Can anal fistulas be left untreated?

Written by Chen Tian Jing
Colorectal Surgery
Updated on May 28, 2025
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If an explicit diagnosis of anal fistula is made, it cannot go untreated. If the anal fistula is localized around the anus but not actively treated and surgically removed, it is very likely to cause branching of the fistula tract or spread to the ischioanal fossa, as well as thickening of the fistula wall. This can exacerbate the symptoms of local infection, causing an increase in stabbing pain or purulent secretions. Prolonged, recurrent episodes of anal fistula may also lead to carcinogenic changes in the fistula wall due to inflammatory stimuli. Therefore, once an anal fistula is diagnosed, it is necessary to promptly undergo surgical treatment with fistulotomy and seton placement to prevent the condition from worsening and complicating later treatments.

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Written by Chen Tian Jing
Colorectal Surgery
1min 4sec home-news-image

Anal fistulas are secondary to what?

Anal fistulas primarily arise from local perianal abscesses that are not actively treated, repeatedly occur, or from severe pus cavity inflammation that causes the abscess to rupture locally, resulting in the formation of an anal fistula. An anal fistula typically has a characteristic internal opening and external opening, as well as a fistula tract connecting them. After the occurrence of an anal fistula, it is recommended that the patient undergo surgery as soon as possible. The surgical method mainly used for anal fistulas is the cutting and threading surgery. If it is a high-position complex anal fistula or there are multiple external openings and branches, the patient needs to complete related examinations, mainly focusing on local perianal color ultrasound or pelvic MRI, which are most important. After clarifying the direction of the fistula branches, a thorough and definitive surgical treatment for the anal fistula can be carried out.

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Written by Chen Tian Jing
Colorectal Surgery
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Does an anal fistula hurt?

Anal fistula mainly refers to the presence of a noticeable fistula in the tissue under the perianal skin, which connects the inner opening in the anal canal and the outer opening around the anus. Usually, the anal fistula does not cause significant pain when it is not in acute flare-up. However, if the anal fistula enters an acute episode, there may be pain due to inflammation at the local external opening of the anus, and possibly an increase in purulent discharge, which can irritate the skin around the external opening, causing stinging pain and itching. To prevent recurrent episodes of anal fistula and further aggravation of the condition, it is advised to seek surgery as soon as the fistula is detected.

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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 Yu Xu Chao
Colorectal Surgery
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Is a second surgery for an anal fistula more difficult than the first one?

Relative to the initial procedure, a second surgery for anal fistula is more difficult. The main goal of anal fistula surgery is to remove the internal opening and the fistula tract completely to cure the condition. During a second surgery for an anal fistula, due to the previous operation, the internal opening may be unclear, and it can be difficult to distinguish between the fistula and scar tissue. This can lead to incomplete removal by less experienced surgeons, increasing the likelihood of the fistula recurring later. Therefore, for a second surgery on an anal fistula, it is essential to undergo the procedure in a specialized colorectal department at a provincial-level top-rated hospital. It is recommended to have a magnetic resonance imaging (MRI) of the anal region before surgery to ensure precise operation and complete removal of the internal opening and fistula tract. Proper postoperative dressing changes are also crucial to avoid infection and inflammation of the wound, which will help with normal recovery after the surgery.

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Written by Si Li Li
Gastroenterology
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Can colitis cause anal fistula?

If it is chronic colitis, it is possible to cause anal fistulas. Most patients with chronic colitis have symptoms of unformed stools and loose feces. Some feces, which are relatively thin, tend to accumulate in the anal crypts, leading to infection of the anal glands in these areas. The inflammation then spreads to the normal soft tissues around the anus, including subcutaneous tissues, forming perianal abscesses. If a perianal abscess ruptures or is surgically incised to release pus, the external opening and the pus cavity gradually heal and narrow, thus forming an anal fistula. If chronic colitis is diagnosed, it should be promptly diagnosed and treated to prevent the formation of anal fistula.