Anal Issues: Symptoms, Diagnosis, and Treatment Options

Anal issues

Hello Dr.
Ke,
I previously had an anal fistula, which was surgically treated and healed (about three years ago on the right side of the anus).
Recently (on 10/25/2012), I felt some discomfort in the anal area (a strange sensation during anal contraction, not painful, more like a foreign body feeling).
Therefore, I immediately scheduled an appointment with a colorectal surgeon for an examination.
After the examination, the doctor diagnosed me with internal hemorrhoids, but stated that it was not serious, and during the digital examination, no fistula was detected (which is what I was most concerned about, as I fear a recurrence).
I felt relieved after hearing this.
The doctor prescribed Proctosedyl suppositories and Tofacitinib ointment, but when I got home, I only applied the Tofacitinib ointment (2-3 times a day) until the evening of 10/28.
While applying the ointment, I noticed a different sensation than before, so I immediately checked in the mirror and found an oval protrusion about 1 cm in diameter on the left side of the anus (it was not there the day before).
It was red, soft to the touch, and I couldn't feel its presence while walking or sitting.
There was no pain when contracting the anus or pressing on it, but sometimes it felt itchy.
I did not notice any discharge on my underwear.
After discovering this lump, I stopped applying any ointment.
I would like to ask Dr.
Ke:
1.
Is there a high probability that this is an anal abscess? Could it be caused by something else?
2.
If it unfortunately is an anal abscess, can it be managed with medication to prevent it from worsening temporarily? (I have a lot going on recently, and if surgery is needed, I would have to take time off to recover, which is not very convenient.)
3.
If surgery is required, how many days of recovery would be needed before I can return to normal work? (Should this be considered an early detection?)
4.
How does the doctor use a digital examination to determine the presence of an anal fistula?
5.
If anal fistula surgery is performed multiple times (for non-complex fistulas and detected early), is there a possibility that it could lead to loss of normal function of the anal sphincter?

Xiao Chen, 20~29 year old female. Ask Date: 2012/10/29

Dr. Ke Fangxu reply Surgery

1.
In addition to the possibility of recurrent anal abscess, it could also be an acute episode of thrombosed hemorrhoids, but it is difficult to determine without direct observation.

2.
If it is an anal abscess, surgical treatment is recommended; however, if there is no fever or pain, oral antibiotics may help alleviate the symptoms.

3.
Surgical treatment depends on the size of the abscess; very small abscesses can sometimes be managed in an outpatient setting, while more severe cases may require hospitalization for up to a week.
Clinical examination results should be used as the basis for judgment.

4.
In the case of simple anal fistula surgery, although a small portion of the sphincter muscle may be disrupted, it does not affect the anal contraction function.

Reply Date: 2012/10/29

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your anal issues. It’s understandable to feel anxious, especially given your history of anal fistula and the recent discovery of a new lump. Let’s address your questions one by one.

1. Is the likelihood of an anal abscess high? Could it be another condition?
The presence of a soft, red, oval protrusion near the anus could suggest several possibilities, including an anal abscess, a thrombosed hemorrhoid, or even a skin tag. An anal abscess typically presents with pain, swelling, and sometimes fever, but since you mentioned that you do not feel pain or significant discomfort, it may not be an abscess. However, it is essential to have a thorough examination by a colorectal surgeon to determine the exact nature of the lump.
2. If it is indeed an anal abscess, can it be managed with medication to prevent worsening?
In some cases, if an abscess is small and not causing significant symptoms, conservative management with antibiotics may be considered. However, abscesses often require drainage to prevent complications. If you suspect an abscess, it is crucial to seek medical attention promptly, as untreated abscesses can lead to more severe infections or complications.

3. Assuming surgery is necessary, how long is the recovery period before returning to work?
Recovery time after surgery for an anal abscess or fistula can vary. Generally, most patients can return to normal activities within a few days to a week, depending on the extent of the surgery and individual healing. However, it is advisable to avoid strenuous activities and heavy lifting for at least a couple of weeks post-surgery. Your surgeon will provide specific guidance based on your situation.

4. How does a physician use a physical examination to determine the presence of an anal fistula?
During a physical examination, a physician will assess the anal area for any signs of abnormal openings, tenderness, or swelling. They may perform a digital rectal examination to feel for any abnormalities within the anal canal. In some cases, additional imaging studies, such as an MRI or endoanal ultrasound, may be required to visualize the fistula tract more clearly.

5. If an anal fistula surgery is performed multiple times (not complex), can it lead to loss of normal anal sphincter function?
Repeated surgeries for anal fistulas can potentially affect the anal sphincter function, especially if the surgeries involve significant dissection or if there is scarring. However, if the fistula is identified and treated early, the risk of complications can be minimized. It is crucial to have a skilled surgeon who can perform the procedure with care to preserve sphincter function.

In conclusion, while your symptoms may not immediately indicate a severe issue, it is essential to follow up with your healthcare provider for a thorough evaluation. Early intervention can often lead to better outcomes and reduce the risk of complications. If you have further concerns or if your symptoms worsen, do not hesitate to seek medical attention sooner rather than later.

Wishing you the best of health,
Doctor Q&A Teams

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