Can anal fistulas be left untreated indefinitely?

Written by Chen Tian Jing
Colorectal Surgery
Updated on February 15, 2025
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If a patient is diagnosed with an anal fistula, it must not be left untreated. If an anal fistula is not actively treated over a long period, it can easily lead to thickening of the fistula tract or an increase in branching. Moreover, after long-term repeated inflammatory stimulation, some fistula tracts are prone to malignant transformations. Therefore, it is recommended that patients with anal fistulas seek symptomatic treatment as soon as they are diagnosed. The primary method of treating anal fistulas is surgical. The main surgical approach for an anal fistula is fistulotomy with seton placement, which involves removing the local fistula tract wall while preserving the function of the patient's sphincter muscle. After the surgery, patients need to follow a light diet to avoid an increase in local secretions, which can lead to inflammatory stimulation and even the recurrence of the anal fistula.

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Written by Chen Tian Jing
Colorectal Surgery
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What is the best treatment for anal fistula?

The primary treatment method for anal fistulas is surgery, which mainly involves the use of a local seton thread. This method allows the surgeons to excise or remove the affected area of the anal fistula while preserving the normal contractile function of the local anal sphincter. This precaution helps prevent excessive removal that could lead to sphincter relaxation or excessive loosening of the anus. As the local sphincter naturally repairs itself and the seton falls out post-surgery, it ensures the proper healing of the local wound. Postoperative care for anal fistula surgery also involves proper drainage and disinfection of the local wound. Daily application of oil gauze and changing of anti-inflammatory medications on the local wound are recommended. This helps in reducing inflammation and facilitating drainage, thereby preventing the occurrence of local pseudohealing.

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Written by Chen Tian Jing
Colorectal Surgery
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How to deal with a ruptured anal fistula?

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 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.

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Written by Chen Tian Jing
Colorectal Surgery
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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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Symptoms of hemorrhoids and anal fistula

If there are concurrent hemorrhoids and anal fistulas, then the clinical manifestations primarily involve the combined symptoms of both conditions. The clinical manifestations of hemorrhoids mainly include recurrent prolapse of local swellings at the anus along with defecation bleeding or pain. As for anal fistulas, they primarily present with local infectious symptoms at the anus because anal fistulas have distinct external and internal openings. During acute episodes, there typically is intermittent discharge of pus from the external opening along with accompanying stabbing pain. If the patient also has hemorrhoids or an exposed anal fissure, it is recommended to proceed with surgical treatment as soon as possible. The only treatment method for anal fistulas is surgery. During the surgery, while excising the wall of the anal fistula tract, mixed hemorrhoids can also be removed simultaneously, achieving the purpose of complete cure.