How to deal with a ruptured anal fistula?

Written by Chen Tian Jing
Colorectal Surgery
Updated on December 14, 2024
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The clinical symptoms of anal fistula mainly include intermittent discharge of pus from the external opening near the anus, or occasional acute attacks that cause redness, swelling, heat, and pain around the external opening of the anus. If the external opening of the anal fistula breaks and discharges pus, or is accompanied by pain, it is considered an acute phase of the anal fistula. The primary method of management and treatment is surgery, with the main surgical approach being fistulotomy and seton placement. To locally alleviate the inflammatory symptoms of the external opening of the anal fistula, anti-inflammatory ointments can be applied for temporary anti-inflammatory treatment. However, to avoid the local complications such as thickening or branching of the fistula, it is advised that patients undergo surgical treatment of the anal fistula as soon as possible. (Please use medication under the guidance of a professional physician, and do not self-medicate.)

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Written by Yang Dong
Colorectal Surgery Department
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What department should I see for anal fistula?

Anal fistula is caused by infection of the anal sinuses and glands. It manifests as hard lumps or cord-like objects around the anus, and may involve recurrent swelling, pain, and discharge of pus. In such cases, it is necessary to consult a colorectal surgeon. Generally, if diagnosed with an anal fistula, surgical treatment is required, as conservative treatment usually does not result in a cure.

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Written by Chen Tian Jing
Colorectal Surgery
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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 Deng Heng
Colorectal Surgery
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What are the symptoms of anal fistula?

An anal fistula generally refers to a tract left behind after an anal abscess bursts on its own or is surgically opened. It usually consists of a primary internal opening and a secondary external opening. The main clinical manifestations, or primary symptoms, are: The first is discharge of pus, which occurs due to recurrent infections in the anal fistula; The second is pain. When the external opening is closed, the pus inside cannot drain properly, or when drainage is poor, this leads to accumulation of pus in the fistula tract, causing localized pain; The third is itching. Continuous irritation of the skin around the external opening by pus draining from the fistula tract can cause itching around the anus and may lead to symptoms like anal eczema.

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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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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.