You feel chilled and feverish. Your head and body ache. Naturally, it feels like the flu. But if your anus is also throbbing, the diagnosis changes completely. Lee Dong-geun, Director of Hansol Hospital, notes that many patients initially mistake their symptoms for a common cold when they are actually progressing toward a perianal abscess—pus collecting in the anorectal area—and eventually an anal fistula. Often, patients endure the pain hoping it will pass, only to worsen the condition.
An anal fistula, sometimes called the “appendicitis of the anus,” is frequently confused with hemorrhoids, but it is a distinct condition. It involves the formation of an abnormal tunnel between the inside of the anus and the skin on the outside. While medication may briefly settle the symptoms, the tract usually does not heal completely and often requires surgery.
Director Lee emphasizes that an anal fistula is "a condition that becomes more complicated the more you try to hide it." Early diagnosis allows for relatively simple treatment, but delay allows inflammation to spread and the tract to become more complex, making surgery more difficult.
Why does an anal fistula occur?
“In most cases, it begins with an infected anal gland. As the infection progresses, a perianal abscess forms. When the pus drains, it creates a tract. If this pathway repeatedly opens, closes, and becomes chronic, it turns into an anal fistula.”
What are the early symptoms? I’ve heard it is often mistaken for a cold.
“Many people feel flu-like at first, experiencing fever and body aches, while the specific anal pain may only become noticeable later.”
An anal fistula or abscess can start with a low-grade fever, chills, and fatigue. This is followed by stinging inside the anus or boil-like swelling on the outside. As pus accumulates, sitting becomes difficult. While the pain and fever may temporarily subside if the pus ruptures and drains, this often leads patients to miss the window for proper treatment.
Who is especially prone to this condition?
“It is more common in men, possibly due to differences in anal gland structure and sphincter pressure. Frequent diarrhea, heavy drinking, and weakened immunity are also factors. It can also occur in those with underlying conditions like Crohn’s disease. However, it can happen to anyone.”
Many patients hesitate to seek help—can it heal naturally?
“Expecting it to go away on its own is unrealistic. Medication might calm the inflammation temporarily, but if the tract remains, pus will build up again. The longer you wait, the more extensive the surgery becomes.”
What happens if an anal fistula is left untreated for a long time?
“The abscesses will recur, and the tract will become more complex. Most importantly, the later the surgery, the harder it is to preserve sphincter function.”
Chronic neglect can lead to multiple or complex fistulas, discharge, and odor that interfere with daily life. In rare cases, long-standing inflammation can increase the risk of anal cancer.
Since medication is difficult, what surgical methods are available?
“The approach depends on the location of the fistula and its involvement with the sphincter. Our goals are preventing recurrence and preserving sphincter function. For a simple fistula, we open the tract to let it heal naturally. However, if it passes deeply through the sphincter, we must be careful; cutting the muscle too aggressively increases the risk of fecal incontinence.”
What is the ‘Seton technique’ mentioned in treatment?
“For deep fistulas, we use the Seton technique, where a thread or rubber band is placed through the tract. This allows us to manage the inflammation and the tract gradually over time while minimizing damage to the sphincter.”
How can people prevent this in everyday life?
“Manage your digestion to avoid alternating between constipation and diarrhea, and avoid sitting on the toilet for long periods. Good hygiene, such as sitz baths, and a high-fiber diet can also help. However, once a fistula has developed, lifestyle changes alone will not resolve it.”
What warning signs should readers absolutely remember?
“If the area next to the anus is swollen and painful, or if you notice recurring pus, blood, or boil-like eruptions, do not put it off. Seek an evaluation immediately.”
An anal fistula becomes harder to treat the more it is concealed. Director Lee Dong-geun’s message is clear: early intervention is the key to a simpler resolution.
