What is an Anal Fistula?
An anal fistula is a small tunnel-like tract that forms between the end of the bowel (anal canal) and the skin near the anus. It usually develops after an anal abscess (collection of pus) drains but does not heal completely.
Common Symptoms:
● Pain and swelling near the anus
● Recurrent infections
● Discharge from the fistula tract
Causes:
● Infection in anal glands
● Crohn’s disease or other inflammatory bowel conditions
● Tuberculosis or trauma to the anal region
Fistulas can range from simple and straight forward to complex with multiple tracts, affecting treatment options.
Types of Anal Fistulas
Anal fistulas are classified based on their path and relationship to the anal sphincter muscles:
Intersphincteric Fistula
- Most common, simple type
- Travels through the internal sphincter only
- Low risk of affecting continence
Transsphincteric Fistula
- Passes through both internal and external sphincters
- May cause recurrent abscesses and discharge
- Treated with seton placement or flap surgery
Suprasphincteric Fistula
- Starts above internal sphincter and arches over puborectalis muscle
- Causes deep pelvic discomfort
- Managed with staged surgery or LIFT procedure
Extrasphincteric Fistula
- Begins in rectum, not anal canal
- Caused by trauma, IBD, or prior surgery
- Requires complex surgical correction
Superficial Fistula
- Travels just beneath the skin
- Minor discomfort or minimal discharge
- Simple surgical treatment with quick recovery
Common Treatment Methods
Fistulotomy
● Opens the entire fistula tract to heal from inside out
● High success rate for simple or intersphincteric fistulas
● Recovery typically takes a few weeks
Seton Placement
● Thread or rubber band keeps tract open for drainage
● Reduces infection and inflammation
● Ideal for complex fistulas to preserve sphincter function
LIFT Procedure (Ligation of Intersphincteric Fistula Tract)
● Internal opening tied off while preserving sphincter
● Less invasive, lower risk of incontinence
● Preferred for high or deep fistulas
Advancement Flap Surgery
● Healthy tissue flap covers internal opening
● Reserved for recurrent or complicated fistulas
● Requires specialized colorectal surgical expertise
Fibrin Glue or Collagen Plug
● Minimally invasive sealing methods
● Preserves continence
● Higher recurrence risk than surgical options
Laser Closure (FiLaC – Fistula Laser Closure)
● Radial-emitting laser destroys tract from inside
● Minimally invasive, less pain, faster recovery
● Not suitable for all fistula types
Benefits of Modern Anal Fistula Treatments
● Minimally invasive: Smaller wounds, less bleeding
● Better sphincter preservation: Lower risk of incontinence
● Faster recovery: Many procedures are day-care surgeries
● Lower recurrence: Accurate imaging ensures complete treatment
● Less postoperative pain: Reduces need for painkillers
● Cosmetic & hygiene benefits: Minimal scarring, easier wound care
● Customized treatment: Tailored to fistula type, depth, and patient health
Post-Treatment Care Tips
- Maintain hygiene: Sitz baths 2–3 times daily for 10–15 minutes
- Follow medication instructions: Antibiotics, painkillers, stool softeners
- Monitor wound site: Watch for redness, swelling, pus, or foul odor
- Avoid straining: Eat fiber-rich foods, drink plenty of fluids
- Take rest but stay active: Gentle walking aids healing
- Change dressings regularly: Keep area clean and dry
- Attend follow-ups: Track healing progress with your doctor
- Avoid delaying bowel movements: Prevent constipation
- Use mild cleansers: Avoid harsh or perfumed soaps
- Report concerns promptly: Pain, fever, leakage, or recurrence
Conclusion
Anal fistulas are common but often misunderstood due to discomfort and stigma. Untreated, they can lead to repeated abscesses, infections, and complex tracts that are harder to manage. Modern treatments—including fistulotomy, LIFT, VAAFT, and FiLaC—are precise, minimally invasive, and focus on preserving anal sphincter function, minimizing the risk of incontinence. Recovery requires proper post-treatment care, including hygiene, sitz baths, a fiber-rich diet, hydration, and timely follow-ups. With early intervention and the right guidance, patients can achieve lasting relief and a better quality of life.