What to do about the false healing of anal fistula?

Written by Chen Tian Jing
Colorectal Surgery
Updated on February 20, 2025
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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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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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Can people with anal fistula drink alcohol?

Patients with anal fistula are advised not to drink alcohol. As an anal fistula already features distinct external and internal openings as well as a fistulous tract, excessive or chronic alcohol consumption can stimulate recurrent local inflammatory episodes. This can cause an increase in the secretions from both openings, leading to varying degrees of anal pain and itching for the patient, worsening the condition, potentially increasing the branches of the fistula, or causing it to spread deeper or to other areas. Therefore, not only should patients with anal fistula abstain from alcohol, but they should also maintain a light diet rich in green vegetables and fruits. Once diagnosed, it is crucial for patients with anal fistula to undergo surgical treatment promptly. The primary surgical approach involves fistulotomy with seton placement. Postoperatively, attention must be paid to the dressing of the local wound to avoid pseudo-healing and infection.

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Can anal fistula be completely cured?

Anal fistulas rarely heal naturally, and surgery is the only treatment method to achieve healing. The reasons are as follows: Aside from an external opening on the skin around the anus, an anal fistula also has a primary infectious internal opening in the anal crypt. The two openings are interconnected, allowing bacteria and intestinal contents to enter the fistula tract through the internal opening, leading to recurrent infections. Persistent inflammation often prevents pus from draining through the external opening. There are complex relationships between the fistula and the sphincter muscles, and the frequent contraction and relaxation of the sphincter muscles can compress the tract, making it easy for pus to remain and cause infection. Therefore, surgery is necessary to completely cure an anal fistula.

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Is a second surgery for an anal fistula more difficult than the first one?

Relative to the initial procedure, a second surgery for anal fistula is more difficult. The main goal of anal fistula surgery is to remove the internal opening and the fistula tract completely to cure the condition. During a second surgery for an anal fistula, due to the previous operation, the internal opening may be unclear, and it can be difficult to distinguish between the fistula and scar tissue. This can lead to incomplete removal by less experienced surgeons, increasing the likelihood of the fistula recurring later. Therefore, for a second surgery on an anal fistula, it is essential to undergo the procedure in a specialized colorectal department at a provincial-level top-rated hospital. It is recommended to have a magnetic resonance imaging (MRI) of the anal region before surgery to ensure precise operation and complete removal of the internal opening and fistula tract. Proper postoperative dressing changes are also crucial to avoid infection and inflammation of the wound, which will help with normal recovery after the 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.