What are the symptoms of an anal fistula?

Written by Yang Dong
Colorectal Surgery Department
Updated on September 05, 2024
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Anal fistula is one of the common diseases in proctology. The most typical symptom of anal fistula is recurrent anal induration, accompanied by swelling, pain, and pus discharge, often with a ruptured external opening. During the quiescent phase, a hard cord can be felt leading from the ruptured external opening to the inside of the anus; during the acute inflammatory phase or abscess phase, pressing may cause pus to ooze from the ruptured opening.

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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.

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Written by Deng Heng
Colorectal Surgery
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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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Written by Yang Dong
Colorectal Surgery Department
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What is the most accurate test for anal fistula?

As a common disease in proctology, simple anal fistulas can be diagnosed through visual inspection and palpation. For high-positioned complex anal fistulas, which cannot be accurately assessed through just visual inspection and palpation, the use of instruments may be necessary. Currently, magnetic resonance imaging (MRI) is recommended as the most accurate method for evaluating anal fistulas, and it is considered the gold standard for examining the course of the fistula tract and the location of the infection.

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Written by Deng Heng
Colorectal Surgery
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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.

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Written by Yu Xu Chao
Colorectal Surgery
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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.