Unsuccessful attempts at treating an anal fistula can manifest as either persistence or recurrence of the fistula.
What does it mean when an anal fistula comes back?
Persistence occurs when the fistula never heals after surgery, while recurrence is defined as healing of the surgical wounds and assumed healing of the fistula. In a recurrence the fistula re-presents because the fistula tract had not healed and fully recurs along the entire original tract.
Why do anal fistulas come back after surgery?
A fistula can be difficult to eliminate because it is a tunnel within scar tissue that may be affected by ongoing infection, inflammation, or pressure from drainage all of which may contribute to blocking the fistula from fully scarring closed. Whether a fistula has truly returned or never fully healed, patients often describe it as a fistula that keeps coming back after surgery.
Risk factors for persistence and recurrence can relate to pre-operative, intra-operative or post-operative issues, including patient co-morbidities, tract position, or even failure to comply with follow-up instructions related to wound hygiene.
Why is it hard to treat recurrences without risking incontinence?
Traditional procedures may involve extensive dissection within the sphincter complex, which can lead to incontinence.
A published study on recurrence found that surgical treatment of recurrent anal fistulas can be associated with a higher likelihood of re-recurrence and potential risk of incontinence.1
To see how the sphincter muscles relate to a fistula, read our guide to anal fistula anatomy.
How can incontinence be avoided after fistula surgery?
The risk to continence depends largely on how much dissection is involved in the surgical procedure and how much sphincter muscle may have been damaged. In addition, scarring within the anal canal can reduce sensation and contribute to incontinence. Sphincter-sparing approaches aim to treat the fistula while protecting the muscles that control continence. Which approach is appropriate depends on the type and location of the fistula, so ask your surgeon which options protect continence in your situation.
BioHealx® delivers extraluminal compression closure of all three segments of the fistula tract to provide optimal primary fistula healing with minimal risk to continence.
What should I ask my surgeon about recurrence?
When discussing treatment options with your colorectal surgeon, ask about persistence and recurrence rates for the different types of procedures and what happens if the fistula returns. Find out whether additional treatment may be needed, what those options might involve, and how they could affect your recovery and long-term outcomes.
Readers who want to compare published results for traditional procedures can see our page on published outcomes from traditional surgical procedures.
To find a surgeon, use the BioHealx surgeon finder.
References
1. Emile SH. Recurrent anal fistulas: When, why, and how to manage? World J Clin Cases 2020; 8(9): 1586-1591
Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC7211523/