Brief Answer:
as explained in details.

Detailed Answer:
Hi.
Thanks for your query.
Noted the history of Female/34 - partial fistulotomy with seton - XXXXXXX 2016 - endorectal advancement flap and seton removal - regular followups - healed great in last examination - today - scar tenderness - no hard spot where infected flid would be inside - does not look red or infected - but all of a sudden got painful - called the Surgeon - said about chances of low grade infection will order antibiotic - will see if surgery failed - your queries :
1. Is it common to have the fistula reopen 3 months after two fistula surgeries (my risk of incontinence was high)?
> Not at all common. Once the healing is proper and complete the reopening is not common as the healing is from within. There is no chance of reopening of the fibrous tissues as it is tough. If at all this occurs, it is rare.
Risk of incontinence was high means this was high-anal fistula.

2. What surgeries do they resort to next and what are the success rates? Is it multiple surgeries?
> Once needs to confirm the cause and effects - meaning the extent of the problem first as the extent of the problem can alone decide what type of management.

3. Does an infection mean the fistula is back? If not, why would it be infected again?
> Infection may not mean that the fistula is back in all cases. Anal canal has many crypts which can get infected. There can be scar tenderness as it is situated at the high pressure zone during bowel movement an is subjected to wear and tear during any movement/ shearing action of buttocks and anal area/scan area while walking, standing up, coughing, sneezing. Such actions can
cause tenderness in the scar and is very well known to occur. As also can be nerve entrapment in the scar causing pain and tenderness.

4. Could it just be painful scar tissue?
> Yes, this is what I just tried to explain. Reopening after 3 months of healing is usually not seen.
The cause can be best studies by the clinical examination that your Surgeon will do and assisted by the MRI of the affected area as it can tell us what exactly is going on inside as the per-rectal digital examination can feel only.

I hope this answers your queries and guides you for an early and proper diagnosis.
Please feel free to ask for further relevant queries if you feel that there is a gap of communication.

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Brief Answer:
As detailed.

Detailed Answer:
Difficult to say for sure without actually examining and having MRI.
The statistics should be known but does not help on individual basis.
Since this is close- cavity area, differentiation is difficult.
Go for examination by your Surgeon and discuss about MRI.

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Brief Answer:
Attach the photos - Meet the Surgeon to get the proper directions

Detailed Answer:
Noted the finding about little hard balls along the scar, larger one at a particular spot and can not see the Surgeon for another days...
This can be due to hypertrophy of the scar.

Can you send the clear and focused photographs of the affected area with someone's help as the photos sometimes help for on-the-spot diagnosis.

You can see your PCP or a Family Doctor to have some evaluation or someone at the office of the operating Surgeon and get started with proper treatment as needed.

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Brief Answer:
As detailed below.

Detailed Answer:
Please find the link attached to this query for attachment of the pictures.
And you can also send by email to
YYYY@YYYY

If not visible but are palpable can be indicative of changes of hypertrophy of the scar, a part of healing process of scar. The scar itself usually does not get infected.

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