Which is more serious, anal fistula or hemorrhoids?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 17, 2024
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Anal fistulas and hemorrhoids are two different types of common colorectal diseases; neither can be said to be more severe than the other, as the severity of each disease depends on its progression and extent. If it's a simple superficial anal fistula, the severity is generally mild, primarily treated with surgery. However, if a high, complex anal fistula is present, in addition to surgery, a comprehensive pelvic MRI examination is also required to rule out any infections in the deep sphincter and ischioanal fossa. The severity of hemorrhoids primarily involves circular mixed hemorrhoids, or those accompanied by incarceration. If circular mixed hemorrhoids with incarceration occur, it is advisable to undergo surgical treatment as soon as possible to avoid necrosis. If hemorrhoids result in persistent and significant rectal bleeding, surgery should also be performed promptly to prevent anemia in the patient.

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Written by Chen Tian Jing
Colorectal Surgery
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How to deal with the internal opening of an anal fistula?

The internal opening of an anal fistula is generally located at the site of inflammation in the anal crypt. The primary reason for the formation of an anal fistula is the repeated outbreaks at the anal crypt, which lead to further infection and the formation of a perianal abscess. When the abscess cavity ruptures, it forms an external opening and the anal fistula. Surgical treatment is required for the internal opening of an anal fistula, generally involving a seton procedure that threads a line through the internal opening and part of the sphincter muscle, gradually cutting and draining the area slowly. If the inflammation at the internal opening is significant, it may also be necessary to excise part of the infected site in the anal crypt. Post-surgery care of the internal opening of an anal fistula primarily involves dressing changes, requiring daily thorough disinfection of the local area, ensuring clear drainage, to allow the granulation tissue at the internal opening to grow freshly, and to slowly heal the wound without infection. (Medication should be taken under the guidance of a doctor.)

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Written by Deng Heng
Colorectal Surgery
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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.

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Written by Chen Tian Jing
Colorectal Surgery
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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.

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Written by Chen Tian Jing
Colorectal Surgery
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Best treatment method for anal fistula abscess

The best treatment method for anal fistula and perianal abscess is surgical treatment, which is also the only curative method. Conservative treatment using drugs alone can only alleviate local inflammatory symptoms and cannot achieve complete cure. The main surgical method is the cutting and threading technique. This involves threading and ligating the infected area and the sphincter muscle. Through the slow cutting and drainage action of the ligature, the infection focus is removed while protecting the anal sphincter. Postoperatively, it is also important to pay attention to disinfecting and draining the local wound, ensuring proper dressing changes, and preventing poor drainage that could lead to infection or recurrence. It is advised that patients avoid spicy and irritating foods for the first six months after surgery.

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Written by Chen Tian Jing
Colorectal Surgery
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How long will it take for a fallen anal fistula seton to heal?

The primary surgical method for anal fistulas is the fistulotomy with seton placement. The duration for which the seton, made of elastic band, remains in place largely depends on the severity of the anal fistula and the amount of sphincter muscle tied. If the fistula is a simple superficial one, the seton usually falls out around seven days. In cases of high, complex anal fistulas, or those with multiple branching fistula tracts and multiple sphincters tied, the seton may take slightly longer to fall out, generally about ten days. If the seton has not fallen out after the local sphincter muscle has fully regenerated, it can be cut by a professional proctologist. However, it is important to note that postoperative care mainly involves dressing changes until the seton falls out, indicating that the wound has largely healed.