Can Anal Fistulas Heal on Their Own? Treatment Options and Risks

Will an anal fistula heal on its own?

Hello, Doctor.
Four days ago, I had a long-standing wound (a hole) near my anus.
I consulted a dermatologist who diagnosed it as eczema.
Eventually, I saw a colorectal surgeon who diagnosed it as an anal fistula and recommended surgery.
However, a few days later, the wound healed on its own.

1.
Can an anal fistula heal on its own? My symptoms include some bleeding around the wound, and I initially thought it was a hole from eczema, as the dermatologist also mentioned eczema.

2.
If surgery is required for an anal fistula, what are the risks? I've heard there could be complications like fecal incontinence or impacts on sexual function, and since this would be my first surgery, I am quite concerned.

3.
If surgery is performed on an anal fistula, will it promote rapid healing or slow healing? Thank you!

Luke, 30~39 year old female. Ask Date: 2017/02/13

Dr. Ke Fangxu reply Surgery

1.
It is possible that if the infection subsides, it may lead to the healing of the fistula opening, which might go unnoticed if not carefully examined.

2.
If it is a simple fistula, there is no risk of incontinence; however, for complex types, it is difficult to determine the specific type and associated risks.
Please have a specialist examine it before discussing further.

3.
The fistula wound must heal gradually to reduce the likelihood of recurrence.

Reply Date: 2017/02/13

More Info

Anal fistulas are abnormal connections between the anal canal and the skin surrounding the anus. They often develop as a result of an infection in the anal glands, leading to an abscess that can drain and create a fistula. Your situation, where a wound near the anus has been diagnosed as a fistula, raises several important considerations regarding healing, treatment options, and associated risks.

1. Can Anal Fistulas Heal on Their Own?
While some superficial anal fistulas may close spontaneously, most do not heal without intervention. The likelihood of self-healing largely depends on the fistula's complexity and underlying causes. In many cases, if the fistula is associated with chronic conditions such as Crohn's disease or if it is a complex fistula (involving multiple branches or located in difficult areas), it is less likely to heal on its own. The presence of ongoing symptoms, such as bleeding or discharge, suggests that the fistula may require surgical intervention to fully resolve.

2. Risks of Surgery for Anal Fistulas:
Surgical treatment is often recommended for anal fistulas, especially if they are symptomatic. However, surgery does carry risks. The most common concerns include:
- Incontinence: There is a risk of damage to the anal sphincter muscles during surgery, which can lead to fecal incontinence. The risk varies depending on the type of fistula and the surgical technique used.

- Sexual Function: While rare, there can be complications affecting sexual function, particularly if the surgery involves significant manipulation of the surrounding tissues.

- Recurrence: There is also a possibility that the fistula may recur after surgery, necessitating further treatment.

Discussing these risks with your surgeon is crucial, as they can provide insights based on your specific case and the complexity of the fistula.

3. Surgical Healing Process:
The goal of surgery for an anal fistula is to create a controlled healing environment. This often involves laying open the fistula tract, which allows it to heal from the inside out. The healing process can take several weeks to months, depending on the size and complexity of the fistula. Post-operative care is essential to promote healing and prevent infection. Your surgeon will provide specific instructions on wound care, dietary modifications, and follow-up appointments to monitor healing.

In conclusion, while some anal fistulas may heal spontaneously, many require surgical intervention for complete resolution. The decision to proceed with surgery should be made after a thorough discussion with your healthcare provider, weighing the potential benefits against the risks. If you have concerns about surgery, it may be helpful to seek a second opinion or discuss non-surgical management options, although these may not be as effective for persistent fistulas. Always prioritize open communication with your healthcare team to ensure the best possible outcome for your condition.

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