Painful Anal Bumps: Fistula, Abscess, or Hemorrhoids?

A lump near the anus that is discharging pus could be an anal fistula or hemorrhoids?

I am almost 30 years old and currently working on an offshore island.
Recently, for the past two months, I have developed a small, red, swollen lump near my anus that occasionally discharges a small amount of pus, enough to be cleaned with a tissue.
It also causes sharp pain, and both standing and sitting can be uncomfortable.
However, the pain improves significantly after the pus is released, so I tend to squeeze it out when it becomes painful.
I often wipe the area with tissue due to my nearly 12-hour work shifts (standing for long periods).
In the mornings, it feels manageable, but by the evening, the pain becomes increasingly noticeable, sometimes making it uncomfortable to stand.
I have also experienced fever.
About a month ago, I visited a clinic and saw a family medicine doctor.
After examining me, the doctor diagnosed it as a "boil" and prescribed a five-day course of antibiotics to be taken three times a day.
After resting for a few days, my condition improved, and there was no pus discharge.
However, in recent days, the pus and swelling have returned.
Today, I went back to the same clinic for a check-up, and the doctor prescribed another five-day course of antibiotics.
He also asked if I had hemorrhoids, to which I replied that I wasn't sure.
He then prescribed an anti-itch ointment to apply three to four times a day, advising me to return if the discomfort persists.
After returning home, I researched online and found that it could be an "anal abscess," "fistula," or "hemorrhoids." I'm confused about my condition, and the recurring swelling and pain are becoming quite bothersome.
I'm worried it might be an "anal fistula" that would require surgical treatment back in Taiwan.

Shunshun, 20~29 year old female. Ask Date: 2012/09/15

Dr. Yu Mingchang reply Surgery

Hello^^ Based on what you described, it seems to be a ruptured anal abscess that has developed into an anal fistula.
You should consult a colorectal surgeon for confirmation and surgical treatment.
Thank you!!

Reply Date: 2012/09/15

More Info

It sounds like you are experiencing significant discomfort and pain in the anal area, which can be caused by a variety of conditions, including anal abscesses, fistulas, or hemorrhoids. Given your symptoms, it is essential to understand these conditions better to determine the best course of action.

Anal Abscess
An anal abscess is a painful condition that occurs when a collection of pus forms near the anus. It can result from an infection of the anal glands or other nearby tissues. Symptoms typically include swelling, redness, and pain in the affected area, often accompanied by fever. The pain may improve temporarily after the pus drains, as you have experienced. Treatment usually involves antibiotics and, in many cases, surgical drainage of the abscess.

Anal Fistula
An anal fistula is a small tunnel that forms between the end of the bowel and the skin near the anus. It often develops after an anal abscess has drained. Symptoms can include pain, swelling, and discharge of pus or blood. Fistulas typically require surgical intervention to heal properly, as they do not usually resolve on their own.

Hemorrhoids
Hemorrhoids are swollen veins in the lower rectum or anus that can cause pain, itching, and bleeding. They can be internal or external. While hemorrhoids can cause discomfort, they usually do not present with pus or significant swelling unless there is a complication such as thrombosis or infection.

Diagnosis and Treatment
Given that you have already seen a physician who prescribed antibiotics and a topical ointment, it is crucial to follow up if your symptoms do not improve. The recurrence of pain and pus suggests that the underlying issue may not be fully resolved. Here are some steps you can take:
1. Follow-Up with a Specialist: If your symptoms persist, consider seeing a colorectal surgeon or a gastroenterologist. They can perform a more thorough examination and may recommend imaging studies or procedures to determine the exact cause of your symptoms.

2. Avoid Self-Drainage: While it may provide temporary relief, squeezing or attempting to drain the area yourself can lead to further infection or complications. It is best to leave drainage to a healthcare professional.

3. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain. However, consult with your doctor before taking any medication, especially if you have underlying health conditions.

4. Hygiene and Care: Maintain good hygiene in the anal area. Warm sitz baths can help soothe discomfort. Avoid harsh soaps and opt for gentle cleansing methods.

5. Dietary Considerations: Ensure you are consuming a diet high in fiber to prevent constipation, which can exacerbate hemorrhoids and anal pain. Staying hydrated is also essential.

6. Monitor Symptoms: Keep track of any changes in your symptoms, including fever, increased pain, or changes in discharge. This information will be helpful for your healthcare provider.

Conclusion
Your symptoms warrant a thorough evaluation to rule out serious conditions such as an anal fistula or persistent abscess. While antibiotics may help manage infection, they may not address the underlying issue if there is a fistula or other complications. Seeking specialized care is crucial for proper diagnosis and treatment. Don't hesitate to advocate for yourself and seek further medical attention if your condition does not improve.

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