Anal Fistula

Anal Fistula: Symptoms, Causes, Treatment & What to Expect From a Specialist

An anal fistula is one of the most frustrating and painful anorectal conditions a person can experience. It often begins as an infection or abscess near the anus, then forms a small tunnel between the inside of the anal canal and the skin. Many patients feel embarrassed to talk about it—yet it’s far more common than most people realize, and highly treatable with the right specialist.

As a board-certified colon and rectal surgeon, I diagnose and treat anal fistulas every day. The more you understand what’s happening, the faster you can get relief.

What Is an Anal Fistula?

An anal fistula is an abnormal connection that develops after an infection in one of the small glands inside the anal canal. When that gland becomes blocked, bacteria build up and form an abscess. Even after the abscess drains, a tract may remain—creating a fistula.

Common signs of an anal fistula include:

• Persistent drainage or discharge from the skin near the anus
• Pain or throbbing, especially when sitting
• Recurrent swelling or abscesses
• Bleeding
• A small opening or bump on the skin

Why Do Anal Fistulas Happen?

Most fistulas come from a simple infected gland, but certain factors increase risk:

• History of anal abscess
• Crohn’s disease
• Prior anorectal surgery
• Trauma or infection
• Radiation or chronic inflammation

Many patients blame themselves—but fistulas almost never form because of hygiene or anything a patient “did wrong.”

Are Anal Fistulas Dangerous?

A fistula that’s left untreated can lead to:

• Recurrent abscesses
• Worsening pain
• Skin irritation or infection
• Complex branching tracts

Early treatment prevents bigger problems and reduces the chance of multiple surgeries.

How Is an Anal Fistula Diagnosed?

Diagnosis typically includes:

• A detailed exam by a specialist
• Gentle inspection of the external opening and internal exam with anoscopy
• In complex or recurrent cases, MRI or endoanal ultrasound may be warranted

Most fistulas are diagnosed in a single office visit.

Treatment Options for Anal Fistula

Because a fistula is a physical tract, it cannot heal on its own. Treatment must close the internal opening and remove or neutralize the tunnel. The best option depends on the anatomy of the fistula and how much sphincter muscle is involved.

Common treatments include:

1. Fistulotomy
For simple fistulas. The tract is opened and allowed to heal from the inside out. High success rate.

2. Seton Placement
Used when the fistula passes through significant muscle. A small silicone loop is placed to keep the tract open and drain infection safely.

3. LIFT Procedure
Ligation of the Intersphincteric Fistula Tract—a muscle-sparing surgical option for complex cases.

4. Advancement Flap
Used in higher, more complex fistulas requiring closure of the internal opening with tissue.

5. Laser or Biologic Therapies
Modern techniques that may be used selectively depending on anatomy.

No two fistulas are identical, which is why seeing a specialized surgeon makes such a dramatic difference.

Recovery: What to Expect

Most patients return to daily activities quickly. Pain is usually manageable, and healing continues over several weeks.

Expect:

• Mild drainage
• Sitz baths
• Temporary activity modification based on symptoms
• Follow-up visits to monitor healing

Most patients feel significant relief once the infection cycle is finally broken.

When Should You See a Specialist?

You should seek evaluation if you notice:

• Persistent drainage
• A recurrent abscess
• Pain with swelling near the anus
• A visible skin opening or bump

The earlier we treat it, the easier the recovery.

Why Choose a Colon & Rectal Surgeon?

Anal fistulas are complex—and treatment requires specialized training to preserve continence while maximizing cure rates. A board-certified specialist performs these procedures routinely and can offer the full range of modern options rather than a one-size-fits-all approach.

Schedule a Consultation

If you’re experiencing symptoms of an anal fistula, professional evaluation is the fastest path to relief.

Call or text 425-515-0276. Same-week appointments are available for urgent issues.