What to do about the false healing of anal fistula?

Written by Chen Tian Jing
Colorectal Surgery
Updated on February 20, 2025
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If a false healing of the wound occurs after local surgical excision of an anal fistula, it is mainly due to improper dressing changes by the patient and a lack of timely observation of the local wound. It is recommended to open the superficially healed wound to allow it to regrow. In particular, the patient needs to change the dressing and observe the wound daily to prevent the situation where the internal part of the wound has not healed, but the external opening appears healed. During dressing changes, hemorrhoid creams and other drugs that promote mucosal healing can also be applied locally and inside the anal canal to further promote the healing of the internal opening. Only when the internal opening has fully grown should treatment that promotes healing of the external opening be applied. (Please use medication under the guidance of a professional physician, and do not self-medicate.)

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Written by Chen Tian Jing
Colorectal Surgery
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The difference between perianal abscess and anal fistula

Perianal abscesses and anal fistulas both belong to local infectious diseases of the anus. A perianal abscess represents the acute phase of infection, characterized by significant localized subcutaneous swelling, heat, pain, and the formation of pus and abscesses. Once the pus breaks through the skin and discharges, it naturally forms an anal fistula. Anal fistulas represent the later stages or dormant phases of local infections. Both perianal abscesses and anal fistulas require surgical treatment. The surgical method for perianal abscesses mainly involves a one-time radical surgery for the abscess, while the surgical approach for anal fistulas primarily involves fistulotomy with seton placement, followed by regular wound cleaning and dressing changes post-surgery.

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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.

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Written by Deng Heng
Colorectal Surgery
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Can anal fistulas be contagious?

An anal fistula is a pathological channel that forms a connection between the anal canal, rectum, and the skin around the anus. It primarily develops from an infection causing a perirectal abscess around the rectal anal canal. These infections are generally purulent, with a smaller number due to tuberculosis. Other specific infections, such as Crohn's disease or ulcerative colitis, can also lead to anal fistulas. Generally, such infections are caused by Escherichia coli, leading to purulent infections; tuberculosis can be contagious, but generally, it is not infectious or contagious.

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Written by Chen Tian Jing
Colorectal Surgery
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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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Written by Yu Xu Chao
Colorectal Surgery
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How to reduce swelling when an anal fistula flares up?

An anal fistula flare-up can cause perianal swelling, pain, and discharge of pus and blood. For an anal fistula flare-up, initial conservative treatment with medications is an option, such as sitting baths using anal cleansing agents or potassium permanganate solutions after defecation. The sitting bath should last between five to ten minutes to help reduce swelling and relieve pain. After the bath, topical application of mupirocin ointment or other anti-inflammatory ointments like Golden Ointment may also be used to reduce swelling and inflammation. For severe infections, intravenous or oral antibiotics may be prescribed to reduce inflammation. However, clinically, it is recommended to opt for surgical removal of the anal fistula as early as possible. Early removal of the internal opening and the fistula tract is necessary for a complete cure of the anal fistula. If an anal fistula repeatedly flares up, it can easily lead to the formation of more fistula branches, forming complex anal fistulas, increasing the difficulty of later surgeries and enlarging the wound surface post-operation.