Can anal fistulas recur?

Written by Chen Tian Jing

Colorectal Surgery

Updated on June 25, 2025

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Anal fistula has a certain possibility of recurrence, especially when it is not actively treated with surgery, which can lead to intermittent discharge of pus from the external opening. However, the likelihood of recurrence can be significantly reduced after an anal fistula fistulotomy with seton placement. Nevertheless, it is recommended that after surgery, patients should develop good dietary and defecation habits to avoid repeated infections in the local anal crypt, leading to recurrent episodes of anal fistula. After surgery, due to the large local wound surface and the presence of secretions, it is also necessary to properly disinfect and change dressings on the wound to prevent poor drainage leading to false healing or local wound infection.

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Written by Chen Tian Jing

Colorectal Surgery

50sec

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Does anal fistula surgery hurt?

Anal fistula surgery primarily involves fistulotomy and ligation, with the surgery’s difficulty and potential for pain depending largely on the severity of the condition and the type of anesthesia used. If local anesthesia is used, patients may experience localized pain six hours post-surgery, especially in cases where the fistula is deep or complex, as the larger surgical wounds tend to cause more intense pain. If a spinal anesthesia method is used, incorporating methylene blue injection for nerve block during surgery, postoperative pain may be slightly less intense. Generally, localized pain might occur after 12 hours. If the pain is severe, patients can be treated with oral or topical pain-relieving medication.

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Written by Chen Tian Jing

Colorectal Surgery

1min 3sec

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What should be paid attention to for anal fistula?

Patients with anal fistula, as there is an external opening in the anal region and intermittent thick secretion from this opening, should first ensure to keep the perianal area clean. It is recommended to change underwear daily and to cleanse the area after bowel movements with saline or hemorrhoid wash, and to conduct fumigation and hot compresses around the perianal area and the external opening to prevent irritation and even sharp pain caused by residual feces and secretions. Furthermore, during acute episodes of anal fistula, mupirocin ointment can be applied around the external opening for anti-inflammatory treatment. The definitive surgery for anal fistula primarily involves fistulotomy with seton placement. Without surgery, an anal fistula cannot be completely cured and may lead to worsened conditions such as thickening of the fistula wall or increased branching of the fistula channels.

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Written by Yu Xu Chao

Colorectal Surgery

1min 11sec

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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.

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Written by Chen Tian Jing

Colorectal Surgery

1min

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When will the anal fistula seton fall off?

After the diagnosis of an anal fistula, it is necessary to perform surgery on the anal fistula as soon as possible. The main surgical method for anal fistula is the fistulotomy with seton placement, which uses an elastic band to indirectly cut the local sphincter. The time for the elastic band to fall off mainly depends on the amount of sphincter involved and the depth of the anal fistula location. If it is a simple anal fistula, the band typically falls off about a week after placement. For high, complex fistulas, or if multiple elastic bands are used, the time may extend to ten or even twelve days. If the band does not fall off after the surgery, and the local sphincter has regenerated, a professional colorectal surgeon can cut the band. However, it is important to ensure that the local sphincter is not damaged before proceeding.

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Written by Chen Tian Jing

Colorectal Surgery

1min 1sec

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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.