatory medication, but instead rinse with clean water after each bowel movement and keep the area dry, can it heal naturally? Thank you, Doctor!

Miss Chen, 30~39 year old female. Ask Date: 2010/10/21

Dr. Ke Fangxu reply Surgery

Hello, in response to your question about folliculitis and the anal canal, the main difference is that the anal canal can be felt as a hard line leading to the anus.
Massaging this hard line may sometimes result in the discharge of pus or blood from the anal canal.
If it is folliculitis, it is not recommended to use acne ointments; however, general anti-inflammatory ointments for external injuries can be used.
Maintaining cleanliness is a good practice, but it does not guarantee healing.
If there is an increase in redness and swelling or if fever occurs, it is important to seek medical attention to prevent progression to cellulitis.
Wishing you safety and well-being.
Dr.
Ke Fang-Hsu, Keelung Hospital.

Reply Date: 2010/10/21

More Info

When differentiating between folliculitis and an anal fistula, it is essential to consider the clinical presentation, symptoms, and underlying causes of each condition. Folliculitis is an inflammation of the hair follicles, often caused by bacterial infection, irritation, or blockage. It typically presents as small, red, pus-filled bumps that can be itchy or painful. These lesions may appear anywhere on the body where hair follicles are present, including the buttocks.

On the other hand, an anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. It usually develops as a complication of an anal abscess, which is a collection of pus that forms due to infection. Symptoms of an anal fistula may include persistent pain, swelling, and discharge of pus or blood from the opening near the anus. The pain associated with a fistula can be more severe and may be accompanied by other symptoms such as fever or changes in bowel habits.

In your case, the presence of two small, painful bumps near the anus that appear to have pus could suggest either folliculitis or an early-stage anal fistula. The fact that these bumps are painful and have not significantly increased in size may lean more towards folliculitis, especially if there is no associated discharge or significant swelling of the surrounding tissue. However, the pain radiating to the pelvic muscles and the location of the bumps warrant careful consideration.

If you are currently abroad and unable to see a physician immediately, there are some steps you can take to manage the symptoms. Keeping the area clean and dry is crucial. You can gently wash the area with mild soap and water and pat it dry. Avoid using harsh soaps or scrubs that could irritate the skin further. While topical treatments like benzoyl peroxide may help with folliculitis, they can also irritate sensitive skin, especially in the anal region. Therefore, it is advisable to use such products cautiously.

If the bumps do not improve within a few days or if you notice any worsening symptoms, such as increased pain, swelling, or discharge, it would be prudent to seek medical attention. A healthcare provider can perform a physical examination to determine the exact nature of the lesions and provide appropriate treatment. In some cases, an incision and drainage may be necessary if an abscess is present.

In summary, while it is possible that the bumps you are experiencing are due to folliculitis, the potential for an anal fistula should not be overlooked, especially given the symptoms you described. Monitoring the situation closely and seeking medical advice if symptoms persist or worsen is the best course of action.

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