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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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.

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Anal fistulas secondary to which disease?

An anal fistula generally originates from a perianal abscess, which is an infection focus formed near the anal sinuses in the local area of the anus. During its onset, there is obvious local redness, swelling, heat, and pain accompanied by the formation of a pus cavity containing pus. As the condition of the perianal abscess worsens, the local pus cavity will rupture and discharge pus, thus forming an anal fistula. After the rupture of a perianal abscess, its external opening cannot heal by itself, and there will be intermittent recurring discharge of pus. Therefore, it is necessary to carry out surgical treatment as soon as possible after the formation of an anal fistula, to prevent the enlargement of the local pus cavity or thickening of the fistula wall, which complicates later surgery and treatment and significantly impacts the patient's normal life.

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What should I do about an anal fistula?

Anal fistula is a disease that occurs when repeated infections in the anal crypts extend to the surface of the skin around the anus. Once formed, there are typical fistula tracts with both internal and external openings. Simple anti-inflammatory drug treatments can only relieve the symptoms of inflammation during the acute phase of an anal fistula. For the fistula tracts themselves, these treatments do not completely cure the condition. It is recommended that patients with an anal fistula undergo a fistulotomy as soon as they are diagnosed. Through surgery, the fistula tract and its walls can be completely excised, completely removing the local lesion, thereby further accelerating the regrowth of fresh granulation tissue locally.

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Which is more serious, anal fistula or hemorrhoids?

Anal fistulas and hemorrhoids are two different types of common colorectal diseases; neither can be said to be more severe than the other, as the severity of each disease depends on its progression and extent. If it's a simple superficial anal fistula, the severity is generally mild, primarily treated with surgery. However, if a high, complex anal fistula is present, in addition to surgery, a comprehensive pelvic MRI examination is also required to rule out any infections in the deep sphincter and ischioanal fossa. The severity of hemorrhoids primarily involves circular mixed hemorrhoids, or those accompanied by incarceration. If circular mixed hemorrhoids with incarceration occur, it is advisable to undergo surgical treatment as soon as possible to avoid necrosis. If hemorrhoids result in persistent and significant rectal bleeding, surgery should also be performed promptly to prevent anemia in the patient.

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What are the precautions after undergoing anal fistula surgery?

Because anal fistula surgery primarily involves removing the internal opening and the fistula tract, the postoperative wound is relatively large. Postoperative care mainly requires consistent dressing changes to ensure the wound drainage remains unobstructed, avoiding infection or false healing. Additionally, patients should develop good bowel habits, maintain smooth bowel movements, and avoid withholding stool. Otherwise, this may lead to dry, hard stools, causing severe pain during defecation or damaging the wound, which could result in bleeding or edema. In terms of diet, patients should choose foods rich in roughage to ensure smooth defecation and eat foods rich in high-quality protein to supplement the amino acids the body needs, promoting wound healing as much as possible. Moreover, after surgery, patients must use an anal wash or potassium permanganate solution for sitz baths. Since the postoperative wound is open and contaminated, changing dressings is especially important.