Is the probability of anal fistula turning into cancer high?

Written by Yang Dong

Colorectal Surgery Department

Updated on September 17, 2024

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An anal fistula, formed due to an anal gland infection, carries a higher risk of malignant transformation if the infection and inflammation are recurrent and persistent, particularly over a long period exceeding five years. Therefore, it is strongly recommended that anal fistulas exceeding five years should be given sufficient attention and surgical treatment should be pursued promptly to prevent malignancy.

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Written by Yu Xu Chao

Colorectal Surgery

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How to reduce swelling when an anal fistula flares up?

An anal fistula flare-up can cause perianal swelling, pain, and discharge of pus and blood. For an anal fistula flare-up, initial conservative treatment with medications is an option, such as sitting baths using anal cleansing agents or potassium permanganate solutions after defecation. The sitting bath should last between five to ten minutes to help reduce swelling and relieve pain. After the bath, topical application of mupirocin ointment or other anti-inflammatory ointments like Golden Ointment may also be used to reduce swelling and inflammation. For severe infections, intravenous or oral antibiotics may be prescribed to reduce inflammation. However, clinically, it is recommended to opt for surgical removal of the anal fistula as early as possible. Early removal of the internal opening and the fistula tract is necessary for a complete cure of the anal fistula. If an anal fistula repeatedly flares up, it can easily lead to the formation of more fistula branches, forming complex anal fistulas, increasing the difficulty of later surgeries and enlarging the wound surface post-operation.

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Written by Chen Tian Jing

Colorectal Surgery

1min 1sec

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Should surgery be performed if there are no symptoms of anal fistula?

If an anal fistula is in its acute phase, the main clinical symptoms are intermittent discharge of pus from the external opening, or pain and itching. If there are no symptoms, and only the external and internal openings along with the fistula tract exist, surgery is still required because the absence of symptoms temporarily does not guarantee that an acute episode will not occur later. During an acute episode, there will be local tissue and skin inflammation, redness, heat, and severe pain. If an anal fistula is not surgically treated for a long time, it may lead to an increase in the number of branches of the fistula or thickening of the fistula wall, and it may even spread to the pelvic cavity. Therefore, once an anal fistula is discovered, it is necessary to perform surgery as soon as possible. Early treatment has significant benefits for wound recovery and the difficulty of the operation.

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Written by Chen Tian Jing

Colorectal Surgery

1min 1sec

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How to cure anal fistula completely

The radical treatment of anal fistula mainly involves surgery, with the choice of surgery being the anal fistula cutting and ligation operation. This primarily utilizes a ligature or elastic band to loop through the local sphincter, thereby achieving slow cutting and drainage of secretions. Anal fistula is considered a local infectious lesion at the anus, and the fundamental principle of the surgery is to remove the local fistula tract and the wall of the fistula completely through cutting and ligation, and after thoroughly removing the local infection, fresh granulation tissue can regrow. Due to the prolonged location of the local lesion in anal fistulas, postoperative wound dressing and drainage are very important. The wound can be disinfected daily with povidone-iodine, and gauze impregnated with oil can be used for pressurized drainage to help facilitate the flow of local secretions.

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Written by Chen Tian Jing

Colorectal Surgery

1min 1sec

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What are the consequences of not treating an anal fistula?

If an anal fistula is not promptly treated with surgery, it may lead to an increase in the number of local branches or a thickening of the fistula wall. If the branches of the anal fistula extend to the ischiorectal fossa, it may also lead to pelvic infections. Moreover, if the anal fistula persists for a long time or if there is significant local inflammatory stimulation, it may even lead to cancerous changes in the fistula. Therefore, once an anal fistula is discovered and diagnosed, it is recommended to promptly undergo surgical treatment with fistulotomy and seton placement. Post-surgery, it is crucial to ensure thorough disinfection of the local wound, debridement, and dressing changes, which are very important for the recovery of the wound. This helps prevent pseudohealing, ensuring that the anal fistula heals completely and preventing recurrent episodes.

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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.