Can anal fistulas be left untreated indefinitely?

Written by Chen Tian Jing
Colorectal Surgery
Updated on February 15, 2025
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If a patient is diagnosed with an anal fistula, it must not be left untreated. If an anal fistula is not actively treated over a long period, it can easily lead to thickening of the fistula tract or an increase in branching. Moreover, after long-term repeated inflammatory stimulation, some fistula tracts are prone to malignant transformations. Therefore, it is recommended that patients with anal fistulas seek symptomatic treatment as soon as they are diagnosed. The primary method of treating anal fistulas is surgical. The main surgical approach for an anal fistula is fistulotomy with seton placement, which involves removing the local fistula tract wall while preserving the function of the patient's sphincter muscle. After the surgery, patients need to follow a light diet to avoid an increase in local secretions, which can lead to inflammatory stimulation and even the recurrence of the anal fistula.

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Written by Chen Tian Jing
Colorectal Surgery
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How long does it take to recover after surgery for an anal fistula?

After surgery for an anal fistula, the general recovery time is about twenty days to a month. The duration of recovery mainly depends on the size of the local lesion before surgery, as well as the surgical wound postoperatively, and also relates to the patient's constitution. Particularly, if the patient has certain underlying diseases, such as diabetes or a history of tuberculosis, the recovery time may be relatively extended. The wound after an anal fistula surgery is an open wound contaminated with bacteria, so postoperative wound dressing changes are very important for wound recovery. It is recommended that the secretion from the local wound be cleared daily, followed by disinfection with povidone-iodine, then application of an anti-inflammatory ointment, and covering the wound with an oil gauze strip for drainage to avoid poor drainage leading to false healing of the local wound.

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Written by Si Li Li
Gastroenterology
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Can colitis cause anal fistula?

If it is chronic colitis, it is possible to cause anal fistulas. Most patients with chronic colitis have symptoms of unformed stools and loose feces. Some feces, which are relatively thin, tend to accumulate in the anal crypts, leading to infection of the anal glands in these areas. The inflammation then spreads to the normal soft tissues around the anus, including subcutaneous tissues, forming perianal abscesses. If a perianal abscess ruptures or is surgically incised to release pus, the external opening and the pus cavity gradually heal and narrow, thus forming an anal fistula. If chronic colitis is diagnosed, it should be promptly diagnosed and treated to prevent the formation of anal fistula.

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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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Do anal fistulas need surgery even if there are no symptoms?

After the formation of an anal fistula, it does not always lead to acute episodes over a long period. Acute episodes of an anal fistula, causing infectious symptoms, occur only when there is a severe localized damp-heat condition. Therefore, the symptoms of an anal fistula are intermittent. The absence of symptoms does not mean that the anal fistula is completely cured or will not recur. Therefore, if an anal fistula is diagnosed, it is necessary to undergo surgical treatment as soon as possible to avoid repeated episodes due to lack of active treatment. Long-term repeated episodes of an anal fistula can lead to thickening of the fistula wall and an increase in branching. Even if an anal fistula is not actively treated over many years, it may even induce carcinogenesis in the local fistula wall.

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Written by Yu Xu Chao
Colorectal Surgery
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Are hemorrhoids the same as anal fistulas?

Hemorrhoids and anal fistulas are two completely different diseases. Clinically, hemorrhoids can be divided into mixed hemorrhoids, internal hemorrhoids, and external hemorrhoids. Internal hemorrhoids are often characterized by intermittent, painless rectal bleeding, while external hemorrhoids primarily cause symptoms such as a foreign body sensation in the anus and itching. For the treatment of hemorrhoids, if the condition severely affects the patient's normal life, surgical treatment can be considered, such as external peeling and internal ligation surgery, and internal hemorrhoid banding. Anal fistulas are mainly due to perianal abscesses that rupture spontaneously or are incised and drained, subsequently forming an anal fistula, which causes the patient to experience recurrent perianal swelling pain and pus and bloody discharge. Treatment for anal fistulas can only be surgical, and early surgical intervention tends to result in relatively fast postoperative recovery. The surgery mainly involves the removal of the internal opening and the fistula tract, followed by diligent postoperative dressing changes to promote wound healing.