Is It Hemorrhoids or an Abscess? Your Symptoms

Unsure if it's hemorrhoids or an abscess?

Hello Doctor: I had anal fistula surgery last year, and it has been over two months now.
I thought I was feeling better, so I reduced the frequency of warm sitz baths.
Recently, I noticed a small bump about 1 cm below the center of my anus that looks like a pimple.
At first, pressing on it caused slight discomfort, and I felt a little pain when sneezing or urinating.
After using an ointment for a week, pressing on it now only feels strange and not painful (it seems to have shrunk a bit), and I no longer feel pain during bowel movements, sneezing, or urination.
I'm unsure whether this bump is a hemorrhoid or an abscess.
When I apply the ointment, I insert my finger into the anus to feel around, and there is no pain or swelling.
I've heard that abscesses can be very painful.
Doctor, could this be a hemorrhoid? Will continued use of the ointment make it go away? I'm very afraid of having to undergo surgery again, as the previous fistula surgery has already caused me a lot of anxiety.
Thank you.

Xiao Gang, 20~29 year old female. Ask Date: 2012/02/04

Dr. Ke Fangxu reply Surgery

If this "pimple" is located near the original surgical site, the likelihood of a fistula recurrence may be higher.
However, as you mentioned, it could also be a hemorrhoidal lesion.
To determine the exact issue, it is best to consult a physician for an accurate diagnosis.
Alternatively, you could wait to see if it resolves on its own.
If it does not disappear after a month or if the pain worsens, you should seek medical attention again, as the chances of fistula recurrence or an anal abscess may be higher.

Reply Date: 2012/02/04

More Info

Hello,
Thank you for reaching out with your concerns regarding the recent changes you've noticed after your anal fistula surgery. It's understandable to feel anxious about any new symptoms, especially after undergoing a surgical procedure. Let's break down your situation and provide some clarity on what you might be experiencing.

From your description, it sounds like you have developed a small lump near the anal area, which could potentially be a hemorrhoid or an abscess. Here’s a brief overview of both conditions:
1. Hemorrhoids: These are swollen veins in the lower rectum or anus. They can be internal (inside the rectum) or external (under the skin around the anus). Symptoms often include discomfort, itching, and sometimes bleeding during bowel movements. The lump you described could be a thrombosed external hemorrhoid, which occurs when a blood clot forms in an external hemorrhoid, leading to swelling and pain.

2. Abscess: An anal abscess is a painful condition that occurs when a cavity filled with pus forms in the tissue around the anus. Symptoms typically include severe pain, swelling, and sometimes fever. Abscesses usually require medical intervention, often needing drainage.

Given that you have had surgery for an anal fistula, it is possible that the lump you are feeling is related to that surgery. Sometimes, post-surgical changes can lead to the formation of scar tissue or even new hemorrhoids due to changes in pressure or blood flow in the area.

What to Consider:
- Pain and Discomfort: You mentioned that the lump was initially painful but has since become less painful and seems to have shrunk. This could be a positive sign, suggesting that it may not be an abscess, which typically remains painful and does not improve without treatment.

- Self-Examination: While it’s good to be aware of your body, inserting fingers into the anal canal can sometimes lead to irritation or further complications. It’s best to avoid this unless advised by a healthcare professional.

- Topical Treatments: You mentioned using a topical ointment. If it’s a hemorrhoid, topical treatments can often help reduce inflammation and discomfort. However, if it’s an abscess, topical treatments alone may not be sufficient, and you would need a healthcare provider to evaluate it.

Recommendations:
1. Consult a Healthcare Provider: Given your history of surgery and the new symptoms, it’s crucial to consult with a healthcare provider, preferably a colorectal surgeon or a gastroenterologist. They can perform a physical examination and possibly imaging studies to determine the exact nature of the lump.

2. Monitor Symptoms: Keep an eye on any changes in the lump, such as increased pain, swelling, or any discharge. If you notice any of these symptoms, seek medical attention promptly.

3. Avoid Self-Diagnosis: While it’s natural to want to understand your symptoms, self-diagnosing can lead to unnecessary anxiety. A professional evaluation is the best way to get accurate information and appropriate treatment.

4. Discuss Surgical Concerns: If you are worried about needing another surgery, express these concerns to your doctor. They can provide reassurance and discuss non-surgical options if applicable.

In summary, while it’s possible that the lump could be a hemorrhoid, it’s essential to have it evaluated by a healthcare professional to rule out any complications related to your previous surgery. Early intervention can help prevent further issues and provide peace of mind. Take care, and I wish you a smooth recovery.

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