What Is An Anal Fistula? Here’s Everything You Need to Know About It!

An anal fistula is not just uncomfortable. It is a condition that disrupts daily life and does not resolve on its own. Many people ignore early symptoms or rely on temporary treatments, only to face repeated pain, discharge, and infections. What often causes frustration is not the diagnosis but the confusion around treatment options and fear of surgery.

This blog explains everything you need to know about anal fistula surgery, from why it is usually necessary to how different procedures work and what recovery actually looks like. The focus is on practical information, realistic expectations, and decision-making that reduces the risk of recurrence and complications.

What Is an Anal Fistula?

An anal fistula is an abnormal tunnel between the anus and the skin around it. It usually develops after an infection in the anal glands. When these glands become infected, a pocket of pus called a perianal abscess forms. If this abscess does not heal completely, it can create a persistent drainage pathway, resulting in a fistula.

Anal fistulas do not close permanently on their own. Even if symptoms temporarily improve, the underlying tunnel often remains, leading to repeated infections and discomfort.

What Are the Signs and Symptoms of Anal Fistula?

The symptoms of an anal fistula often begin mildly and become more severe over time. Early signs are frequently mistaken for piles or a simple infection, which delays proper treatment and allows the condition to worsen.

Common signs and symptoms include:

Recurrent anal abscesses
Persistent pain or swelling around the anus
Foul-smelling discharge that may contain pus or blood
Skin irritation or itching around the anal area
Pain or difficulty during bowel movements
Bleeding from the anal region
Episodes of fever and chills
General weakness or fatigue

What Does an Anal Fistula Look Like?

An anal fistula usually looks like a small hole or opening in the skin near the anus. This opening connects to an infected tunnel inside the anal canal and may leak pus, blood, or stool. Sometimes the outer opening closes while the tunnel remains infected. This traps discharge, causing pain and swelling until the fistula opens again, which is why symptoms often come and go.

What Causes Anal Fistula?

An anal fistula usually develops after a perianal abscess caused by an infected anal gland. When the infection does not drain properly, pus builds up and creates a tunnel to the skin near the anus.

The area may not heal completely even after the abscess is drained. If the internal opening remains open, the tunnel can persist and form a fistula.

Less common causes include Crohn’s disease, anal infections, tuberculosis, previous anal surgery or injury, radiation therapy, and rare chronic inflammatory conditions.

Risk Factors for Anal Fistula

You may be at higher risk of developing an anal fistula if you have had a perianal abscess before. Other risk factors include inflammatory bowel disease, a weakened immune system, frequent infections, prior surgery or radiation near the anus, chronic sexually transmitted infections, and male sex.

Possible Complications of Anal Fistula

An anal fistula rarely heals on its own. Without treatment, it can cause ongoing problems.

Persistent infection is common, with repeated cycles of pain, drainage, and abscess formation. Over time, the fistula may spread and form multiple branching tunnels, complicating treatment.

How Is an Anal Fistula Diagnosed?

Doctors also need to locate the internal opening inside the anal canal, which may require anesthesia if the area is too painful.

A lighted instrument such as an anoscope or proctoscope may be used to examine the area. Sometimes, hydrogen peroxide is injected into the external opening to confirm the fistula by identifying its internal source.

Imaging tests may be needed to map the fistula and plan treatment. These may include MRI, endoscopic ultrasound, or fistulography. Accurate mapping helps doctors choose the safest and most effective treatment.

What Are The Different Types Of Anal Fistulas?

Anal fistulas are classified based on how they pass through or around the anal sphincter muscles, which control bowel movements. The amount of muscle involved determines how complex treatment will be.

Common types include:

Intersphincteric fistula, the most common type, runs between the sphincter muscles.
Transsphincteric fistula, passing through both sphincter muscles and requiring careful treatment
Suprasphincteric fistula, which goes above the sphincter muscles, is usually more complex.
Extrasphincteric fistula, a rare type that passes outside the sphincter muscles and often starts from the rectum.
Superficial fistula, located close to the skin and easier to treat

You do not need to remember these terms. What matters is that fistulas involving more sphincter muscle need more careful surgical planning to reduce complications.

How Is an Anal Fistula Treated?

Treating an anal fistula early, at the abscess stage, can sometimes prevent fistula formation. However, once a fistula develops, antibiotics alone cannot cure it. Surgery is usually required for complete healing. If Crohn’s disease is present, medical treatment may be tried first.

Common treatment options include:

Fistulotomy, a single-stage procedure used for small, simple fistulas
Glue or plug treatment, where the internal opening is closed using absorbable material
Seton placement, where a surgical thread or rubber band helps drain infection and reduce the risk of incontinence
Reconstructive surgery, used for advanced or complex fistulas and often done in stages
Laser ablation (FILAC), a minimally invasive technique to close the fistula tract

The choice of treatment depends on the type of fistula and its relationship to the anal muscles.

We Are Here for You

An anal fistula is a condition that rarely improves without proper treatment. Early diagnosis, the right surgical approach, and careful follow-up play a critical role in preventing recurrence and long-term complications. Understanding your options helps you make informed decisions and avoid unnecessary delays that can worsen outcomes.

If you have symptoms of an anal fistula, Arden Jr Surgery offers expert evaluation and advanced care focused on complete healing. Schedule a consultation for timely treatment.