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Have a secretion from anal crack. It is odoriferous and oily with bleeding from crack. Suggest?

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General & Family Physician
Practicing since : 2009
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As embarrassing as it is, here goes: More often than not, now, I have a secretion from my anal crack. NOT the anal opening, but the crevice above. I am very very clean, I take care to dry there, because at first I thought this was because, perhaps, I wasn't drying off well enough. But it is constant, now, and "oily" discharge, VERY odoriferous. Sometimes there is bleeding from where it seems to be "cracked" open. Please help.
Posted Sat, 1 Jun 2013 in Medicines and Side Effects
 
 
Answered by Dr. Shoaib Khan 43 minutes later
Hello ma'am and welcome to XXXXXXX

Thank you for using our services.

From your presentation and the precise description you have provided, it appears as though you could have an anal fissure. As mentioned by you, your medical history is irrelevant.

Let us come down to the details of an anal fissure for your better understanding. First of all, an anal fissure is a tear in the mucosa that lines your anus. The most common causes for this are:
-Constipation
-Straining while passing your bowels
-Hard stools
-Childbirth
-Chronic diarrhea
-Bowel conditions like Symptoms of an anal fissure include:
-Pain during and/or after bowel movements
-Irritation or itching around anus
-Discharge
-Blood
-Visible tear in skin around anus

I understand you feel this is embarrassing, but do not worry ma'am, this is in fact very common. And I request you to visit a doctor you are comfortable with and get examined, so that the diagnosis can be confirmed, and your treatment can be initiated.

Treatment includes application of medication directly at the site of the fissure and a control in blood pressure. You will also be advised a more healthy diet XXXXXXX in fiber, and plenty of fluids.

I hope you found my response helpful and informative. Do write back to me for any further clarifications, or you could rate my answers after closing this discussion. I wish you a speedy recovery and a beautiful life thereafter.

Best wishes.
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Follow-up: Have a secretion from anal crack. It is odoriferous and oily with bleeding from crack. Suggest? 9 minutes later
Hello Dr. XXXXXXX ..

I read about fissures...this is NOT that. Again, it's no where near the anal opening. It is literally a open crack in the crevice of my bottom cheeks. Must like you would expect if I did not dry off well, etc. Again, it's oily and tacky in texture, pungent & sometimes a hint of yellow to it. On occasion there is bleeding, like the area "busted" open. Again, the location is two to three inches ABOVE the anus.

Shall we try again?
 
 
Answered by Dr. Shoaib Khan 38 minutes later
Sure we can. And thank you for that vital information. I hope you understand it is a little more difficult to diagnose without looking at and properly examining you, but I shall try my best to do so. Do not worry, we shall find the cause.

From you current description, two conditions come to my mind, mainly due to the location, presence of blood, and discharge.

They are:
1. Fistula in Ano- This is somewhat of a passage that is artificially created due to various reasons. It has an inner opening and an external opening. Location of the inner opening will decide the type of discharge (whether pus, fluid, dead cells, blood or fecal matter)

Causes: Infections or abscesses in the ano-rectal region that are inadequately treated or drained. These form a passage through the muscles in the gluteal region and create a small external opening through which they drain pus, dead tissue or even blood.

The opening can at times look small or even absent. This will have to be investigated and blocked off.

2.Abscess in the gluteal region (buttocks)- A cavity created under the skin and subcutaneous layer with the accumulation of pus, dead cells/debris and blood

Causes: A crack in the skin or a hair follicle that has been damaged or removed or from friction due clothing. This provides access to bacteria to enter the skin and form a small cavity under the skin, with the accumulation of pus, debris and blood. This can occasionally drain, but almost always recurs without treatment, which is why it appears to exist continuously to patients

The pungent smell and hint of yellow is most probably pus (in case of the abscess) or fecal matter (the fecal matter drains in case of a fistula, if the inner opening is close to the anal canal).

I hope this information was more accurate. If you wish, we have an option of uploading pictures to the discussion as well. But, only if you are comfortable.

Best wishes.
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Follow-up: Have a secretion from anal crack. It is odoriferous and oily with bleeding from crack. Suggest? 52 minutes later
Thank you Dr. XXXXXXX ..this I understand...how is it treated???
 
 
Answered by Dr. Shoaib Khan 15 minutes later
I am glad I could be of assistance.

I shall explain the treatment of both conditions to you for your better understanding.

1. Fistula in Ano: The latest treatment used for this is something called VAAFT (video assisted anal fistula treatment). In this, the doctor passes a very thin tube inside the fistula and electrocauterizes (something like melting) it to close it completely. This is a day-care procedure, and a patient undergoing this procedure can be discharged the very same day. Thus, it is a minor procedure, with hardly any pain or side-effects.

Other techniques include:
-Fistulectomy (surgical removal of the fistula)
-Glues fibrin (inserting a glue to close and seal the fistula)
-Fistulotomy (surgical opening and removal of fistula and surrounding structures): Is considered the treatment of choice and this procedure carries the least risk for recurrences
-Setons: Wires inserted inside the fistula. These are turned and twisted at regular intervals, till they fibrose and die. They are then removed out along with the wire

2.Abscess: Treatment is usually initiated with antibiotic medication (tablets) if the cavity is small. Depending on response, the antibiotic course is continued and completed, with good results

If the cavity is large or if the patient is non-responsive to medication, it is surgically opened, drained and cleaned. This is followed by antibiotic medication to promote healing and recovery. Regular dressings will also be required

I hope you found my response helpful and informative. Do write back to me for any further clarifications, or you could rate my answers after closing this discussion.

Best wishes.
Above answer was peer-reviewed by
 
Follow-up: Have a secretion from anal crack. It is odoriferous and oily with bleeding from crack. Suggest? 9 minutes later
Dr. thank you. I think I need to make an appt w/ my gen prac. Upon observation, there is a small "hump" so to speak directly to the right of the anal crevice. While the opening I have is vertical and above the anal opening (literally in the crack), I am surprised my the small change in "terrain". The left side of the crevice is completely smooth, with the right having a hump. I had never noticed that. So I feel what you are telling me is accurate. Still very confused as to how I got it. Thank you so much.
 
 
Answered by Dr. Shoaib Khan 36 minutes later
You are most welcome.

I am extremely happy I could be of assistance.

Take care.
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