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Anal fistula
Can a twenty-year anal fistula turn into cancer?
Firstly, anal fistulas can become cancerous. Statistical data show that the probability of malignant transformation in anal fistulas is 1/1000, and such transformations are relatively rare in clinical practice. However, anal fistulas can change, but the timing of malignant transformation varies. Generally, the longer the duration of an anal fistula, the higher the chance of it becoming cancerous. The factors contributing to this transformation typically include chronic inflammation, long-term irritation, bacterial infection, and stimulation from medications, all of which can lead to cancerous changes.
Are hemorrhoids the same as anal fistulas?
Hemorrhoids and anal fistulas are two completely different diseases. Clinically, hemorrhoids can be divided into mixed hemorrhoids, internal hemorrhoids, and external hemorrhoids. Internal hemorrhoids are often characterized by intermittent, painless rectal bleeding, while external hemorrhoids primarily cause symptoms such as a foreign body sensation in the anus and itching. For the treatment of hemorrhoids, if the condition severely affects the patient's normal life, surgical treatment can be considered, such as external peeling and internal ligation surgery, and internal hemorrhoid banding. Anal fistulas are mainly due to perianal abscesses that rupture spontaneously or are incised and drained, subsequently forming an anal fistula, which causes the patient to experience recurrent perianal swelling pain and pus and bloody discharge. Treatment for anal fistulas can only be surgical, and early surgical intervention tends to result in relatively fast postoperative recovery. The surgery mainly involves the removal of the internal opening and the fistula tract, followed by diligent postoperative dressing changes to promote wound healing.
What are the precautions after undergoing anal fistula surgery?
Because anal fistula surgery primarily involves removing the internal opening and the fistula tract, the postoperative wound is relatively large. Postoperative care mainly requires consistent dressing changes to ensure the wound drainage remains unobstructed, avoiding infection or false healing. Additionally, patients should develop good bowel habits, maintain smooth bowel movements, and avoid withholding stool. Otherwise, this may lead to dry, hard stools, causing severe pain during defecation or damaging the wound, which could result in bleeding or edema. In terms of diet, patients should choose foods rich in roughage to ensure smooth defecation and eat foods rich in high-quality protein to supplement the amino acids the body needs, promoting wound healing as much as possible. Moreover, after surgery, patients must use an anal wash or potassium permanganate solution for sitz baths. Since the postoperative wound is open and contaminated, changing dressings is especially important.
Should surgery be performed if there are no symptoms of anal fistula?
If an anal fistula is in its acute phase, the main clinical symptoms are intermittent discharge of pus from the external opening, or pain and itching. If there are no symptoms, and only the external and internal openings along with the fistula tract exist, surgery is still required because the absence of symptoms temporarily does not guarantee that an acute episode will not occur later. During an acute episode, there will be local tissue and skin inflammation, redness, heat, and severe pain. If an anal fistula is not surgically treated for a long time, it may lead to an increase in the number of branches of the fistula or thickening of the fistula wall, and it may even spread to the pelvic cavity. Therefore, once an anal fistula is discovered, it is necessary to perform surgery as soon as possible. Early treatment has significant benefits for wound recovery and the difficulty of the operation.
What to do about the false healing of anal fistula?
If a false healing of the wound occurs after local surgical excision of an anal fistula, it is mainly due to improper dressing changes by the patient and a lack of timely observation of the local wound. It is recommended to open the superficially healed wound to allow it to regrow. In particular, the patient needs to change the dressing and observe the wound daily to prevent the situation where the internal part of the wound has not healed, but the external opening appears healed. During dressing changes, hemorrhoid creams and other drugs that promote mucosal healing can also be applied locally and inside the anal canal to further promote the healing of the internal opening. Only when the internal opening has fully grown should treatment that promotes healing of the external opening be applied. (Please use medication under the guidance of a professional physician, and do not self-medicate.)
Can anal fistulas be left untreated indefinitely?
If a patient is diagnosed with an anal fistula, it must not be left untreated. If an anal fistula is not actively treated over a long period, it can easily lead to thickening of the fistula tract or an increase in branching. Moreover, after long-term repeated inflammatory stimulation, some fistula tracts are prone to malignant transformations. Therefore, it is recommended that patients with anal fistulas seek symptomatic treatment as soon as they are diagnosed. The primary method of treating anal fistulas is surgical. The main surgical approach for an anal fistula is fistulotomy with seton placement, which involves removing the local fistula tract wall while preserving the function of the patient's sphincter muscle. After the surgery, patients need to follow a light diet to avoid an increase in local secretions, which can lead to inflammatory stimulation and even the recurrence of the anal fistula.
Do anal fistulas need surgery even if there are no symptoms?
After the formation of an anal fistula, it does not always lead to acute episodes over a long period. Acute episodes of an anal fistula, causing infectious symptoms, occur only when there is a severe localized damp-heat condition. Therefore, the symptoms of an anal fistula are intermittent. The absence of symptoms does not mean that the anal fistula is completely cured or will not recur. Therefore, if an anal fistula is diagnosed, it is necessary to undergo surgical treatment as soon as possible to avoid repeated episodes due to lack of active treatment. Long-term repeated episodes of an anal fistula can lead to thickening of the fistula wall and an increase in branching. Even if an anal fistula is not actively treated over many years, it may even induce carcinogenesis in the local fistula wall.
What should I do about an anal fistula?
Anal fistula is a disease that occurs when repeated infections in the anal crypts extend to the surface of the skin around the anus. Once formed, there are typical fistula tracts with both internal and external openings. Simple anti-inflammatory drug treatments can only relieve the symptoms of inflammation during the acute phase of an anal fistula. For the fistula tracts themselves, these treatments do not completely cure the condition. It is recommended that patients with an anal fistula undergo a fistulotomy as soon as they are diagnosed. Through surgery, the fistula tract and its walls can be completely excised, completely removing the local lesion, thereby further accelerating the regrowth of fresh granulation tissue locally.
Does an anal fistula require surgery?
The treatment of anal fistula mainly focuses on surgical treatment, with medication as a secondary support. This means that without surgery, an anal fistula essentially cannot heal. Non-conservative treatments for anal fistulas are only temporary symptomatic treatments that manage the condition and alleviate clinical symptoms. For example, during an acute attack of an anal fistula, anti-inflammatory drugs can be used to temporarily relieve symptoms such as pain. Therefore, surgery is necessary for anal fistulas, as surgical treatment can completely eradicate the source of the disease, addressing the internal and external origins of the fistula for a complete cure.
Is it better for the external opening of an anal fistula to be closed or not closed?
In clinical practice, it is generally best not to close the external opening of an anal fistula. Keeping the drainage unobstructed can prevent the infection from worsening or the formation of multiple branches. This is because when the fistula drains properly, the infectious secretions can flow out of the external opening. However, if the external opening does close, the infected tissues and secretions will accumulate within the fistula and then spread to the surrounding areas, forming branches and leading to an increase in the number of branches, thus creating a complex anal fistula and increasing the difficulty of future surgeries. Therefore, it is best not to close the external opening of an anal fistula. Clinically, the treatment for an anal fistula involves fistulectomy, which primarily involves removing the internal opening and the fistula. The external opening also needs to be treated. Postoperatively, medications such as erythromycin ointment gauze strips should be used for dressing changes.