Anal Fistulas: Do You Still Need Surgery After Drainage?

Anal fistula

Hello Doctor, about two weeks ago, I noticed a lump the size of a thumb near my anus, which made it difficult to sit comfortably.
I went to the hospital for an examination and was diagnosed with an anal fistula.
On the same day, the doctor drained the pus from the fistula for testing and scheduled a follow-up appointment for surgery in two weeks.
After the pus was drained, the fistula has decreased in size.
The surgery date has not yet arrived, and I have not undergone the procedure.
Every day, I gently touch the fistula to check if it has enlarged.
The fistula is located at the upper right side of the anus and is easily palpable.
After the drainage, I have not experienced any discomfort, my bowel movements are normal and painless, and there is no blood on the toilet paper after wiping, nor any abnormalities on my underwear.
It has been about two weeks since the drainage, and I could always feel the protruding fistula until suddenly, in the past two days, I can no longer feel it.
The area where the fistula was has flattened, but upon careful examination, I can still feel a slight hard lump that is not painful and does not cause any sensation.
I have read several articles, and some mention that a small number of people do not experience a recurrence after drainage.
My question is, do I still need to undergo surgery? What does this situation indicate? Thank you for your response, Doctor.

Jie, 30~39 year old female. Ask Date: 2018/06/09

Dr. Xu Kaixi reply Surgery

After the anal fistula becomes infected and receives initial drainage and antibiotic treatment, symptoms may improve; however, there is still a possibility of recurrence, which varies from person to person.
To achieve a complete cure of the anal fistula, surgical excision is the most effective method.

Reply Date: 2018/06/09

More Info

Understanding anal fistulas and their management is crucial for anyone experiencing this condition. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus, often resulting from an infection that leads to the formation of an abscess. In your case, it sounds like you had an abscess that was drained, which is a common first step in managing an anal fistula.

1. Do You Still Need Surgery After Drainage?
Yes, surgery is typically recommended even after the drainage of an abscess. While draining the abscess can relieve symptoms and may lead to temporary improvement, it does not address the underlying fistula. The fistula itself usually requires surgical intervention to prevent recurrence and to promote healing. The surgery aims to remove the fistula tract and ensure that the area heals properly.

2. Current Situation and Changes:
It’s encouraging to hear that after the drainage, you have experienced a reduction in the size of the fistula and that you are not experiencing discomfort or abnormal symptoms. The fact that the area feels flatter and you can no longer palpate the fistula as before could indicate that the inflammation has decreased, and the body may be healing. However, it is essential to understand that the absence of symptoms does not necessarily mean the fistula has resolved.
3. Potential for Spontaneous Healing:
In some cases, particularly with superficial fistulas or those that are not complex, there is a possibility that the fistula may close on its own after drainage. However, this is not the norm, and many fistulas will not heal without surgical intervention. The risk of recurrence remains significant if the fistula is not surgically addressed.

4. Importance of Follow-Up:
It is crucial to follow up with your healthcare provider as scheduled. They will be able to assess the fistula more thoroughly and determine whether surgery is still necessary. They may perform imaging studies or an examination under anesthesia to evaluate the fistula's extent and complexity.

5. Surgical Options:
If surgery is deemed necessary, there are various techniques available, including fistulotomy, seton placement, or advancement flap procedures, depending on the fistula's characteristics. Your surgeon will discuss the best approach based on your specific situation.

6. Post-Surgical Recovery:
If you do undergo surgery, recovery will involve managing pain, maintaining hygiene, and possibly modifying your diet to avoid constipation, which can strain the surgical site. Regular follow-up appointments will be essential to monitor healing and prevent complications.

In conclusion, while the drainage of the abscess may have provided temporary relief and improvement, it is essential to consult with your healthcare provider regarding the necessity of surgical intervention for the fistula. Early surgical treatment can prevent complications and improve long-term outcomes. Always prioritize open communication with your healthcare team to ensure the best care for your condition.

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