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Anal fistula
What to do about the false healing of anal fistula?
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.)
Can anal fistulas be left untreated indefinitely?
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.
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.
What should I do about an anal fistula?
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.
Does an anal fistula require surgery?
The treatment of anal fistula mainly focuses on surgical treatment, with medication as a secondary support. This means that without surgery, an anal fistula essentially cannot heal. Non-conservative treatments for anal fistulas are only temporary symptomatic treatments that manage the condition and alleviate clinical symptoms. For example, during an acute attack of an anal fistula, anti-inflammatory drugs can be used to temporarily relieve symptoms such as pain. Therefore, surgery is necessary for anal fistulas, as surgical treatment can completely eradicate the source of the disease, addressing the internal and external origins of the fistula for a complete cure.
Is it better for the external opening of an anal fistula to be closed or not closed?
In clinical practice, it is generally best not to close the external opening of an anal fistula. Keeping the drainage unobstructed can prevent the infection from worsening or the formation of multiple branches. This is because when the fistula drains properly, the infectious secretions can flow out of the external opening. However, if the external opening does close, the infected tissues and secretions will accumulate within the fistula and then spread to the surrounding areas, forming branches and leading to an increase in the number of branches, thus creating a complex anal fistula and increasing the difficulty of future surgeries. Therefore, it is best not to close the external opening of an anal fistula. Clinically, the treatment for an anal fistula involves fistulectomy, which primarily involves removing the internal opening and the fistula. The external opening also needs to be treated. Postoperatively, medications such as erythromycin ointment gauze strips should be used for dressing changes.
How is an anal fistula treated?
The treatment methods for anal fistula mainly involve surgery. Conservative medication for anal fistula does not provide a definitive cure but can alleviate the inflammatory symptoms triggered during acute episodes by using anti-inflammatory symptomatic drugs. The surgical method primarily used for anal fistula is the fistulotomy with seton placement. This procedure involves cutting the local sphincter either partially or completely using a thread, while preserving the function of the surrounding sphincter and thoroughly removing the fistula tract wall to further eliminate the local lesions. After the surgery, due to the large wound area, it is recommended that patients stay in the hospital for dressing changes and symptomatic treatment to avoid complications like poor healing leading to pseudo-healing or wound infection. (Medication should be used under the guidance of a doctor.)
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.
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.
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.