Top 5 Warning Signs of an Anal Fistula

Warning Sign 2: Pain That Doesn’t Make Sense

Now, anal fistula pain is weird. It’s not like stubbing your toe – sharp, obvious, and then gone. This pain is sneaky. It’s more like having a deep ache that you can’t quite pinpoint, but it’s always there, nagging at you.

My patient Robert described it perfectly: “It felt like someone was pressing on a bruise that I couldn’t see.” He’d been dealing with this discomfort for months, thinking he’d pulled something at the gym. The pain would get worse when he sat for long periods (he was a truck driver), and especially during bowel movements.

What’s interesting about this particular fistula symptom is that it might actually feel better when the discharge is flowing freely. Weird, right? That’s because when the infected material can drain out easily, there’s less pressure building up inside. But don’t let temporary relief fool you – the underlying problem is still there.

I’ve had patients tell me they thought they were just getting old, or that their desk chair was uncomfortable, or that they needed more fiber in their diet. Meanwhile, they’re dealing with one of the key top 5 warning signs of an anal fistula and don’t realize it.

The pain can also be unpredictable. Sometimes it’s a dull ache, other times it might spike into something more intense, especially if the fistula gets blocked temporarily. When that happens, the pressure builds up, and let me tell you, that’s when people really pay attention.

Lisa, another patient, said she thought she had hemorrhoids for the longest time. “But hemorrhoid pain comes and goes with bowel movements,” she told me. “This was just… always there.” That constant, nagging quality is what sets anal fistula pain apart from other conditions.

If you’ve got unexplained pain or discomfort in your anal area that’s been hanging around for weeks, don’t brush it off. It’s trying to tell you something.

Warning Sign 3: Lumps, Bumps, and Swelling That Won’t Go Away

Finding any kind of lump “down there” is terrifying. I get it. But here’s the thing about anal fistula-related swelling – it’s usually tender, persistent, and has this annoying habit of not responding to typical treatments.

The swelling happens because your body is fighting an ongoing infection. Think of it like your immune system working overtime, which leads to inflammation and puffiness around the anal opening. You might feel a soft, squishy area, or sometimes a firmer lump.

Here’s where it gets tricky – the external opening of the fistula can look like a small pimple or bump. I can’t tell you how many patients have tried treating it with acne medication, antibiotic ointment, or just hoped it would pop and disappear.

Karen spent three months putting various creams on what she thought was “just a weird pimple.” When she finally came to see me, she said, “I tried everything from the pharmacy, but it just kept coming back.” That persistence is the key – normal bumps and pimples heal and disappear. Anal fistula openings don’t.

The swelling might be more noticeable at certain times. Maybe it’s worse after you’ve been sitting for a while, or after a bowel movement. Some patients notice it’s more prominent when they’re constipated or straining.

What really concerns me is when people assume the worst. “I was convinced it was cancer,” one patient told me. While it’s always smart to get lumps checked out, most anal swelling related to fistulas is from infection and inflammation, not something more serious.

If you’ve noticed any persistent swelling, lumps, or bumps around your anal area that have been there for more than a couple weeks, don’t ignore it. It’s definitely one of the top 5 warning signs of an anal fistula that deserves attention.

Warning Sign 4: Blood Where Blood Shouldn’t Be

Seeing blood in your underwear or on toilet paper is never fun. With anal fistulas, the bleeding usually isn’t dramatic – it’s more like spots or streaks that show up at random times, not just during bowel movements.

This is different from hemorrhoid bleeding, which typically happens when you’re straining or having a bowel movement and then stops. Anal fistula bleeding can occur anytime because it’s coming from that infected tunnel, not from surface irritation.

My patient Dave noticed blood staining his underwear and immediately panicked. “I thought I had colon cancer,” he told me. After examination, we discovered he had been dealing with several fistula symptoms for months, including this anal bleeding, but hadn’t connected the dots.

Sometimes the blood mixes with discharge, which can look particularly concerning. Patients often describe seeing pinkish or reddish drainage that worried them. The key thing to understand is that while any bleeding should be checked out, fistula-related bleeding is usually manageable once the underlying condition is treated.

What I find interesting is the pattern. Unlike other causes of anal bleeding that come and go with specific activities, fistula bleeding tends to be more persistent and unpredictable. You might notice it when you’re just going about your day, not necessarily related to bathroom activities.

Sarah mentioned that she’d see blood on her underwear even on days when she hadn’t had a bowel movement. “That’s when I knew something was really wrong,” she said. That unpredictable nature is actually a helpful diagnostic clue.

If you’re seeing recurring blood around your anal area, especially if it’s happening at random times and not just during bowel movements, you’re dealing with one of the top 5 warning signs of an anal fistula that needs professional evaluation.

Warning Sign 5: Feeling Crummy for No Good Reason

This last symptom is the one that people almost never connect to their other issues, but it’s actually really important. When you have an ongoing infection – even a relatively localized one like an anal fistula – your whole body feels it.

You know that feeling when you’re fighting off a cold? Not quite sick, but definitely not right? That’s what many patients with anal fistulas describe. Low-grade fever that comes and goes, feeling more tired than usual, just generally feeling “off” without being able to put your finger on why.

Tom, a construction worker I treated, kept thinking he was just getting older. “I figured turning 45 meant feeling tired all the time,” he said. But after we treated his anal fistula, he was amazed at how much better he felt overall. He hadn’t realized that chronic infection was draining his energy.

The fever usually isn’t high – maybe just a degree or two above normal – but it’s persistent. Your immune system is working overtime to fight the infection, and that takes energy. That’s why you might feel rundown even when nothing else seems obviously wrong.

What’s particularly frustrating for patients is that this fatigue and general malaise often gets blamed on stress, work, family life, or just “getting older.” Meanwhile, they’re dealing with one of the top 5 warning signs of an anal fistula that’s actually treatable.

I always tell patients: if you’re feeling generally unwell and also experiencing any other symptoms we’ve talked about, don’t assume they’re unrelated. Your body is pretty smart about letting you know when something needs attention.