What should I do about an anal fistula?

Written by Chen Tian Jing
Colorectal Surgery
Updated on February 01, 2025
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Anal fistula is a disease that occurs when repeated infections in the anal crypts extend to the surface of the skin around the anus. Once formed, there are typical fistula tracts with both internal and external openings. Simple anti-inflammatory drug treatments can only relieve the symptoms of inflammation during the acute phase of an anal fistula. For the fistula tracts themselves, these treatments do not completely cure the condition. It is recommended that patients with an anal fistula undergo a fistulotomy as soon as they are diagnosed. Through surgery, the fistula tract and its walls can be completely excised, completely removing the local lesion, thereby further accelerating the regrowth of fresh granulation tissue locally.

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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 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 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 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 Deng Heng
Colorectal Surgery
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How long does it take for an anal fistula to form?

An anal fistula is a tract left after an anal abscess bursts spontaneously or is surgically drained, generally consisting of a primary internal opening, a fistula tract, and a secondary external opening. Thus, an anal fistula and an anal abscess represent two stages of the same disease: initially, there is an anal abscess, and then, after the pus from the abscess is drained, an anal fistula forms. Typically, the transformation from an anal abscess to an anal fistula takes about two to three months, meaning that an anal fistula can form about three months after the abscess bursts.