Ignoring anal pain, swelling? GI surgeon Dr Pankaj Sharma explains why stigma around fistula symptoms may increase risk

Symptoms like pain and swelling in the anal area are normal medical conditions that need to be treated. Dr Sharma shares the risks of delaying intervention.

Pain, swelling or persistent discharge around the anal area is something many people hesitate to discuss. Out of embarrassment, these symptoms are often mistaken for piles or managed with home remedies in the hope that they'll resolve on their own. However, doctors caution that delaying medical attention can allow an anal fistula to worsen. Unlike some minor anorectal conditions, an anal fistula rarely heals without proper treatment and can become increasingly complex if left untreated.

An anal fistula is an abnormal tunnel that forms between the anal canal and the skin around the anus, most commonly after an anal abscess or infection. Although it is a treatable condition, the hesitation to seek timely medical care often results in recurrent infections, repeated pain and more extensive surgery.

HT Lifestyle spoke to Dr Pankaj Sharma – director of the Department of Robotic, Bariatric, Laparoscopic and General Surgery at Fortis Hospital, Shalimar Bagh, and the founder of Shalya Clinic, Rohini – who explains, “Patients often spend months hiding their symptoms because they feel embarrassed or assume it's just piles. By the time they reach a surgeon, the infection may have spread or the fistula may have become more complex. There's no reason to suffer in silence – early diagnosis makes treatment more straightforward and improves recovery.”

Why does a fistula develop?

Most anal fistulas develop after an infected gland inside the anal canal forms an abscess. Even if the abscess drains on its own or is treated, an abnormal passage can remain between the anal canal and the skin.

Dr Sharma elaborates, “Certain conditions such as Crohn's disease, tuberculosis, diabetes, previous anal surgeries and repeated infections may also increase the risk, although many fistulas occur in otherwise healthy individuals. Unlike piles, which involve swollen veins, or fissures, which are small tears in the anal lining, a fistula is usually linked to an underlying infection that requires medical attention.”

An anal fistula needs to be treated surgically. (Unsplash)

Symptoms that shouldn't be ignored

The symptoms of an anal fistula are often distinct, but many patients mistake them for other anorectal conditions. The surgeon points out, “Warning signs include persistent pain around the anus, swelling, recurrent boils, pus or blood-stained discharge, foul-smelling fluid, irritation of the surrounding skin and, in some cases, fever.”

Studies suggest that up to 50 percent of patients who develop an anal abscess may later go on to develop an anal fistula, making appropriate follow-up important even after the initial infection appears to have settled.

“One of the biggest mistakes patients make is relying on over-the-counter creams or repeated courses of antibiotics without identifying the underlying problem. A fistula is not simply a skin infection. If there is persistent discharge, recurrent swelling or a boil that keeps coming back, it should always be evaluated by a specialist,” cautions Dr Sharma.

How is it treated?

Dr Sharma points out that diagnosis usually begins with a clinical examination, while imaging such as an MRI may be recommended for complex fistulas to accurately map the tract before surgery. Unfortunately, unlike piles or some fissures, anal fistulas rarely heal with medicines alone.

He highlights, “Surgery remains the definitive treatment. Depending on the location and complexity of the fistula, surgeons may recommend procedures such as fistulotomy, sphincter-preserving techniques or minimally invasive approaches designed to remove the infected tract while protecting bowel control.”

Advances in surgical techniques have significantly improved recovery and reduced recurrence in appropriately selected patients. Recovery, however, also depends on maintaining good hygiene, following dietary advice, preventing constipation and attending regular follow-up appointments to ensure proper healing.

Breaking the stigma

Despite being a common surgical condition, anal fistulas continue to carry unnecessary stigma because of their location. The surgeon believes that changing the conversation around anorectal health is just as important as improving access to treatment.

Anal fistulas are a medical condition – not something to be hidden or ignored. Dr Sharma emphasises that prompt evaluation, an accurate diagnosis and timely surgical treatment can not only relieve symptoms but also reduce the risk of recurrence and help patients return to their daily lives with confidence.

He concludes, “People readily seek help for a toothache or knee pain, but many hesitate to discuss anal symptoms because they feel embarrassed. Delaying treatment only allows the infection to progress and may make surgery more complicated. Recognising the symptoms early and consulting a qualified surgeon can prevent months of discomfort and significantly improve outcomes.”

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

Dr Pankaj Sharma is the Head of GI, Minimal Access, Robotic and Bariatric Surgery at Fortis Hospital, Shalimar Bagh, and Director of Shalya Clinic, Rohini in New Delhi. With 26 years of experience, the MBBS, MS surgeon specialises in gastrointestinal, laparoscopic, robotic and bariatric surgery, with international fellowship training in bariatric and metabolic surgery.