How is anal fistula treated?

Nov 14, 2025 Source: Cainiu Health

Dr. Li Jingxiang

Introduction

Treatment options for anal fistula include fistulotomy, seton placement, fistulectomy, minimally invasive procedures, and adjunctive medical therapy. Surgery remains the primary method for definitive treatment, and the choice of procedure should be based on the type of fistula and individual patient condition. If symptoms such as recurrent pus discharge, worsening pain, or fever occur, prompt medical attention is recommended. Complete incision of the fistula tract allows open drainage of the wound.

　　Treatment options for anal fistula include fistulotomy, seton placement, fistulectomy, minimally invasive procedures, and adjunctive drug therapy. Surgery remains the primary method for definitive treatment, with the choice of approach depending on the type of fistula and individual patient condition. If symptoms such as recurrent pus discharge, worsening pain, or fever occur, prompt medical attention is recommended.

　　1. Fistulotomy: This procedure involves fully opening the fistula tract to allow drainage and healing from the base upward. It is suitable for low-lying, simple anal fistulas. The technique is straightforward, promotes rapid healing, effectively removes the infected tissue, and reduces the risk of recurrence.

　　2. Seton placement: A rubber band or surgical thread is threaded through the fistula tract, using gradual tension to slowly cut through the surrounding tissue while simultaneously draining pus. This method is ideal for high-level or complex anal fistulas and helps preserve the function of the anal sphincter muscles.

　　3. Fistulectomy: Involves complete removal of the fistula tract along with surrounding diseased tissue. It is appropriate for low, superficial fistulas without branches. Postoperative wound care is essential to prevent infection and support healing.

　　4. Minimally invasive treatments: These use endoscopic or laser techniques, such as endoscopic fistula plug insertion. They are associated with less trauma and faster recovery, making them suitable for selected cases of simple anal fistulas, while minimizing damage to surrounding anal tissues.

　　5. Adjunctive drug therapy: Antibiotics may be used preoperatively to control infection, while anti-inflammatory and analgesic medications help relieve symptoms post-surgery. Topical antiseptics can also be applied to clean the wound, supporting surgical treatment and promoting recovery.

　　After surgery, it is important to keep the wound clean and dry, rinsing with warm water after bowel movements. Maintain a light diet rich in dietary fiber to prevent constipation. Avoid strenuous exercise and maintain regular sleep patterns to support wound healing.

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What ointment is good for cleaning an anal fistula wound?

In general, wound care after anal fistula surgery requires the use of ointments that have both anti-infective and healing-promoting properties. Patients may use medications such as mupirocin ointment, compound polymyxin B ointment, recombinant human epidermal growth factor gel, Longzhu ointment, or Kangfuxin solution as directed by their physician to aid recovery. Before applying medication, ensure the wound is clean, and rinse the perianal area with warm water after each bowel movement.

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What are the causes of bleeding in anal fistula?

Bleeding from an anal fistula may be caused by bowel movement irritation, local friction, fistula infection, perianal abscess, or perianal eczema. It can be improved by adjusting bowel movements, reducing irritation, and medication. If bleeding increases or is accompanied by severe pain, prompt medical attention is necessary. Hard, dry stool passing through the area of the anal fistula can cause friction against the fistula's mucosal lining, leading to tissue damage and bleeding.

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What causes the wound to turn white after anal fistula surgery?

In general, whitening of the wound after anal fistula surgery may be caused by normal granulation tissue, local moisture maceration, wound infection, ischemia, or false healing. If any discomfort occurs, it is recommended to seek timely medical evaluation and treatment at a reputable hospital. Maintain a light and easily digestible diet, consume more protein-rich foods, keep bowel movements smooth, and avoid constipation that could lead to straining and wound tearing.

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What medication should be taken after anal fistula surgery?

In general, medication after anal fistula surgery aims to prevent infection, relieve pain, promote wound healing, and maintain smooth bowel movements. Patients may follow their doctor's instructions to use medications such as cefdinir dispersible tablets, ibuprofen sustained-release capsules, kangfuxin liquid, lactulose oral solution, and compound alginates suppositories for treatment. It is also important to develop regular bowel habits and consume more foods rich in dietary fiber.