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Q. I have pain on the left side of the anus while sitting. Please help me.

Answered by
Dr. Vivek Chail
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 22, 2021

Hello doctor,

I have pain, especially during sitting primarily on the left side of the anus and a little bit on the bottom right side of the anus. I feel a solid line-like structure which also pains on pressing on the left side of the anus with a soft round small ball-like structure (top left side of anus) internally in between, which pains on pressing. I have drawn a picture depicting the same. Please go through the documents with the history that I have attached. Doctor ordered a 3 Telsa MRI (magnetic resonance imaging) of the spine, coccyx, and pelvic region, which has also been attached. Please help me out sir, I have been suffering from past 1 and half year and this has drastically impacted my life.

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Hello,

Welcome to icliniq.com.

I hope you are not having much discomfort due to the pain near the anus. The other disc problems in the MRI scan report can cause pain in the lower back and legs but are not connected to the perianal area problem. It is so coming to the findings of the swelling near the anus. MRI (magnetic resonance imaging) scan is showing a small fluid collection area near the midline gluteal cleft in the perianal area slightly to the right. The collection is measuring 5 x 6 x 3 mm and is likely an area of a small abscess in the subcutaneous fascial plane. The images are not clear, and I am not sure if it continues to the anal wall and forms any perianal sinus tract. This is fitting well with the swelling mentioned. I am not sure why the swelling in the above area is not mentioned in the MRI findings sent by you. It is possible that you will need an MRI fistulogram scan to see the area in more detail.

Thank you doctor,

First of all, I want to thank you for making the diagnosis. The original MRI report has been attached for your kind reference (attachment removed to protect the patient's identity). It did not contain any of the findings that you mentioned. I was running from pillar to post for a diagnosis. At last, I came through your profile and immediately contacted you. I am glad that you helped me out. I have a few questions. I have pain on the lower right side of the anus too. Is it also because of the same? I shared your diagnosis with my cousin's brother, who also is a general surgeon. As per his opinion, it might be a blind end of the fistula or healed fissure track, and it might have also had fibrosis. Sir, I wanted to ask how we can see the fibrosis in MRI if I go for an MRI fistulogram, is there any specific instruction that should be given to the radiologist or radio technician of the hospital for checking or screening fibrosis. Should I get the MRI fistulogram with contrast or without contrast? Should I consult a colo-rectal surgeon, general surgeon, or gastrointestinal surgeon, please guide me. Please let me know of any additional imaging required for diagnosis, and I want to get an accurate diagnosis. For the past one and half years, I have been agonized by pain. I can hardly sit for 20-25 minutes, and you are the only person that has been able to diagnose the problem.

#

Hello,

Welcome back to icliniq.com.

Thanks for your question and for sharing the MRI (magnetic resonance imaging) lumbar spine report (attachment removed to protect the patient's identity), and I am happy to give you suggestions. The small lesion is in the midline and slightly to the right. So I feel that the pain on the right is coming from the swelling in the picture, and also, there is some inflammation extending to the left. It is possible that previously there was a similar problem on the left, and now it is healed. I, too, was a bit confused when you mentioned pain on the left, but in the picture, the area of the collection was near the midline on the right. I support the comments made by your cousin's brother, who is a general surgeon. There can be infections that heal and a new one arises, like if I were to believe that you had an infection on the left and that healed with fibrosis, and now there is an active infection on the right. Fibrosis is a healed scar tissue from an old infection, and it does not hold much significance except for mentioning in the report. There is no need to ask the technician to do anything about it. Contrast is always better to know if there is a spread of infection and see a tract well. So I will suggest going for a contrast MRI fistulogram after doing kidney function testing. It will show communicating fistula and blind tracts and perianal abscess collections. This condition is treated better by an experienced general surgeon. You can take the suggestion of your cousin, brother, and or his teachers and get any procedure done after detailed consultation. However, even the best surgeon's treatment can cause the condition to happen again. So please do not get anxious if the problem happens after few years after taking the best treatments. If you are sitting for long times, then use a cushion with a hole in the center. It will not cure the problem, but your discomfort will be reduced.


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