If an anal fistula occurs, during the acute phase of the anal fistula, or when the internal and external openings of the anal fistula are ulcerated, there may also be bleeding during defecation. However, the bleeding from defecation due to an anal fistula is generally minor, and occasionally pus may also be discharged from the anus, or pus may be discharged from the external opening, causing itching or stinging of the skin around the external opening. If local pain or bleeding from defecation occurs with an anal fistula, prompt local anti-inflammatory treatment is needed; an anti-inflammatory ointment can be chosen for local application. However, the fundamental treatment for an anal fistula still requires surgery. It is generally recommended to directly perform a fistulotomy with seton placement to completely heal the fistula and prevent recurrent episodes.