What should be paid attention to for anal fistula?

Written by Chen Tian Jing
Colorectal Surgery
Updated on December 16, 2024
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Patients with anal fistula, as there is an external opening in the anal region and intermittent thick secretion from this opening, should first ensure to keep the perianal area clean. It is recommended to change underwear daily and to cleanse the area after bowel movements with saline or hemorrhoid wash, and to conduct fumigation and hot compresses around the perianal area and the external opening to prevent irritation and even sharp pain caused by residual feces and secretions. Furthermore, during acute episodes of anal fistula, mupirocin ointment can be applied around the external opening for anti-inflammatory treatment. The definitive surgery for anal fistula primarily involves fistulotomy with seton placement. Without surgery, an anal fistula cannot be completely cured and may lead to worsened conditions such as thickening of the fistula wall or increased branching of the fistula channels.

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Written by Chen Tian Jing
Colorectal Surgery
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Can an anal fistula be left untreated for a lifetime?

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 Chen Tian Jing
Colorectal Surgery
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What causes anal fistulas?

The most common cause of anal fistula is perianal abscess. Both anal fistula and perianal abscess involve infections at the anal crypts. Typically, an anal fistula forms naturally after a perianal abscess ruptures. Once an anal fistula occurs, it requires prompt surgical treatment. The primary surgical technique is fistulotomy with seton placement, thoroughly removing the local lesion and infection focus to allow fresh granulation tissue to regrow. Anal fistula is a local infectious disease of the anus, generally categorized into simple superficial anal fistula and high-risk complex anal fistula. If a high-position complex anal fistula is suspected, further diagnosis may require additional examination with pelvic MRI or perianal ultrasonography. After the rupture of a perianal abscess, it typically forms a characteristic internal and external opening, with a fistula tract connecting them, thereby forming the typical anal fistula.

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Written by Chen Tian Jing
Colorectal Surgery
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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
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How long will it take for a fallen anal fistula seton to heal?

The primary surgical method for anal fistulas is the fistulotomy with seton placement. The duration for which the seton, made of elastic band, remains in place largely depends on the severity of the anal fistula and the amount of sphincter muscle tied. If the fistula is a simple superficial one, the seton usually falls out around seven days. In cases of high, complex anal fistulas, or those with multiple branching fistula tracts and multiple sphincters tied, the seton may take slightly longer to fall out, generally about ten days. If the seton has not fallen out after the local sphincter muscle has fully regenerated, it can be cut by a professional proctologist. However, it is important to note that postoperative care mainly involves dressing changes until the seton falls out, indicating that the wound has largely healed.

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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.