Can an anal fistula be left untreated for a lifetime?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 30, 2024
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If diagnosed with an anal fistula, one should not forego treatment indefinitely, as an anal fistula is a localized infectious disease of the anal region. Without active treatment, the infection may further spread, increase the number of fistula branches, and potentially induce a high, complex anal fistula. There is also a risk that the fistula and the infection might penetrate the local anal sphincter, reaching the ischioanal fossa and causing other infectious diseases. The primary treatment method for anal fistulas is surgical, mainly involving fistulotomy with seton placement, which thoroughly removes the local infection, allowing the anal fistula to heal. Neglecting active treatment could worsen the condition or increase the difficulty of future surgeries.

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Written by Chen Tian Jing
Colorectal Surgery
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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.)

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Written by Yang Dong
Colorectal Surgery Department
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What is the most accurate test for anal fistula?

As a common disease in proctology, simple anal fistulas can be diagnosed through visual inspection and palpation. For high-positioned complex anal fistulas, which cannot be accurately assessed through just visual inspection and palpation, the use of instruments may be necessary. Currently, magnetic resonance imaging (MRI) is recommended as the most accurate method for evaluating anal fistulas, and it is considered the gold standard for examining the course of the fistula tract and the location of the infection.

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Written by Yu Xu Chao
Colorectal Surgery
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Is an anal fistula close to the anus considered high or low position?

In general, anal fistulas close to the anus are considered low anal fistulas. Clinically, anal fistulas are classified as either high or low based on the levator ani muscle as the boundary. Those located above the levator ani muscle are considered high anal fistulas, while those below are considered low anal fistulas. Clinically, the treatment for anal fistulas primarily involves surgical intervention. Options include fistulectomy, which involves the removal of the internal opening and the fistula tract. Post-surgery care may include the use of anal cleansing agents, red oil gauze strips, and golden ointment for dressing changes to promote wound healing. It is important to maintain smooth bowel movements and consume a light diet. High, complex anal fistulas may easily damage the anal sphincter or even the anorectal ring, leading to fecal incontinence. Therefore, during surgery, the thread hanging method may be chosen to avoid excessive damage to the anal sphincter.

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Written by Chen Tian Jing
Colorectal Surgery
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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.)

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Written by Yu Xu Chao
Colorectal Surgery
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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.