What are the precautions after undergoing anal fistula surgery?

Written by Yu Xu Chao
Colorectal Surgery
Updated on March 02, 2025
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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.

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Written by Yang Dong
Colorectal Surgery Department
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Anal fistula etiology

The cause of an anal fistula is due to infection of the anal glands. In normal human anatomy, there is a location at the junction of the rectum and the anal canal called the anal sinus or anal gland, which is relatively weak. If it is damaged, intestinal bacteria can enter the anal gland, causing inflammation. Over time, the infected anal gland leads to further abscesses towards the perianal space, causing a perianal abscess. After the perianal abscess ruptures, it further develops into an anal fistula.

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Written by Yang Dong
Colorectal Surgery Department
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causes of anal fistula

Anal fistula is one of the common diseases in proctology. The formation of an anal fistula is caused by infection of the anal sinuses and anal glands. Due to damage to the anal sinuses and anal glands, bacteria from the intestines enter these areas. As immunity weakens, the bacteria cause localized inflammation, which then leads to the formation of an abscess. After the abscess bursts, an anal fistula forms. This is the pathogenesis of anal fistula.

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Written by Yu Xu Chao
Colorectal Surgery
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What are the consequences of not treating anal fistulas?

Since an anal fistula is caused by the infection and inflammation of the anal glands, it connects the rectum or anal canal with the skin around the anus, forming repeated abscesses, pain, and discharge of pus and blood around the anus. If an anal fistula is not treated, more fistula tracts will develop over time, and more of the muscles around the anus will become infected. This can even lead to high, complex anal fistulas, making surgical treatment later on more difficult and could easily lead to anal incontinence. Also, if an anal fistula is left untreated for a long time, there is the possibility of malignant transformation. Therefore, in clinical practice, it is recommended to undertake surgical treatment for anal fistulas as early as possible. The surgery for an anal fistula mainly involves the removal of the internal opening and the fistula tract, which is essential for a complete cure. Postoperatively, it is necessary to persist in changing dressings to avoid infection or pseudohealing at the wound site. Moreover, patients should be mindful of their diet.

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Written by Chen Tian Jing
Colorectal Surgery
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Does an anal fistula hurt?

Anal fistula mainly refers to the presence of a noticeable fistula in the tissue under the perianal skin, which connects the inner opening in the anal canal and the outer opening around the anus. Usually, the anal fistula does not cause significant pain when it is not in acute flare-up. However, if the anal fistula enters an acute episode, there may be pain due to inflammation at the local external opening of the anus, and possibly an increase in purulent discharge, which can irritate the skin around the external opening, causing stinging pain and itching. To prevent recurrent episodes of anal fistula and further aggravation of the condition, it is advised to seek surgery as soon as the fistula is detected.

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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.