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Anal fistula
How is an anal fistula treated?
The treatment methods for anal fistula mainly involve surgery. Conservative medication for anal fistula does not provide a definitive cure but can alleviate the inflammatory symptoms triggered during acute episodes by using anti-inflammatory symptomatic drugs. The surgical method primarily used for anal fistula is the fistulotomy with seton placement. This procedure involves cutting the local sphincter either partially or completely using a thread, while preserving the function of the surrounding sphincter and thoroughly removing the fistula tract wall to further eliminate the local lesions. After the surgery, due to the large wound area, it is recommended that patients stay in the hospital for dressing changes and symptomatic treatment to avoid complications like poor healing leading to pseudo-healing or wound infection. (Medication should be used under the guidance of a doctor.)
Symptoms of cancerous transformation in anal fistula
The vast majority of anal fistulas do not undergo malignant transformation. However, there is a possibility of cancerous changes if an anal fistula that has repeatedly recurred over a long period is not treated aggressively, or if the inflammation of the fistula tract is severe. When an anal fistula undergoes malignant transformation, the secretion from the local fistula tract increases and is accompanied by a foul smell, and there may even be ulceration of the local fistula tract mucosa. Further surgical procedures, such as fistulotomy with seton placement, are required, and the excised fistula tract suspected of high-grade malignant transformation should be sent for pathological examination. If malignant transformation is confirmed, further pelvic MRI examinations are necessary to determine whether there is local and surrounding lymph node metastasis.
Can anal fistula be completely cured?
Anal fistulas rarely heal naturally, and surgery is the only treatment method to achieve healing. The reasons are as follows: Aside from an external opening on the skin around the anus, an anal fistula also has a primary infectious internal opening in the anal crypt. The two openings are interconnected, allowing bacteria and intestinal contents to enter the fistula tract through the internal opening, leading to recurrent infections. Persistent inflammation often prevents pus from draining through the external opening. There are complex relationships between the fistula and the sphincter muscles, and the frequent contraction and relaxation of the sphincter muscles can compress the tract, making it easy for pus to remain and cause infection. Therefore, surgery is necessary to completely cure an anal fistula.
Is a second surgery for an anal fistula more difficult than the first one?
Relative to the initial procedure, a second surgery for anal fistula is more difficult. The main goal of anal fistula surgery is to remove the internal opening and the fistula tract completely to cure the condition. During a second surgery for an anal fistula, due to the previous operation, the internal opening may be unclear, and it can be difficult to distinguish between the fistula and scar tissue. This can lead to incomplete removal by less experienced surgeons, increasing the likelihood of the fistula recurring later. Therefore, for a second surgery on an anal fistula, it is essential to undergo the procedure in a specialized colorectal department at a provincial-level top-rated hospital. It is recommended to have a magnetic resonance imaging (MRI) of the anal region before surgery to ensure precise operation and complete removal of the internal opening and fistula tract. Proper postoperative dressing changes are also crucial to avoid infection and inflammation of the wound, which will help with normal recovery after the surgery.
What are the consequences of not treating anal fistulas?
Since an anal fistula is caused by the infection and inflammation of the anal glands, it connects the rectum or anal canal with the skin around the anus, forming repeated abscesses, pain, and discharge of pus and blood around the anus. If an anal fistula is not treated, more fistula tracts will develop over time, and more of the muscles around the anus will become infected. This can even lead to high, complex anal fistulas, making surgical treatment later on more difficult and could easily lead to anal incontinence. Also, if an anal fistula is left untreated for a long time, there is the possibility of malignant transformation. Therefore, in clinical practice, it is recommended to undertake surgical treatment for anal fistulas as early as possible. The surgery for an anal fistula mainly involves the removal of the internal opening and the fistula tract, which is essential for a complete cure. Postoperatively, it is necessary to persist in changing dressings to avoid infection or pseudohealing at the wound site. Moreover, patients should be mindful of their diet.
Is the recovery from a second anal fistula surgery quick?
Whether the recovery from a second surgery for anal fistula is quick primarily depends on whether the surgical wound is infected and bleeding, and it is also directly related to the patient's own immunity and the size of the wound. Generally, if the wound from the second surgery is relatively small and the patient does not have diabetes, tuberculosis, or inflammatory bowel disease, then the postoperative recovery tends to be quicker. Moreover, the patient should eat foods rich in high-quality protein and persist in changing dressings to avoid infection and bleeding of the wound, which also facilitates recovery after anal fistula surgery. However, if the wound from the anal fistula surgery is larger and the second procedure involves the seton technique, and since the patient's second surgery is for a high complex anal fistula, the recovery time is relatively slower. Additionally, if the patient has diabetes or inflammatory bowel disease, this will directly affect the postoperative recovery.
What should be paid attention to for anal fistula?
Patients with anal fistula, as there is an external opening in the anal region and intermittent thick secretion from this opening, should first ensure to keep the perianal area clean. It is recommended to change underwear daily and to cleanse the area after bowel movements with saline or hemorrhoid wash, and to conduct fumigation and hot compresses around the perianal area and the external opening to prevent irritation and even sharp pain caused by residual feces and secretions. Furthermore, during acute episodes of anal fistula, mupirocin ointment can be applied around the external opening for anti-inflammatory treatment. The definitive surgery for anal fistula primarily involves fistulotomy with seton placement. Without surgery, an anal fistula cannot be completely cured and may lead to worsened conditions such as thickening of the fistula wall or increased branching of the fistula channels.
How to deal with a ruptured anal fistula?
The clinical symptoms of anal fistula mainly include intermittent discharge of pus from the external opening near the anus, or occasional acute attacks that cause redness, swelling, heat, and pain around the external opening of the anus. If the external opening of the anal fistula breaks and discharges pus, or is accompanied by pain, it is considered an acute phase of the anal fistula. The primary method of management and treatment is surgery, with the main surgical approach being fistulotomy and seton placement. To locally alleviate the inflammatory symptoms of the external opening of the anal fistula, anti-inflammatory ointments can be applied for temporary anti-inflammatory treatment. However, to avoid the local complications such as thickening or branching of the fistula, it is advised that patients undergo surgical treatment of the anal fistula as soon as possible. (Please use medication under the guidance of a professional physician, and do not self-medicate.)
Does an anal fistula hurt?
Anal fistula mainly refers to the presence of a noticeable fistula in the tissue under the perianal skin, which connects the inner opening in the anal canal and the outer opening around the anus. Usually, the anal fistula does not cause significant pain when it is not in acute flare-up. However, if the anal fistula enters an acute episode, there may be pain due to inflammation at the local external opening of the anus, and possibly an increase in purulent discharge, which can irritate the skin around the external opening, causing stinging pain and itching. To prevent recurrent episodes of anal fistula and further aggravation of the condition, it is advised to seek surgery as soon as the fistula is detected.
Is anal fistula prone to recurrence?
If active anal fistulotomy and thread-drawing surgery are carried out after the onset of an anal fistula, it generally does not recur easily. However, if patients do not pay attention to good dietary and defecation habits after being discharged, it may lead to the reoccurrence of the anal fistula. This is because there are multiple anal crypts within the anal canal, and removing the local anal crypts during this episode does not guarantee that other anal crypts will not become inflamed or infected in the future. Especially when patients consume excessive amounts of chili peppers or alcohol, or when they experience diarrhea, it can potentially trigger another infection of the anal crypts. Therefore, to prevent recurrence of anal fistulas, it is necessary to cultivate good defecation and dietary habits to avoid the reoccurrence of anal fistulas.