What is an anal fistula?
The anal canal is the end part of the intestinal tract. It includes the rectum and
anus. Sometimes an abnormal passage forms from the anal canal to the skin near the
anus. This is called an anal fistula. Anal fistulas can also form from the anal canal
to other organs, such as the vagina or urinary tract.
What causes an anal fistula?
An anal fistula most often happens from an anal gland that has developed a pus-filled
infection (abscess). A fistula can also happen with certain conditions such as Crohn’s
disease. Or it may happen after radiation therapy for cancer. Injury to the anal canal
and surgery can also cause anal fistulas.
Who is at risk for an anal fistula?
Having an anal abscess raises your risk of having an anal fistula. Certain conditions
of the lower digestive tract or anal area may also raise your risk. These include:
What are the symptoms of an anal fistula?
The symptoms of an anal abscess and an anal fistula can be similar and may include:
Pain and swelling around the anal area
Fever and chills
Feeling tired and sick
Redness, soreness, or itching of the skin around the anal opening
Pus drainage near the anal opening
How is an anal fistula diagnosed?
If you have symptoms that seem like an anal fistula, your healthcare provider may
refer you to a specialist for colon and rectal diseases. The specialist will ask about
your symptoms and your health history. During your physical exam, the doctor will
look for a fistula opening near your anal opening. He or she may press on the area
to see if it is sore and if pus comes out. Sometimes, you will need to have a special
exam under anesthesia so the doctor can get more information while not causing you
pain. Different methods may be used to help with the diagnosis. These include:
Fistula probe. A long, thin probe is guided through the outer opening of the fistula. A special
dye may be injected to find out where the fistula opens up.
Anoscope. This is a special scope used to look inside your anal canal.
Imaging tests. These may include an ultrasound, which creates an image of the anal area using sound
waves. Or they may include an MRI, which makes images of the area by using special
magnets and a computer.
How is an anal fistula treated?
Once you have an anal fistula, antibiotics alone will not cure it. You will need to
have surgery to cure the fistula. Surgical treatment includes:
Fistulotomy. This procedure opens up the fistula in a way that lets it heal from the inside out.
It is usually an outpatient procedure. This means you go home the same day.
Filling the fistula with a special glue or plug. This is a newer type of treatment that closes the inner opening of the fistula. The
doctor then fills the fistula tunnel with a material that your body will absorb over
Reconstructive surgery or surgery that is done in stages. This may be an option in some cases.
Seton placement. This procedure places a suture or rubber band (seton) in the fistula that is slowly
tightened. It lets the fistula heal behind the seton. It lowers the risk for incontinence.
Anal fistulas are very common in people with Crohn’s disease. For those with both
Crohn's disease and a fistula, medical therapy is often tried before surgery.
What are the possible complications of an anal fistula?
Complications of an anal fistula include a fistula that returns after treatment. Another
complication is an inability to control bowel movements (fecal incontinence). This
is most likely if some of the muscle around the anal opening, called the anal sphincter,
How do I manage an anal fistula?
When recovering from anal fistula treatment, make sure to take pain medicine as directed
by your surgeon. Finish all your antibiotics. Don’t take any over-the-counter medicines
without first talking with your provider.
Other important instructions may include:
Soaking in a warm bath 3 or 4 times a day
Wearing a pad over your anal area until healing is complete
Going back to normal activities only when your surgeon says you can
Eating a high-fiber diet and drinking plenty of fluids
Using a stool softener or bulk laxative as needed
When should I call my healthcare provider?
Call your healthcare provider if you have symptoms of an anal fistula, especially
if you have had an anal abscess in the past. If you have been treated for an abscess
or fistula, call your provider right away if any of these occur:
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Symptoms of the anal fistula return, such as pain or drainage
Increased pain, redness, swelling, or drainage in or near the anus or rectum
Trouble controlling your bowel movements
Hard or painful stools or trouble controlling your bowel movements
Mucus, pus, or blood in the stool (dark or bright red)
Belly pain that does not respond to treatment or that does not go away after a few
Belly swelling that does not go away after a few hours
Vomiting that won’t stop
If the problem returns, see a colon and rectal surgeon. This is a physician who has
completed advanced training in the surgical and non-surgical treatment of problems
of the colon, rectum, and anus.
Key points about an anal fistula
An anal fistula is an abnormal passage that forms from the anal canal to the skin
near the anus.
Symptoms include pain, swelling, or pus draining from the anal opening.
This condition often occurs from an anal gland that has developed a pus-filled infection
It can also occur with certain conditions, such as Crohn’s disease. Injury to the
anal canal and surgery can also cause it.
Antibiotics alone will not cure it. You will need to have surgery to cure the fistula.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells
At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that
Know how you can contact your provider if you have questions.