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Chronic fissure with starting fistula
I am having chronic fissure from October heals and reccour again and again two times I had pimple near my anus which get healed automatically but this time doctor asked for mri which showed small low intersphinteric fistula with tiny absecss volume 0.03 cc but after physical check up by one doctor he said no fistula just chronic fissure please tell what should I do other doctors are just saying fistula surgery after mri report but that doctor said no fistula after physical check up
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There was fistula which almost healed , If there is no small opening around anus and nothing coming out (watery discharge or pus)of that opening then nothing to be done as internal opening is already closed .
But if pus collection increases then it May form new opening /tract . So get treatment for fissure /constipation and antibiotics course .
Next Steps
No need of treatment of fistula as such at present
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Get treatment for Constipation and fissure
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It’s very small abscess , n rest of the tract is fibrotic
You can wait
I have some follow up questions
Do you have any discharge ? ( like pus or water )
Do you have pain
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Answer my questions , so that I can address your concerns
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✓Most likely it's Chronic anal fissure+Low intersphincteric fistula..
✓Until the diagnosis is clear, focus on preventing constipation and allowing the fissure to heal.
Next Steps
✓Rule out any abnormalities in following tests
CBC,Blood sugar,Iron studies,Vitamin B12,
Vitamin D..
✓crohns disease needs to be rule out as well
Health Tips
✓High-fiber diet+Plenty of water.
✓Stool softener syrups.
✓Warm sitz baths 3-4 times daily.
continue follow up with your gastro surgeon
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Based on your MRI, there is a small low intersphincteric fistula with a tiny intersphincteric abscess (0.03 cc). However, MRI findings should always be correlated with clinical examination, and a chronic fissure can sometimes mimic or coexist with a small fistula.
Since one surgeon could not identify a fistula clinically while others advised surgery based on the MRI, I recommend consulting an experienced colorectal surgeon. If there is recurrent pus discharge, repeated swelling (“pimple”), or persistent symptoms, an Examination Under Anaesthesia (EUA) may be the best way to confirm or rule out a fistula before proceeding with surgery.
Meanwhile, continue fissure care with a high-fiber diet, adequate fluids, warm sitz baths, and stool softeners if needed. Do not rush into surgery based on the MRI report alone; the decision should be based on both your symptoms and examination findings.
Next Steps
Consult a colorectal surgeon for clinical correlation and, if needed, EUA to establish the diagnosis before planning treatment.
Health Tips
Recurrent swelling or pus discharge strongly suggests a fistula, whereas a fissure alone usually causes pain and bleeding without recurrent boils.
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Since you are having chronic fissure in ano, which is causing you discomfort and pain; and also MRI has shown small low intersphinteric fistula with small absecss , you have to get operated for the chronic fissure and also fistula in ano. Since MRI has shown fistula with abscess, it catto be wrong. The MRI report is always correct. So please consult a general surgeon or GI surgeon and get it operated.
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consult a general surgeon or GI surgeon and get it operated.
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Dr. Avinash Pratap Singh Thakur
Urologist
18 yrs exp
Jabalpur
If no complaint.. nothing to do
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Disclaimer : The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.