Everything You Should Know About Anal Fistulas

An anal fistula is a tiny tunnel that forms between the skin and the anal canal. Anal fistulas are usually the result of an infection in the anal glands on either side of the anus. The condition leads to the formation of an abscess, or pus-filled pocket, which eventually breaks through your skin and creates the fistula.

Most anal fistulas are painful and can cause bleeding. They can also become infected, leading to more pain and inflammation. Anal fistulas can be hard to treat and may require surgery depending on your health or medical history.

Anal fistulas are more common in men than women and people between the ages of 30 and 50. People with chronic inflammatory diseases, such as Crohn’s disease or ulcerative colitis, are at an increased risk of developing anal fistulas. Smoking is also a risk factor for developing anal fistulas.

What Causes a Fistula?

Fistulas can be congenital or acquired later in life. Congenital fistulas are usually the result of abnormal development in the womb. Acquired fistulas can be caused by injury, surgery, or infection.

The Most Common Causes of Anal Fistula Include:

Injury: An injury can cause tissue damage that leads to the formation of a fistula.

Surgery: Surgery, especially in your abdominal or pelvic area, can damage the tissue and lead to the formation of a fistula.

Infection: Infections, such as those caused by bacteria or viruses, can damage the tissue and lead to a fistula.

What are the Symptoms of an Anal Fistula?

The most common symptom of an anal fistula is pain. Other symptoms may include:

  • Bleeding from the anus
  • Discharge from the anus
  • Fever
  • Chills
  • Constipation or diarrhea
  • Rectal bleeding
  • Abdominal pain

Anal fistulas can be both painful and embarrassing. If you think you may have an anal fistula, you must see a doctor to diagnose and treat it. It is generally treated with surgery, but a few nonsurgical options may be effective for some people.

How is a Fistula Diagnosed?

Examine the region surrounding your anus to determine whether you have an anal fistula. The doctor will look for a hole (tract) on your skin. The doctor will determine how far down it extends and where it is heading in that direction. Some fistulas may not be visible clearly on your skin’s surface. Your doctor may need to conduct additional tests if necessary:

  • An Anoscopy is an examination in which a particular device is used to inspect your anus and rectum.
  • To acquire a clearer picture of the fistula tract, your doctor may request an ultrasound or an MRI of the anal region.
  • Your surgeon may need to examine you in the operating room (also known as an exam under anesthesia) to diagnose the fistula.

If a fistula is detected, your doctor may do additional testing to see whether the problem is linked to Crohn’s disease, an inflammatory intestine disease. Fistulas can affect up to 25% of individuals with Crohn’s disease. Blood tests, X-rays, and colonoscopy are the other procedures employed in these studies. A colonoscopy involves inserting a flexible, lighted instrument into the anus using conscious sedation as light anesthesia.

What are the Treatment Options for Anal Fistula?

Almost always, surgical treatment is required to cure an anal fistula. A colorectal surgeon does the operation. The process aims to eliminate the fistula while preserving the anal sphincter muscles, which might lead to incontinence if damaged.

A fistulotomy repairs fistulas when your sphincter muscle isn’t involved. Instead, the skin and muscles surrounding the tunnel are cut open to change it from a tunnel into a recessed groove. It allows the fistula tract to mend from bottom to top.

In the case of a more complicated fistula, the surgeon may need to insert a special drain known as a seton, which is kept in the body for at least six weeks. A second operation is usually required after the placement of a seton:

  • A fistulotomy, a flap procedure in which the fistula is covered with a piece of rectum tissue, or an advancement flap procedure
  • A fistula repair in which the skin above is opened up, the sphincter muscles are spread, and the fistula is tied off.

Stem cells may be injected into fistulas as a new treatment for Crohn’s disease fistulas. Before the operation, your colorectal surgeon will review any alternatives with you. After surgery, some fistulas necessitate multiple treatments to destroy the fovea.

What are the Prevention Methods for Fistula?

There is no proper way to prevent the formation of a fistula. However, there are some things you can do to lower your risk, such as:

  • Practicing good hygiene includes washing your hands regularly and keeping cuts and wounds clean.
  • Use caution when participating in activities that could lead to an injury.
  • If possible, avoid surgery in your abdominal or pelvic area. If you need surgery, talk to the doctor about ways to minimize the risk of developing a fistula.


An anal fistula is a relatively rare condition that can cause significant discomfort and distress. If you are experiencing any symptoms of anal fistula, it is essential to seek medical attention immediately. Treatment for an anal fistula can vary depending on the severity of the condition but typically involves antibiotics and surgery. By understanding anal fistula and its treatments more, you can better manage this condition if you or someone is affected by it.

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