Can an anal fistula be left untreated for a lifetime?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 30, 2024
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If diagnosed with an anal fistula, one should not forego treatment indefinitely, as an anal fistula is a localized infectious disease of the anal region. Without active treatment, the infection may further spread, increase the number of fistula branches, and potentially induce a high, complex anal fistula. There is also a risk that the fistula and the infection might penetrate the local anal sphincter, reaching the ischioanal fossa and causing other infectious diseases. The primary treatment method for anal fistulas is surgical, mainly involving fistulotomy with seton placement, which thoroughly removes the local infection, allowing the anal fistula to heal. Neglecting active treatment could worsen the condition or increase the difficulty of future surgeries.

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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 Yang Dong
Colorectal Surgery Department
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What will happen if an anal fistula is not treated?

An anal fistula is a chronic fistula and duct caused by an infection of the anal sinuses. If not treated, an anal fistula may repeatedly flare up. The consequences of repeated occurrences can lead to abscesses, peripheral spreading, and eventually extensive spreading of the loose tissue around the anus, which in severe cases may damage the anal muscles, leading to anal incontinence. If an anal fistula persists for a long time, there is also a possibility of malignant transformation.

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Written by Yang Dong
Colorectal Surgery Department
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causes of anal fistula

Anal fistula is one of the common diseases in proctology. The formation of an anal fistula is caused by infection of the anal sinuses and anal glands. Due to damage to the anal sinuses and anal glands, bacteria from the intestines enter these areas. As immunity weakens, the bacteria cause localized inflammation, which then leads to the formation of an abscess. After the abscess bursts, an anal fistula forms. This is the pathogenesis of anal fistula.

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Written by Chen Tian Jing
Colorectal Surgery
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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.

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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.