When will the anal fistula seton fall off?

Written by Chen Tian Jing
Colorectal Surgery
Updated on May 13, 2025
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After the diagnosis of an anal fistula, it is necessary to perform surgery on the anal fistula as soon as possible. The main surgical method for anal fistula is the fistulotomy with seton placement, which uses an elastic band to indirectly cut the local sphincter. The time for the elastic band to fall off mainly depends on the amount of sphincter involved and the depth of the anal fistula location. If it is a simple anal fistula, the band typically falls off about a week after placement. For high, complex fistulas, or if multiple elastic bands are used, the time may extend to ten or even twelve days. If the band does not fall off after the surgery, and the local sphincter has regenerated, a professional colorectal surgeon can cut the band. However, it is important to ensure that the local sphincter is not damaged before proceeding.

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Written by Chen Tian Jing
Colorectal Surgery
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Will anal fistula cause bleeding during bowel movements?

If an anal fistula occurs, during the acute phase of the anal fistula, or when the internal and external openings of the anal fistula are ulcerated, there may also be bleeding during defecation. However, the bleeding from defecation due to an anal fistula is generally minor, and occasionally pus may also be discharged from the anus, or pus may be discharged from the external opening, causing itching or stinging of the skin around the external opening. If local pain or bleeding from defecation occurs with an anal fistula, prompt local anti-inflammatory treatment is needed; an anti-inflammatory ointment can be chosen for local application. However, the fundamental treatment for an anal fistula still requires surgery. It is generally recommended to directly perform a fistulotomy with seton placement to completely heal the fistula and prevent recurrent episodes.

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Written by Chen Tian Jing
Colorectal Surgery
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How to relieve pain from anal fistula?

The main reason that anal fistulas cause pain is because they are severe infectious lesions. During the acute phase, local inflammation causes pain or itching around the external opening, along with discharge from this opening. To alleviate the pain caused by anal fistulas, one can first apply anti-inflammatory ointments to temporarily relieve the symptoms. It is also important to maintain cleanliness around the anal area. Hemorrhoid suppositories can be used to ease the inflammation in the anal and intestinal tract. However, to completely cure the pain from anal fistulas, besides conservative medication, surgical treatment is often necessary. The main surgical method for anal fistulas is fistulotomy with a seton placement, which thoroughly removes the local infection and prevents the recurrence of pain.

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Written by Yang Dong
Colorectal Surgery Department
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Consequences of recurrent anal fistulas

If an anal fistula is not treated in time, it may repeatedly occur. If an anal fistula repeatedly occurs, due to local inflammation, pus will spread and infiltrate into the perianal tissues, causing further aggravation of infection. This can then affect the function of the anus, potentially leading to symptoms such as fecal incontinence. Moreover, if an anal fistula repeatedly occurs over a long period, there is a possibility of malignant transformation.

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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 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.