Can anal fistulas be contagious?

Written by Deng Heng
Colorectal Surgery
Updated on April 06, 2025
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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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How to deal with the internal opening of an anal fistula?

The internal opening of an anal fistula is generally located at the site of inflammation in the anal crypt. The primary reason for the formation of an anal fistula is the repeated outbreaks at the anal crypt, which lead to further infection and the formation of a perianal abscess. When the abscess cavity ruptures, it forms an external opening and the anal fistula. Surgical treatment is required for the internal opening of an anal fistula, generally involving a seton procedure that threads a line through the internal opening and part of the sphincter muscle, gradually cutting and draining the area slowly. If the inflammation at the internal opening is significant, it may also be necessary to excise part of the infected site in the anal crypt. Post-surgery care of the internal opening of an anal fistula primarily involves dressing changes, requiring daily thorough disinfection of the local area, ensuring clear drainage, to allow the granulation tissue at the internal opening to grow freshly, and to slowly heal the wound without infection. (Medication should be taken under the guidance of a doctor.)

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Written by Chen Tian Jing
Colorectal Surgery
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Is anal fistula prone to recurrence?

If active anal fistulotomy and thread-drawing surgery are carried out after the onset of an anal fistula, it generally does not recur easily. However, if patients do not pay attention to good dietary and defecation habits after being discharged, it may lead to the reoccurrence of the anal fistula. This is because there are multiple anal crypts within the anal canal, and removing the local anal crypts during this episode does not guarantee that other anal crypts will not become inflamed or infected in the future. Especially when patients consume excessive amounts of chili peppers or alcohol, or when they experience diarrhea, it can potentially trigger another infection of the anal crypts. Therefore, to prevent recurrence of anal fistulas, it is necessary to cultivate good defecation and dietary habits to avoid the reoccurrence of anal fistulas.

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Written by Yang Dong
Colorectal Surgery Department
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What will happen if an anal fistula is not treated?

An anal fistula is a chronic fistula and duct caused by an infection of the anal sinuses. If not treated, an anal fistula may repeatedly flare up. The consequences of repeated occurrences can lead to abscesses, peripheral spreading, and eventually extensive spreading of the loose tissue around the anus, which in severe cases may damage the anal muscles, leading to anal incontinence. If an anal fistula persists for a long time, there is also a possibility of malignant transformation.

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Written by Deng Heng
Colorectal Surgery
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Can a twenty-year anal fistula turn into cancer?

Firstly, anal fistulas can become cancerous. Statistical data show that the probability of malignant transformation in anal fistulas is 1/1000, and such transformations are relatively rare in clinical practice. However, anal fistulas can change, but the timing of malignant transformation varies. Generally, the longer the duration of an anal fistula, the higher the chance of it becoming cancerous. The factors contributing to this transformation typically include chronic inflammation, long-term irritation, bacterial infection, and stimulation from medications, all of which can lead to cancerous changes.

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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.