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Anal fistula
Can anal fistulas recur?
Anal fistula has a certain possibility of recurrence, especially when it is not actively treated with surgery, which can lead to intermittent discharge of pus from the external opening. However, the likelihood of recurrence can be significantly reduced after an anal fistula fistulotomy with seton placement. Nevertheless, it is recommended that after surgery, patients should develop good dietary and defecation habits to avoid repeated infections in the local anal crypt, leading to recurrent episodes of anal fistula. After surgery, due to the large local wound surface and the presence of secretions, it is also necessary to properly disinfect and change dressings on the wound to prevent poor drainage leading to false healing or local wound infection.
Does an anal fistula hurt?
The main clinical symptoms of anal fistula mainly include pus discharge, pain, and itching, therefore it definitely causes pain. Usually, anal fistulas do not cause much pain, but when the external opening's drainage is obstructed, pus accumulation can lead to acute episodes, characterized by local swelling and pain, accompanied by significant tenderness. After the pus drains, the pain will decrease, indicating that anal fistulas do cause pain. Other main clinical manifestations of anal fistulas primarily involve pus discharge; that is, there is continuous secretion of small amounts of pus from the external fistula opening, which then causes local moisture around the anus, irritating the skin around the anus and leading to anal itching.
How is an anal fistula formed?
The main causes of anal fistula include the following: First, perirectal abscesses, which are the most common cause and account for over 95% of anal fistulas. Second, rectal and anal injuries caused by trauma, swallowing bones, metals, etc., lead to bacterial infection of the wound. Third, anal fissures, where recurrent infections can lead to subcutaneous fistulas. Fourth, perineal surgery, where incorrect injection into the base during internal hemorrhoid treatment or post-surgical infection can occur. Fifth, tuberculosis; many cases of tuberculosis include complications of tubercular anal fistulas. Sixth, ulcerative colitis, which can also lead to anal fistulas. Seventh, Crohn's disease, which is also complicated by anal fistulas.
How to completely cure an anal fistula?
Anal fistula is a tract left after an anal abscess bursts open spontaneously or is surgically incised, generally consisting of a primary internal opening and a secondary external opening. The key to curing an anal fistula lies in the finding and management of the internal opening, meaning that during surgery, the internal opening of the anal fistula must be located and then incised. Managing the internal opening is crucial to the treatment of the anal fistula. The complete removal of the fistula's tract, internal and external openings, until healthy tissue is formed, is the safest and most essential method for curing an anal fistula.
Does anal fistula surgery hurt?
Anal fistula surgery primarily involves fistulotomy and ligation, with the surgery’s difficulty and potential for pain depending largely on the severity of the condition and the type of anesthesia used. If local anesthesia is used, patients may experience localized pain six hours post-surgery, especially in cases where the fistula is deep or complex, as the larger surgical wounds tend to cause more intense pain. If a spinal anesthesia method is used, incorporating methylene blue injection for nerve block during surgery, postoperative pain may be slightly less intense. Generally, localized pain might occur after 12 hours. If the pain is severe, patients can be treated with oral or topical pain-relieving medication.
Can anal fistulas be left untreated?
If an explicit diagnosis of anal fistula is made, it cannot go untreated. If the anal fistula is localized around the anus but not actively treated and surgically removed, it is very likely to cause branching of the fistula tract or spread to the ischioanal fossa, as well as thickening of the fistula wall. This can exacerbate the symptoms of local infection, causing an increase in stabbing pain or purulent secretions. Prolonged, recurrent episodes of anal fistula may also lead to carcinogenic changes in the fistula wall due to inflammatory stimuli. Therefore, once an anal fistula is diagnosed, it is necessary to promptly undergo surgical treatment with fistulotomy and seton placement to prevent the condition from worsening and complicating later treatments.
What is the best treatment for anal fistula?
The primary treatment method for anal fistulas is surgery, which mainly involves the use of a local seton thread. This method allows the surgeons to excise or remove the affected area of the anal fistula while preserving the normal contractile function of the local anal sphincter. This precaution helps prevent excessive removal that could lead to sphincter relaxation or excessive loosening of the anus. As the local sphincter naturally repairs itself and the seton falls out post-surgery, it ensures the proper healing of the local wound. Postoperative care for anal fistula surgery also involves proper drainage and disinfection of the local wound. Daily application of oil gauze and changing of anti-inflammatory medications on the local wound are recommended. This helps in reducing inflammation and facilitating drainage, thereby preventing the occurrence of local pseudohealing.
What department should I go to for anal fistula?
If you suspect you have an anal fistula, it is recommended to register with a proctology department for examination and treatment. The examination of an anal fistula mainly involves digital rectal examination, local perianal ultrasound, and probing with a probe. Typically, an anal fistula will have an external opening in the local anal area, and when the doctor touches near the dentate line of the anal canal with their index finger, an internal opening will be found in the anal crypt. Pressing on the local internal opening will cause secretions to flow out from it. Anal fistulas are relatively easy to diagnose, but further examinations such as perianal ultrasound and pelvic MRI are needed to clarify the direction of the fistula tract and the extent of the lesion. The treatment of an anal fistula primarily involves surgery, using techniques such as fistulotomy with seton placement to remove the local infection.
Is the effect of minimally invasive surgery for anal fistula good?
Anal fistulas generally require surgical treatment, which can be divided into traditional surgery and newer minimally invasive surgeries. Minimally invasive surgeries can protect anal function and the muscles around the anus, and they can reduce pain. However, they have a higher recurrence rate, meaning the recurrence rate for minimally invasive surgeries is significantly higher compared to traditional surgeries. Therefore, it is recommended that for complex anal fistulas, traditional surgical methods should still be used.
When will the anal fistula seton fall off?
After the diagnosis of an anal fistula, it is necessary to perform surgery on the anal fistula as soon as possible. The main surgical method for anal fistula is the fistulotomy with seton placement, which uses an elastic band to indirectly cut the local sphincter. The time for the elastic band to fall off mainly depends on the amount of sphincter involved and the depth of the anal fistula location. If it is a simple anal fistula, the band typically falls off about a week after placement. For high, complex fistulas, or if multiple elastic bands are used, the time may extend to ten or even twelve days. If the band does not fall off after the surgery, and the local sphincter has regenerated, a professional colorectal surgeon can cut the band. However, it is important to ensure that the local sphincter is not damaged before proceeding.