Anal Abscesses and Fistulas: Symptoms and Treatment Options

Anal fistula or abscess

Hello Dr.
Ke, on September 4th, I noticed some pain around the anus, but there were no abnormalities upon examination.
On September 7th, I experienced mild pain, although I could sit, stand, and walk without issues.
Upon examination, I felt a lump on the right side of the anal opening.
On September 11th, I visited Tzu Chi Hospital in Xindian, where the doctor informed me that it was an anal fistula and scheduled surgery for September 13th.
I was prescribed Diclofenac Potassium 25 mg, to be taken one tablet three times a day, and Flagyl 250 mg, to be taken two tablets three times a day.

On September 12th, the anal lump was still present, and the mild pain persisted, but I could still sit, stand, and walk.
I thought it would be more convenient to have the surgery in Xizhi.
On September 13th, I visited Cathay General Hospital in Xizhi, where the doctor noted an opening on the left side of the anus, while I was experiencing swelling and pain on the right side.
After a physical examination, the doctor said that it was already draining on its own and advised me to continue medication.
If it does not resolve within a month, we would consider surgery.
I was prescribed Cefuroxime 250 mg, to be taken one tablet twice a day, and Fusidic acid cream 5 g, to be applied once a day.
As of September 16th, I have been taking the medication as prescribed, but the lump is still present, and I continue to experience pain.
My bowel movements are normal, but I have been urinating more frequently, and there is slight pain during defecation.
Could you please help me understand what symptoms I am experiencing and what the next steps should be?

Xiao Lin, 30~39 year old female. Ask Date: 2012/09/16

Dr. Ke Fangxu reply Surgery

After the rupture of an anal abscess, most individuals will develop a channel between the skin and the anal canal known as an anal fistula.
Some people can manage symptoms with medication, but it does not provide a cure.
If there is no pain, inflammation, or spreading, surgery is not life-threatening and may not be necessary.
However, the only definitive way to completely eradicate the condition is through surgical intervention.

Reply Date: 2012/09/16

More Info

Anal abscesses and fistulas are common conditions that can cause significant discomfort and complications if not treated properly. Based on your description, it seems you are experiencing symptoms consistent with an anal abscess, which is a localized collection of pus that can occur in the anal region. This condition often arises from an infection of the anal glands, leading to inflammation and the formation of a painful lump.

Symptoms of Anal Abscesses
The symptoms you are experiencing, such as localized pain, swelling, and the presence of a hard lump near the anus, are typical of an anal abscess. Other common symptoms may include:
- Pain that worsens with sitting or during bowel movements.

- Redness and swelling around the anus.

- Fever or chills in some cases, indicating a more systemic infection.

- Discharge of pus or blood from the abscess if it ruptures.

Diagnosis
Your healthcare providers have diagnosed you with an anal fistula, which is often a complication of an anal abscess. An anal fistula is a small tunnel that forms between the end of the bowel and the skin near the anus, usually as a result of an abscess that has drained. The presence of a fistula can lead to persistent pain and discomfort, as well as recurrent infections.

Treatment Options
1. Medications: You have been prescribed antibiotics (Diclofenac Potassium, Flagyl, Cefuroxime) to help manage the infection and reduce inflammation. It's essential to complete the full course of antibiotics as prescribed, even if symptoms improve.

2. Sitz Baths: Taking warm sitz baths several times a day can help relieve pain and promote drainage of the abscess.

3. Surgical Intervention: If the abscess does not resolve with medication or if it continues to cause significant discomfort, surgical intervention may be necessary. This typically involves incision and drainage of the abscess, and if a fistula is present, it may also need to be surgically treated.

4. Follow-Up Care: Since you mentioned that the lump and pain persist despite medication, it is crucial to follow up with your healthcare provider. They may recommend further imaging studies or a referral to a colorectal surgeon for evaluation and potential surgical intervention.

5. Dietary Adjustments: Increasing fiber intake and staying hydrated can help soften stools and reduce pain during bowel movements.

Next Steps
Given that you are still experiencing pain and the lump has not resolved, I recommend the following:
- Return to your healthcare provider: It’s important to communicate that the symptoms persist despite treatment. They may need to reassess the situation and consider surgical options.

- Monitor for changes: Keep an eye on any changes in symptoms, such as increased pain, fever, or changes in bowel habits, and report these to your doctor immediately.

Conclusion
Anal abscesses and fistulas can be uncomfortable and may require surgical intervention if they do not improve with conservative treatment. It is essential to maintain open communication with your healthcare provider and follow their recommendations closely. If you have any concerns or if your symptoms worsen, do not hesitate to seek medical attention promptly.

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