Anal Fistulas: Symptoms, Diagnosis, and Surgical Options - Surgery

How to determine the presence of an anal fistula and whether surgical intervention is necessary?

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Hello, Doctor.
I have a few questions I would like to ask you: I am 175 cm tall and weigh 90 kg.
In the second half of 2013, I developed a painful lump in the perineal area below the anus and was diagnosed with an anal abscess.
After drainage by a physician, the abscess resolved and has not recurred, but there is a very slight indentation at the original abscess site.
After healing, I occasionally experience a sharp pain in the anal area, but examinations revealed that most of it was due to external hemorrhoid thrombosis.
During this time, I consulted Dr.
Hsu Tzu-Chi at Mackay Memorial Hospital in Taipei, but he indicated that it had healed and there was no visible outlet, so he did not recommend surgery.
Later, when I visited another hospital, the doctor found that the anal gland that caused the abscess still showed signs of inflammation, which he referred to as cryptitis, but he did not recommend surgery, believing it was not worth performing a major operation for one inflamed gland.
Since the abscess, I have noticed several unusual phenomena, including: 1.
Occasionally (about every month or two), the anus discharges a yellow, watery secretion, which usually stops after wiping.
2.
There is frequent redness and itching around the anus.
3.
I occasionally feel mild pain in the perineal area (near the original abscess site), suspecting it may be caused by a fistula.
4.
There is a sensation of muscle pain at the junction of my thigh and buttock on the left side of the original abscess site, even though I have not exercised that area, raising suspicion of a fistula.
5.
I easily develop rashes or pimples around the buttocks and anus, and on one occasion, it led to cellulitis.
I would like to ask the following questions: 1.
Since the abscess has not recurred, does this mean I do not have a fistula? The original drainage incision has completely healed and has not swollen again.
2.
Since the anal abscess, I have been washing thoroughly with water after each bowel movement.
Could this be the reason for the absence of ongoing pus formation? 3.
Given my current condition, should I consider surgery? The occasional discomfort in the anal area (secretion and redness) is quite bothersome.
4.
If cryptitis continues to be inflamed without a clear anal abscess, is it possible for it to extend through the original fistula, potentially affecting the perineal area and even extending to the junction of the thigh and buttock? I am concerned that if the symptoms are not obvious, it could lead to a complex fistula later on.
5.
I have discussed the possibility of surgery with various physicians; some say that a fistula surgery requires only one day of hospitalization, while others say it could take up to a week.
What could account for such a significant difference in recovery time? 6.
Is the continuous development of pimples and rashes, even leading to cellulitis, related to an anal fistula? 7.
A fistula is caused by inflammation that invades tissue, but does this always result in the redness and swelling of an abscess? I worry that without a clearly visible abscess, the anal fistula may continue to extend.
I apologize for the numerous questions, but since I am asking, I hope to provide you with the clearest information for your assessment.
Thank you for your explanation and assistance!

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Guang, 30~39 year old female. Ask Date: 2015/08/12