Fistulas

What Causes an Anal Fistula?
An anal fistula usually develops after an infection in an anal gland, often following an anorectal abscess. Think of a fistula as an abnormal tunnel between the anus and the perianal skin. It is more common in people with conditions such as Crohn’s disease, tuberculosis, diverticulitis, or those who have had anal or rectal injury. In rare cases, cancer may be a contributing factor.

Symptoms
Common symptoms include:

• Pain or swelling around the anus
• Drainage of pus or blood
• Discomfort during bowel movements
• Fever, fatigue, or feeling unwell

Diagnosis
Diagnosis begins with a physical exam. If the fistula is not easily seen, imaging or endoscopic tests such as anoscopy, ultrasound, MRI, or sigmoidoscopy may be used. A colonoscopy may be recommended if Crohn’s disease is suspected.

Treatment
Most anal fistulas require surgical treatment. The approach depends on the fistula’s location and complexity and may include:

• Fistulotomy: Opening the fistula to allow it to heal from the inside out
• Advancement flap: Closing the fistula using healthy tissue for more complex cases
• Seton placement: Using a soft thread to safely drain the fistula while protecting muscle control
• LIFT (Ligation of Intersphinteric Fistula Tract): Surgical technique that involves ligating and removing the tract

One of our colorectal specialists will recommend the safest and most effective treatment based on your individual condition.