Necrotizing fasciitis (NF) is a rare, life-threatening acute critical illness in colorectal and anal surgery, characterized by insidious onset, rapid progression, extensive tissue destruction and high mortality. The infection can spread rapidly along fascial planes, involving the perianal region, perineum, pelvic floor, and even the retroperitoneal space. Traditional management has mainly focused on infection control and surgical debridement during the acute phase, while insufficient attention has been paid to functional preservation, staged reconstruction, and long-term rehabilitation in the later course of treatment. The concept of whole-course management emphasizes the establishment of a comprehensive care system spanning prevention, screening, diagnosis, treatment and rehabilitation. Through multidisciplinary collaboration and individualized decision-making, it integrates early recognition and differential diagnosis, imaging-based stratified assessment, thorough debridement and targeted antimicrobial therapy in the acute phase, staged wound management, functional reconstruction and long-term rehabilitation follow-up, thereby reducing gaps in care and optimizing overall prognosis. This review discusses the clinical application of the whole-course management concept for NF in colorectal and anal surgery, and its significance in improving treatment success rate and patients’ long-term quality of life.