Anal Health: Symptoms, Concerns, and Surgical Options

Anus and buttocks

Hello, Dr.
Ke.
I would like to ask you about a concern.
After cleaning my anus with body wash, I notice a foul smell about an hour later when I touch it.
Is this normal? Additionally, I experience swelling and pain on the left side of my buttock, approximately to the left of the anus (not in the area between the anus and perineum), about 1 to 2 times a year.
When I touch it, I find it to be a linear swelling, and sometimes it becomes very painful (as if it is infected).
I have occasionally punctured it myself, and the pus that comes out has a foul odor (similar to feces, which is the same smell as when I touch my anus).
After I puncture it, the wound (after drainage) feels much better, but once healed, it forms a bump that never goes away.
Is this what is referred to as an anal fistula or an abscess? If it is a fistula, considering the frequency of my episodes, would I need to undergo surgical removal? Would the surgery be performed from the outside of the buttock or through the rectum? I am concerned because I read that the surgical wound cannot be stitched (I have seen Q&A), which makes me anxious.

Additionally, I had a hemorrhoidectomy at the age of 20 while serving in the military.
Could this have caused poor anal sphincter function, leading to the foul smell?
I have one more question: I often experience abdominal pain and diarrhea after eating, which has been ongoing for about five years.
My stools frequently have a foul odor, and I often pass long gas.
A few years ago, I noticed blood in my stool (deep red blood in the toilet water after a bowel movement) and have had black stools about twice (in the past five years, I have only visually observed blood once and black stools twice).
Besides cancer, are there other gastrointestinal diseases that could explain these symptoms? I frequently have diarrhea, sometimes several times a day, while other times my bowel movements are normal (once a day).
The shape of my stools varies; sometimes they are cylindrical, and other times they are not.
The stools are definitely thinner than before (ranging from 2 to 4 centimeters), and the foul odor is usually associated with loose stools, which smell very bad!

David, 40~49 year old female. Ask Date: 2012/08/03

Dr. Ke Fangxu reply Surgery

1.
It is normal for the anus to have an odor.

2.
Based on your description, it seems you may have an anal fistula.
If not surgically excised, it can recur, and in severe cases, it may develop into a complex fistula, increasing the difficulty of surgery.
The procedure involves incising the fistula tract all the way to the anal opening, known as fistulotomy.
The surgical wound is left open to prevent recurrence of the fistula.

3.
No.

4.
Commonly, this may be due to irritable bowel syndrome or abnormal fermentation in the intestines.
However, if you are over 40 years old, it is important to be aware of the possibility of malignant tumors, and you should consult a physician for further evaluation to confirm.

Reply Date: 2012/08/03

More Info

Hello! Thank you for your detailed questions regarding anal health and digestive issues. It seems you are experiencing a combination of symptoms that can be quite concerning. Let's break down your concerns step by step.

Anal Health Concerns
1. Odor After Cleaning: It's not uncommon for the anal area to have a natural odor, even after cleaning. The presence of bacteria in the area can contribute to this smell. However, if the odor is particularly strong or foul, it may indicate an underlying issue, such as an infection or an abscess.

2. Recurring Pain and Swelling: The symptoms you describe, particularly the painful, swollen area near your anus that occurs 1-2 times a year, could suggest the presence of an anal abscess or possibly a fistula. An abscess is a collection of pus that can form due to infection, while a fistula is an abnormal connection between the anal canal and the skin. The fact that you have experienced drainage of pus with a foul odor supports the possibility of an infection.

3. Surgical Options: If you are experiencing recurrent abscesses or if a fistula is suspected, surgical intervention may be necessary. The surgery typically involves draining the abscess and possibly removing the fistula if one is present. The procedure can be performed through the skin near the anus or internally, depending on the location and nature of the issue. It's important to discuss your specific case with a colorectal surgeon who can provide tailored advice.

4. Post-Surgery Concerns: You mentioned concerns about the surgical site not being sutured. In many cases, the wound is left open to heal from the inside out, which can be concerning but is often necessary to prevent infection. Your previous surgery for hemorrhoids may have contributed to changes in the anal area, but it is unlikely to be the sole cause of the odor.

Digestive Health Concerns
1. Frequent Diarrhea and Abdominal Pain: The symptoms of frequent diarrhea, abdominal pain, and foul-smelling stools can be indicative of several gastrointestinal conditions. These may include irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or infections. The presence of blood in your stool, especially if it is bright red or dark, should be evaluated by a healthcare professional as it can indicate more serious conditions, including gastrointestinal bleeding.

2. Dietary Factors: Your symptoms may also be influenced by your diet. Certain foods can exacerbate gastrointestinal issues, leading to diarrhea and discomfort. Keeping a food diary to track what you eat and how it affects your symptoms can be helpful.

3. Further Evaluation: Given the complexity of your symptoms, it is crucial to consult with a gastroenterologist. They may recommend tests such as a colonoscopy, stool tests, or imaging studies to better understand your digestive health.

Conclusion
In summary, your symptoms warrant a thorough evaluation by healthcare professionals. For your anal health concerns, a colorectal surgeon can assess the need for surgical intervention, while a gastroenterologist can help address your digestive issues. It's essential to communicate all your symptoms clearly to your healthcare providers to receive the most accurate diagnosis and appropriate treatment.

Please do not hesitate to seek medical attention, as early intervention can lead to better outcomes. Your health is important, and addressing these issues can significantly improve your quality of life.

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