Anal Fistula

Table of Contents

What is an Anal Fistula?

An anal fistula is a small tunnel that develops between the end of the intestine and the skin near the anus. It usually results from an infection near the anus that causes a collection of pus (abscess) in the surrounding tissue. A small channel can form when the pus drains away. 

Anal fistulas can cause symptoms of skin discomfort and irritation. In most cases, the symptoms of anal fistula will not improve on their own, where instead surgery is recommended.

Consult with a surgeon through Smarter Health to find the right treatment for your condition. 

Causes of Anal Fistula

Inside your anus, there are several glands that produce fluid. Sometimes, these glands become blocked. When there is a blockage, a buildup of bacteria can lead to a swollen pocket of infected tissue and liquid – known as abscess. 

An abscess will grow if it is not treated properly. It will eventually make its way to the outside and make a hole in the skin near your anus so that the gunk inside dries up. The fistula is a tunnel that connects the gland to the opening.

Although rare, the following conditions are at risk of causing an anal fistula:

  • Crohn’s Disease is a long-term condition when the digestive system becomes inflamed
  • Diverticulitis is an infection of the small sac that can exit the side of the large intestine
  • Hidradenitis suppurativa is a long-term skin condition that causes abscesses and scarring
  • Tuberculosis (TB) or HIV infection
  • Complications of surgery near the anus

When to See a Doctor for Anal Fistula

If your doctor suspects you have an anal fistula, he or she will ask about your medical history and perform a physical exam.

Some fistulas are easy to spot and others are not. Sometimes, the fistula can close on its own, then reopen. Your doctor will look for signs of discharge or bleeding and may also insert a finger into your anus during the examination.

Your doctor will likely refer you to a specialist in colon and rectal problems for further tests or imaging tests such as an X-ray or CT scan.

You may even need a colonoscopy. For this test, your doctor will insert a tube with a camera on the end into your anus to see the inside of your intestine.

Symptoms of Anal Fistula

The most common symptoms of an anal fistula include: 

  • Skin irritation around the anus.
  • Persistent, throbbing pain that may hurt more when you sit, move, pass stool, or cough.
  • Foul-smelling discharge near the anus.
  • Passing pus or blood during a bowel movement.
  • Swelling and redness around the anus
  • Fever, if you also have an abscess.
  • In some cases, you may experience bowel incontinence
  • The end of the fistula may appear as a hole in the skin near your anus, although this may be difficult for you to see on your own.

Treatment for Anal Fistula


The most common type of surgery for an anal fistula is a fistulotomy. This surgical procedure involves cutting open the whole length of the fistula.

Fistulotomy is the most effective treatment for many cases of anal fistula, although it usually works best for fistulas that do not pass through most of the sphincter muscles, since the risk of incontinence is lowest in these cases.

If the risk of incontinence is too high, other procedures may be recommended.

Seton Technique

If the fistula passes through most of the sphincter muscle, your surgeon may recommend inserting a seton. A seton is a surgical thread that stays in the fistula for several weeks to keep it open.

A loose seton allows the fistula to drain, but does not heal it. A tighter seton may be used to slowly cut the fistula in order to heal. 

Advance Flap Procedure

This procedure may be recommended if the fistula passes through the anal sphincter and a fistulotomy is at high risk of causing incontinence.

This procedure involves cutting or scraping the fistula and covering the opening where the fistula enters the intestine with a fold of tissue taken from inside the rectum. This has a lower success rate than a fistulotomy, but avoids the need to cut the anal sphincter muscles.

LIFT procedure

Ligation intersphincteric fistula tract (LIFT) is a treatment for fistulas that pass through the anal sphincter muscles, where a fistulotomy would be too risky.

The LIFT procedure will provide promising results, but it has only been around for a few years. More research is needed to determine how well this procedure works in the short and long term.


In this procedure, an endoscope (a tube with a camera on the end) is inserted into the fistula. The electrodes are then passed through the endoscope to close the fistula. Endoscopy works effectively and there are no serious concerns about the procedure’s safety. 

Laser Surgery

This treatment option involves using a small laser beam to seal off the fistula. There is uncertainty around how well laser surgery works, but there are no major safety concerns.

Bioprosthetic Plugs

Another treatment option is to insert a bioprosthetic plug. This is a cone-shaped plug made of animal tissue to block the internal opening of the fistula.

Treatment Cost for Anal Fistula

Anal fistulas cannot heal on their own or be treated with medications. Surgery is one of the most common anal fistula treatments. Surgery treatment cost for anal fistulas may vary greatly. 

To calculate the estimated treatment cost for anal fistulas at home and abroad, contact Smarter Health.

Prevention of Anal Fistula

The following are some ways to prevent anal fistulas:

  • Eat lots of fiber, especially from fruits and vegetables can help prevent constipation.
  • Stay well-hydrated can help prevent constipation. Drinking lots of fluids can keep your stool soft and easy to pass.
  • Exercise for at least 30 minutes on a daily basis to help keep your digestive system moving and in good shape.
  • If your body tells you it is time to have a bowel movement, do not wait until later. The longer you hold it, the harder and drier the stool will be–making it harder to pass.
  • Practice healthy bowel movements, such as giving yourself enough time to have a bowel movement comfortably, not sitting on the toilet for too long, not straining during bowel movements, and keeping the anal area dry.

Home Remedies for Anal Fistula 

When recovering from treatment for an anal fistula, be sure to take painkillers as recommended by your surgeon. Do not take over-the-counter medications without consulting your doctor first. Other important instructions may include:

  • Bathe in warm water 3 or 4 times a day.
  • Wear sanitary pads until you complete recovery. 
  • Continue with your normal activities if your surgeon instructs you to do so
  • Eat foods high in fiber and drink plenty of fluids.
  • Use a stool softener or bulk laxative as needed.

Make an appointment with a surgeon at home and abroad through Smarter Health if you have any symptoms of anal fistulas. 

Smarter Health‘s teleconsultation service allows you to get treatment whenever you need it without leaving the house – thus minimizing the spread of COVID-19.

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