Hello doctor, Suffering from mild IBS D since last four years. Noticed a tender lump beneath skin near anus three years ago. Swells and shrinks itself. Mild throbbing and pale yellow fluid discharge from anus when pressed during swelling. Proctoscopy was done in a piles hospital. The doctor said no piles, fissure and fistula. MRI was done in another hospital. 17 mm T2 hyperintense linear tract with no abscess. No overt fluid signal as well. The doctor said nothing and discharged me. What is this tender lump? I am a healthy 35 years old male working in a office.
Hi. After reviewing the information shared and your pictures (attachment removed to protect patient identity), it appears you are suffering from Fistula -in Ano (tubular interconnection between anal canal and outside skin near the anal opening). The swelling you are talking about is called perianal abscess. It is a swelling because of infection of some anal glands.Around 30-40 % perinal abscesses are associated with a fistula. In your case having a couple of good quality pictures of the anal region can help in suggesting further treatment. Your MRI report reported presence of around 2 cm size fistula, with no abscess at the time of imaging and no higher up extension. This is a good prognosis type. It will need either of two things: (There are many treatments possible but for you I would suggest these).  1. Thread insertion in the fistula a tightening it every week. This treatment is called "Cutting Seton". You can use Shar-sutra or Silk thread. 2. Surgery to take the fistula out and let the area heal by itself over time (4 - 6 weeks). This can lead to loss of incontinence as well (control on stool holding) What to do now: You need to followup with a surgeon to do any one of the above two suggested treatments. Do sitz bath - take lukewarm water in a tub put a half a teaspoon of ordinary salt in it. Now sit in this water and try to make the water clean and sooth your anal region. Sit for around 15 min, 3 to 4 times everyday. Try to do at least twice per day. It will decrease itching and help to heal the fissure (as reported by you in your info provided). Avoid constipation with a large platter of salad, sprouts or Sat-Isabgol 2 teaspoon three times per day. Take 3 to 4 litres of water, measured by a bottle, measuring cup everyday. In case you need more information and help regarding what to choose and why, kindly followup with a couple of good quality pictures of the fistula site or discuss it with your local doctor.