Anal fissure vs anal fistula

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Regular Member

Date Joined Jan 2006
Total Posts : 315
   Posted 3/18/2010 7:07 AM (GMT -7)   
For the past several days, I noticed my underwear got soiled more often from tiny liquid around my anus area.  I had had hemorrhoids before I was diagnosed of Crohn's Disease.  I also have slight irritations or pain around anus area.  Could this be a pus or anal fissure or anal fistula?  What is the difference?  I hope it will heal by itself.  Thanks

Diagnosed with CD in 1994;

In 1994 I was treated with Pentasa of no avail.  Have being treated with Chinese herbal medicines for over 10 years.

Veteran Member

Date Joined Sep 2005
Total Posts : 517
   Posted 3/18/2010 7:20 AM (GMT -7)   
Fissure is a tear in the surface of the opening area kinda like a scratch. is typical for when you strain and enlarge the anus with hard stool or, particular to crohns is also attributable to electrolyte imbalance of some sort eg. typically potassium. A fistula is an actual opening other the the anus and could appear anywheres in the skin as an exit, with origin from the bowel and therefore can transport stool abnormally from the bowel through a fistula canal out through the fistula opening as an additionally location from where the stool is normally supposed to exit through the anus. A hemmorhoid is more like an inflammed skin tab and typically doesnt leak pus. both fissure and fistula can have pus but fissure is more likely to have blood while a fistula more likely to contain pus with possible stool.

Regular Member

Date Joined Jan 2010
Total Posts : 432
   Posted 3/18/2010 8:14 AM (GMT -7)   
A Fissure makes you want to die.
A Fistula doesn't hurt.
Diagnosed with typical Crohn's at 16.
Got lucky with Asacol for a year, then even luckier with ten years of relative remission.
Now abscesses and fistulas are having an "atypical" Crohn's party around my junk.
My HMO refused the Remicade and now I could be going on Lialda or sulfa? blah

Regular Member

Date Joined Jan 2006
Total Posts : 315
   Posted 3/18/2010 8:19 AM (GMT -7)   
Thank you, medchrt1, for your reply!
If it is a fistula, then I should see stool coming out from a hole or something, right?  But I do not see real stool coming out.  I think (I am not sure) it is primarily pus like substance on my underwear or toilet paper.  I do not feel there is hole there either.  
If it is a fissure, why don't I see blood on the toilet paper? 
I cannot see my anus area, of course.  So I cannot be sure what it is.  I am also reluctant to see my primary doctor, as I hope it can go away by itself (which happened before). 

Diagnosed with CD in 1994;

In 1994 I was treated with Pentasa of no avail.  Have being treated with Chinese herbal medicines for over 10 years.

Regular Member

Date Joined Aug 2009
Total Posts : 41
   Posted 3/18/2010 8:24 AM (GMT -7)   

I've had both. My fistula hurt(s) like hell. I guess from the inflammation and the reabscessing that happens.

I have a sneaking suspicion my fistula and abscess came from my chronic fissure. My fissure rarely bled, except when it was new.

Can you squat over a mirror? I've perfected this :) and it helps to see what could be going on.

Good luck!!

Regular Member

Date Joined Mar 2010
Total Posts : 28
   Posted 3/18/2010 9:55 AM (GMT -7)   
I had a fistula removed last fall.  It seemed to have it's own little cycle of getting infected, which would be very painful, and then there would be drainage and some bleeding.  The drainage didn't look exactly like stool-but more of a discolored pus-which I assume had a small amount of stool fragments in it.  It had it's own yucky smell.  It was always sore with a little leakage, but when it would go thru the inflammed/infected stage it hurt really bad.  There was a definate lesion "down there" on the skin outside the anal opening.

Regular Member

Date Joined Jan 2006
Total Posts : 315
   Posted 3/18/2010 1:22 PM (GMT -7)   
As a follow up:
I called my primary doctor's office, and at my sincere request, they let me book a same day urgent appointment.  So I went in to see my primary this afternoon.
My primary doctor told me fistula usually takes time to form.  If my Crohn's acted up, then I would have many other symptoms, such as fever, abdominal pain and diarrhea, which I don't have, other than one short episode of diarrhea 4 days ago.
So I lied down on the table while he examed my rear.  He said there was no visable fissure or fistula.  He did a rectal exam, pulled something and put it on a test paper.  He said there is no blood. 
He did not say what caused the stains on my underwear and said not to worry too much.  Then I left with a paper with "anal pain" written on it. 
I guess that healthy normal people can also have stains on their underwears, right? Or could this be genetic, because I heard my dad (who doesn't have Crohn) also had stains on his underwear from time to time?

Diagnosed with CD in 1994;

In 1994 I was treated with Pentasa of no avail.  Have being treated with Chinese herbal medicines for over 10 years.

Veteran Member

Date Joined Oct 2009
Total Posts : 1070
   Posted 3/18/2010 9:35 PM (GMT -7)   
If you are going often it is sometimes hard to maintain the best of hygiene throughout the day. If you are having mucus that will sometimes pass, sneakily, when you fart. I often have stained underwear when my CD acts up.

Regular Member

Date Joined Jan 2010
Total Posts : 265
   Posted 3/19/2010 12:39 PM (GMT -7)   
My GI calls it "Rectal soiling" and says that it has no clinic significance (and nothing to do about it, besides cleaning).

I find that when I wash (water jet directed) my anus after BM, the soiling is reduced or disapear. When I just wipe it, it comes again. But I found that in US, this "bidet" toilet (or a water jet beside the toilet) is quite uncommon. Bad for chronnies. I coudn't live without mine.
Diagnosed in nov/94 - Started with Prednisone, followed by Pentasa, entocort, flagyl, Imuran, Cipro, etc.
Blockage - First Surgery 2001 (no ressection)
Severe bleedind - 2003 - Stopped by 60mg of Prednisone
Stricture leading to a ressection in Dec/2008 - Second Surgery
Now on Remicade + 100 mg Imuran + Iron (sort of remission, not sure at all)

Veteran Member

Date Joined Aug 2007
Total Posts : 1202
   Posted 3/19/2010 1:46 PM (GMT -7)   
Agreed completely with Djin. I couldn't live without my sprayer... It's the only way I feel clean between Crohn's in general and the fistula.

Oh, and my fistula hurts too... The one time I had a fissure, it felt like knife pains. Worse than the fistula/abscess but both hurt.

Good luck!
1 fistula, crohn's colitis, limited to large intestine
Compounded budesonide 3mg/daily, Cimzia, MTX . Dx Osteoporosis 10/08 started Forteo 1/27/09

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