Depending on presence of systemic symptoms and condition of patient, the patient with an anal fistula may require continued IV antibiotics, fluids, pressors, and, possibly, surgery. For anal fissures, WASH regimen is indicated. For anal fistulas, outpatient follow-up with a surgeon is indicated if consultation did not take place at time of presentation. Stress importance of diet modification to soften stools. Patients should increase fruits, vegetables, and soluble and insoluble fibers in their diets and increase fluid intake.
Acute fissures can become chronic.
Sentinel pile can result. Permanent skin tag can result. Fistulas may form. Carcinoma has been reported in chronic untreated anorectal fistulas. Most uncomplicated fissures resolve in 2-4 weeks with supportive care.