Anal Fistulas: Treatment Challenges and Long-Term Care

Please inquire about anal fistula issues?

Dear Dr.
Ke,
I developed an anal fistula at the age of 15, with abscesses on both sides that ruptured.
At that time, I did not receive aggressive treatment, which led to a long-standing hidden condition that feels like a concealed fistula.
According to information online, if it is not visible externally, it indicates that the fistula has penetrated deeper into the subcutaneous tissue, often complicating treatment for physicians.

Until June 23 of last year, I underwent surgery performed by Director Rao Shuwen at Tri-Service General Hospital, using a "dorsal recumbent" anesthesia position.
So far, it seems that the left fistula has not been completely cured, as pressing around it still feels strange, and there may be an abscess.
On the right side, he indicated that it was not a fistula, but I can feel some cord-like structures extending toward the anus.
I had mentioned this to him during the digital examination, and he said he would confirm it on the day of the surgery, but post-operation, he stated that it was not a fistula.

I truly regret not understanding the importance of early detection and treatment at such a young age.
It is quite frustrating to think about my long-standing medical history.
I have a few questions I would like to ask you:
1.
Is it true that a concealed fistula that has persisted for fifteen years has no possibility of complete healing? (Since I missed the golden treatment period, it has evolved into a chronic condition.)
2.
Are there any current medical techniques, such as fistulography or other methods, that can accurately determine the location, depth, and size of the fistulas on both sides?
3.
Can the fistula invade the sciatic nerve or the pubic bone? (I sometimes feel discomfort around the anus when sitting on hard chairs.)
Now that I am thirty, I want to ensure that I completely heal from this condition.
I am concerned about the possibility of developing anal cancer or needing a colostomy in my forties or fifties, which could ruin my dreams of traveling abroad.

I hope you can take the time to respond to my questions.
Thank you very much!

Alex Chou, 30~39 year old female. Ask Date: 2016/02/11

Dr. Ke Fangxu reply Surgery

1.
Cure is possible, but complex anal fistulas can be quite troublesome to open up, with a longer recovery time and a higher likelihood of recurrence.
Some cases may require multiple surgeries to achieve eradication.
2.
Indeed, some major hospitals perform fistulography; you can inquire with your physician, as it is mostly available at medical centers.
3.
Fistulas generally do not invade such distant areas; the discomfort from sitting on hard chairs likely originates from the anal area.
4.
Anal fistulas do not evolve into anal cancer, but chronic inflammation can cause significant daily discomfort.
It is still recommended that you undergo eradication surgery as soon as possible to prevent the fistula from becoming increasingly complex, which would only complicate surgery and recovery.

Reply Date: 2016/02/11

More Info

Understanding anal fistulas can be quite complex, especially when they have been present for an extended period, as in your case. It is commendable that you are seeking to understand your condition better and are proactive about your health.
1. Possibility of Complete Healing: Chronic anal fistulas, especially those that have been present for many years, can be challenging to treat. The longer a fistula remains untreated, the more likely it is to develop complications and become entrenched in the surrounding tissue. While complete healing is possible, it often requires careful evaluation and possibly multiple treatment approaches. The fact that you have had surgery but are still experiencing symptoms suggests that the fistula may not have been fully excised or that there may be additional fistulous tracts that were not addressed during the initial surgery. It is crucial to have a thorough follow-up with your surgeon or a colorectal specialist who can assess the situation and recommend further treatment options.

2. Imaging Techniques: In modern medicine, there are several imaging techniques available to evaluate anal fistulas. One common method is an MRI, which can provide detailed images of the fistula's path, including its depth and any branching tracts. Fistulography, where a contrast dye is injected into the fistula, can also help visualize its anatomy. These imaging modalities can assist in planning further surgical interventions if necessary. Discussing these options with your healthcare provider can help determine the best approach for your situation.

3. Potential Complications: Concerns about the fistula invading nearby structures, such as the sacral nerves or pelvic bones, are valid. While it is less common for a fistula to directly invade these structures, chronic inflammation and infection can lead to complications that may affect nearby nerves and tissues. If you are experiencing discomfort while sitting, especially on hard surfaces, it may be worth discussing with your doctor. They may recommend adjustments in your seating or further evaluation to rule out any complications.

4. Long-term Management and Risks: Your concern about the potential progression to more severe conditions, such as anal cancer, is understandable. Chronic inflammation and irritation in the anal region can increase the risk of certain cancers over time. Therefore, it is essential to manage your fistula effectively and to have regular follow-ups with your healthcare provider. They can monitor your condition and provide guidance on lifestyle modifications, dietary changes, and other supportive measures that may help alleviate symptoms and improve your quality of life.

In conclusion, while the journey with anal fistulas can be frustrating, especially with a long history, it is essential to remain proactive in your treatment. Engaging with a specialist who understands the complexities of anal fistulas can provide you with the best chance for a successful outcome. Regular follow-ups, appropriate imaging, and possibly further surgical intervention may be necessary to achieve the healing you desire. Remember, you are not alone in this, and there are healthcare professionals dedicated to helping you navigate this challenging condition.

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