Does an anal fistula require surgery?

Written by Deng Heng
Colorectal Surgery
Updated on January 19, 2025
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The treatment of anal fistula mainly focuses on surgical treatment, with medication as a secondary support. This means that without surgery, an anal fistula essentially cannot heal. Non-conservative treatments for anal fistulas are only temporary symptomatic treatments that manage the condition and alleviate clinical symptoms. For example, during an acute attack of an anal fistula, anti-inflammatory drugs can be used to temporarily relieve symptoms such as pain. Therefore, surgery is necessary for anal fistulas, as surgical treatment can completely eradicate the source of the disease, addressing the internal and external origins of the fistula for a complete cure.

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Written by Yu Xu Chao
Colorectal Surgery
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How to determine if you have an anal fistula

First, you can judge whether you have an anal fistula based on symptoms. Patients with anal fistula often experience recurrent perianal swelling and pain, as well as discharge of pus and blood, which may also have a foul odor, with secretion often found on their underwear. In such cases, patients should consider whether they have an anal fistula. Additionally, patients with anal fistulas in the early stages often have perianal abscesses, which generally tend to form fistulas after the abscess ruptures spontaneously or is surgically drained. Patients can also visit the colorectal surgery department of a hospital for a digital rectal examination, where the fistula tract and the internal opening can be felt. MRI scans of the perianal region can also be performed to determine the type and severity of the anal fistula. Clinically, once an anal fistula is detected, it is advisable to opt for fistula excision surgery to completely cure the anal fistula by removing the internal opening and the fistula tract. Post-surgery, it is essential to persist with dressing changes to avoid wound infection and bleeding.

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Written by Deng Heng
Colorectal Surgery
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How to completely cure an anal fistula?

Anal fistula is a tract left after an anal abscess bursts open spontaneously or is surgically incised, generally consisting of a primary internal opening and a secondary external opening. The key to curing an anal fistula lies in the finding and management of the internal opening, meaning that during surgery, the internal opening of the anal fistula must be located and then incised. Managing the internal opening is crucial to the treatment of the anal fistula. The complete removal of the fistula's tract, internal and external openings, until healthy tissue is formed, is the safest and most essential method for curing an anal fistula.

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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 Chen Tian Jing
Colorectal Surgery
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Symptoms of cancerous transformation in anal fistula

The vast majority of anal fistulas do not undergo malignant transformation. However, there is a possibility of cancerous changes if an anal fistula that has repeatedly recurred over a long period is not treated aggressively, or if the inflammation of the fistula tract is severe. When an anal fistula undergoes malignant transformation, the secretion from the local fistula tract increases and is accompanied by a foul smell, and there may even be ulceration of the local fistula tract mucosa. Further surgical procedures, such as fistulotomy with seton placement, are required, and the excised fistula tract suspected of high-grade malignant transformation should be sent for pathological examination. If malignant transformation is confirmed, further pelvic MRI examinations are necessary to determine whether there is local and surrounding lymph node metastasis.

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Written by Yang Dong
Colorectal Surgery Department
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What department should I see for anal fistula?

Anal fistula is caused by infection of the anal sinuses and glands. It manifests as hard lumps or cord-like objects around the anus, and may involve recurrent swelling, pain, and discharge of pus. In such cases, it is necessary to consult a colorectal surgeon. Generally, if diagnosed with an anal fistula, surgical treatment is required, as conservative treatment usually does not result in a cure.