Persistent Anal Issues: Fistula or Folliculitis?

Is it an anal fistula?

I apologize for the inconvenience, but I would like to inquire about something.
About six months ago, I developed a lump on my buttocks, and I underwent incision and drainage.
It healed, but the wound turned into a small pit that occasionally oozes pus and blood.
There is a ring of tissue around the wound, and the center feels soft.
I visited the colorectal department at Chang Gung Hospital in Taipei, where the doctor performed a digital rectal examination and said it was not a fistula, and that the small pit is located quite a distance from the anus.
After two or three months, since it still occasionally oozes pus, I returned to Shin Kong Hospital for a follow-up.
The doctor there also said it was not a fistula, but rather an inflammatory tissue, similar to folliculitis, and suggested surgery, which would require an appointment and could be done in about 15 minutes.

Yesterday, I went to see another doctor at Shin Kong Hospital.
He used a needle to examine the area but did not perform a digital rectal examination.
He diagnosed it as an anal fistula.
However, I told him that the previous doctors had said it was not a fistula.
He kept insisting that it would be complicated because it is located further from the anus, and he was concerned that the fistula might have a complex course, making surgery difficult.
He mentioned that the bacteria involved are Escherichia coli.
I am confused about what is actually happening.
He prescribed me an ointment and medication, but it seems he is hesitant to perform surgery.
After three visits, how can I determine whether it is folliculitis or a fistula?

janice, 20~29 year old female. Ask Date: 2011/07/14

Dr. Lin Zhiguang reply Surgery

Hello, because you only underwent incision and drainage, if it is folliculitis or another type of subcutaneous abscess, it may not fully heal.
The farther away from the anus, the lower the likelihood of an anal fistula, but it cannot be completely ruled out; further examination is necessary.
Sometimes, diagnosis cannot rely solely on examinations.
It is recommended to schedule a minor surgical procedure first.
If there is a recurrence, the likelihood of an anal fistula becomes higher, and a fistulotomy may be required.
Please note that the incision from the fistula surgery will be larger, and the recovery time will be longer.

Reply Date: 2011/07/14

More Info

It sounds like you're experiencing a complex and frustrating situation with your anal issues, and I can understand how confusing it must be to receive different opinions from various doctors. Let's break down the potential conditions you might be dealing with and the steps you can take to clarify your diagnosis.

Understanding Fistulas and Folliculitis
1. Anal Fistula: An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus. It often develops after an abscess (a collection of pus) forms in the anal area. Symptoms typically include persistent drainage of pus or blood, pain, and sometimes swelling. If your doctor has ruled out a fistula based on examinations, it’s a positive sign, but it’s essential to ensure that this assessment is thorough.

2. Folliculitis: This condition refers to the inflammation of hair follicles, which can occur anywhere on the body, including the anal region. It can cause small bumps, redness, and sometimes pus-filled blisters. Folliculitis can be caused by bacterial infections, irritation, or even friction from clothing. If your doctor suspects this, they may recommend topical treatments or antibiotics.

Your Symptoms
You mentioned that you have a small pit that occasionally drains pus and blood, and that there is a soft area surrounded by firmer tissue. This could indicate a few possibilities:
- Chronic Abscess or Sinus: Sometimes, after an abscess is drained, a small cavity can remain that may not fully heal, leading to chronic drainage.

- Inflammation: The soft tissue you feel could be inflamed tissue or granulation tissue, which can occur after an injury or surgery.

- Misdiagnosis: Given that you've received conflicting opinions, it’s possible that the diagnosis may not be straightforward.

Steps to Take
1. Seek a Specialist: If you haven't already, consider seeing a colorectal surgeon who specializes in anal conditions. They may have more experience with complex cases and can provide a more definitive diagnosis.

2. Imaging Studies: Sometimes, imaging studies like an MRI or an ultrasound can help visualize the area better and confirm the presence of a fistula or other abnormalities that might not be apparent during a physical examination.

3. Second Opinion: If you feel uncertain about the diagnosis, it’s perfectly reasonable to seek a second opinion from another colorectal specialist. Bring all your previous medical records and imaging studies to help them understand your case better.

4. Surgical Evaluation: If a fistula is suspected, surgical intervention may be necessary to address the issue. A surgeon can evaluate the anatomy of the area and determine the best course of action.

5. Follow-Up Care: Regardless of the diagnosis, maintaining follow-up appointments is crucial. Chronic conditions can require ongoing management, and regular check-ups can help monitor any changes.

Conclusion
In summary, your situation requires careful evaluation to distinguish between a fistula and folliculitis or other conditions. Given the conflicting opinions you've received, pursuing a consultation with a colorectal specialist and possibly undergoing imaging studies could provide clarity. Remember, it’s important to advocate for your health and seek the answers you need. Don't hesitate to ask your healthcare providers for detailed explanations and the rationale behind their diagnoses and treatment plans.

Similar Q&A

Understanding Perianal Issues: Folliculitis or Fistula?

Hello, on April 1st, I discovered a small lump near the hair follicle around the anus (approximately 2-3 cm from the anal opening). Initially, I thought it was just folliculitis, so I performed warm sitz baths daily and applied anti-inflammatory ointment. After a few days, I noti...

Dr. Ke Fangxu reply Surgery
The diagnosis on the prescription represents the considerations of the physician, and it is not necessary to overly focus on which specific diagnosis it is; it is best to rely on what the physician states. After all, the diagnosis of such diseases still depends on physical examin...

Fistula or Skin Issue? Understanding Recurring Abscesses

A year ago, I developed an abscess on the left side of my anus, which was drained and has not recurred at the same location. However, over the past year, I have been experiencing the emergence of harder small nodules from the right labia to the right perianal area. Last month, a ...

Dr. Ke Fangxu reply Surgery
Without a definitive diagnosis, it is certainly unwise to proceed with surgery. I recommend that you consult a physician for a thorough evaluation before making any decisions. In addition to anal abscess and fistula, it is also possible that it could be Bartholin's gland inf...

Understanding Folliculitis and Preventing Anal Abscesses and Fistulas

Hello, Doctor Ko. I often develop what looks like acne around my anus, which I believe is folliculitis. Typically, these bumps heal within 2 to 3 weeks. However, I tend to worry excessively, especially since I come from a single-parent family. I prefer to face my health issues al...

Dr. Ke Fangxu reply Surgery
1. Folliculitis and anal abscess are different conditions with no correlation, so there is no possibility of one worsening the other. 2. It is impossible to make an accurate diagnosis without a physician's direct examination; conditions such as anal fissures, hemorrhoids, f...

Understanding Buttock Pimples: Causes and Concerns About Folliculitis

Recently, I have developed two to three pimples on both sides of my buttocks that resemble folliculitis, located about 10 cm away from the anal opening. Currently, there is no discharge, and I do not feel any obvious hard lumps or any tubular sensations. I am concerned if this co...

Dr. Ke Fangxu reply Surgery
If you have already consulted a qualified physician, there should be no doubts. Not all skin conditions around the anus are anal fistulas. Ultimately, the clinical diagnosis made by the physician is more accurate than the advice given by online consultants who are not physically ...