How to deal with a ruptured anal fistula?

Written by Chen Tian Jing
Colorectal Surgery
Updated on December 14, 2024
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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 Chen Tian Jing
Colorectal Surgery
49sec home-news-image

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.

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Written by Yu Xu Chao
Colorectal Surgery
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How to reduce swelling when an anal fistula flares up?

An anal fistula flare-up can cause perianal swelling, pain, and discharge of pus and blood. For an anal fistula flare-up, initial conservative treatment with medications is an option, such as sitting baths using anal cleansing agents or potassium permanganate solutions after defecation. The sitting bath should last between five to ten minutes to help reduce swelling and relieve pain. After the bath, topical application of mupirocin ointment or other anti-inflammatory ointments like Golden Ointment may also be used to reduce swelling and inflammation. For severe infections, intravenous or oral antibiotics may be prescribed to reduce inflammation. However, clinically, it is recommended to opt for surgical removal of the anal fistula as early as possible. Early removal of the internal opening and the fistula tract is necessary for a complete cure of the anal fistula. If an anal fistula repeatedly flares up, it can easily lead to the formation of more fistula branches, forming complex anal fistulas, increasing the difficulty of later surgeries and enlarging the wound surface post-operation.

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Written by Chen Tian Jing
Colorectal Surgery
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What causes anal fistulas?

The most common cause of anal fistula is perianal abscess. Both anal fistula and perianal abscess involve infections at the anal crypts. Typically, an anal fistula forms naturally after a perianal abscess ruptures. Once an anal fistula occurs, it requires prompt surgical treatment. The primary surgical technique is fistulotomy with seton placement, thoroughly removing the local lesion and infection focus to allow fresh granulation tissue to regrow. Anal fistula is a local infectious disease of the anus, generally categorized into simple superficial anal fistula and high-risk complex anal fistula. If a high-position complex anal fistula is suspected, further diagnosis may require additional examination with pelvic MRI or perianal ultrasonography. After the rupture of a perianal abscess, it typically forms a characteristic internal and external opening, with a fistula tract connecting them, thereby forming the typical anal fistula.

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Written by Yang Dong
Colorectal Surgery Department
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How long does it take for the rubber band of an anal fistula to fall off?

For high anal fistulas, we opt for the seton therapy, where we typically use rubber bands as the thread. For the rubber bands used in seton therapy, we believe it is best if they fall off around ten days. Therefore, for the anal fistula rubber bands, we think it is ideal if they fall off in about two weeks at the latest. If they have not fallen off after about two weeks, we may consider further interventions such as cutting the thread or directly cutting the sphincter muscle.

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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.