Anal Fistula: Their Causes, Symptoms, and Treatment Options

Anal fistula, is a condition that demands attention and understanding. In this comprehensive guide, we delve into the causes, symptoms, and treatment options for anal fistula to provide valuable information for those seeking knowledge and support.

What is an Anal Fistula?

An anal fistula is a tunnel-like abnormal connection that develops between the anal canal (the last portion of the large intestine) and the skin surrounding the anus. It typically forms as a result of an infection or an abscess near the anus. The process begins when an anal gland becomes blocked, leading to the accumulation of bacteria, pus, and other fluids. As the infection progresses, it seeks an escape route, creating a channel or fistula that extends from the anal canal to the skin.

Anatomy of an Anal Fistula

Understanding the anatomy of an anal fistula is crucial in grasping the complexities of this condition. The anal canal, composed of muscular tissue, is surrounded by various structures, including sphincters that control bowel movements. When a fistula forms, it disrupts the natural anatomy, creating an abnormal passageway that may involve one or more of the sphincters.

What Causes an Anal Fistula?

Anal fistulas can be triggered by various factors, and understanding these causes is essential for effective management. Common causes include:

Anal Abscesses

An untreated anal abscess can burst and lead to the formation of a fistula.


Bacterial infections in the anal glands can result in the development of a fistula.

Inflammatory Bowel Disease (Crohn’s Disease)

Individuals with Crohn’s disease are at an increased risk of anal fistula due to inflammation in the digestive tract.


Injury or trauma to the anal area can create conditions favourable for fistula formation.

What are the Symptoms of an Anal Fistula?

Anal Fissures

Recognising the symptoms of anal fistula is crucial for early detection and prompt medical intervention. The signs may vary depending on the type and complexity of the fistula, but common symptoms include:

Pain and Discomfort

An anal fistula often causes pain and discomfort, especially during bowel movements. The pain may be mild or severe, depending on factors such as the location and depth of the fistula.

Swelling and Tenderness

Swelling around the anus is a common symptom of anal fistulas. The affected area may feel tender to the touch, and the swelling can exacerbate during or after bowel movements.


The presence of persistent, foul-smelling discharge is often a hallmark of an anal fistula. This discharge may be pus or a combination of blood and mucus. Individuals may notice it on underwear or toilet paper.

Recurring Abscesses

Individuals with anal fistulas may experience recurring abscesses in the anal region. These abscesses can cause additional pain, swelling, and redness.

Itching or Irritation

The continuous irritation caused by the fistula and its discharge can lead to itching around the anal area. This symptom may contribute to discomfort and a sense of uncleanliness.

Changes in Bowel Habits

Some individuals may experience changes in bowel habits, including constipation or diarrhoea, as a result of the anal fistula’s impact on the surrounding structures.

Fever and General Malaise

In cases where the anal fistula is associated with infection or abscess formation, individuals may experience systemic symptoms such as fever and a general feeling of unwellness.

What are the Types of Anal Fistula?

Anal fistula can vary in complexity and may be classified based on their location, depth, and the structures they involve. The three main types include:

Intersphincteric Fistula

Located between the internal and external sphincters.

Transsphincteric Fistula

Extend through one or both sphincters.

Extrasphincteric Fistula

Extend beyond the external sphincter.

Each type presents unique challenges in terms of treatment and management, emphasizing the need for accurate classification during diagnosis.

How is an Anal Fistula Diagnosed?

Accurate diagnosis of anal fistulas is crucial for determining the most effective treatment plan. The diagnostic process involves a combination of a detailed medical history, physical examination, and, in some cases, imaging studies. Here’s what you can expect during the diagnosis of anal fistulas:

Initial Consultation

Our colorectal team will conduct a thorough consultation to gather information about your symptoms, medical history, and any previous treatments or surgeries.

Describing the nature, frequency, and severity of your symptoms, such as pain, discharge, and swelling, helps in understanding the possible presence of an anal fistula.

Physical Examination & DRE

A Digital Rectal Examination (DRE) involves the insertion of a gloved, lubricated finger into the rectum to assess for tenderness, swelling, and the presence of any abnormal tracts or openings. The anal area will be visually inspected for signs of inflammation, discharge, or visible fistula openings.

Imaging Studies

An MRI (Magnetic Resonance Imaging) An MRI is a key tool for diagnosing anal fistulas. It provides detailed images of the anal and pelvic region, allowing healthcare professionals to visualise the fistula’s location, depth, and relationship to surrounding structures.

A Fistulography may also be required. This involves injecting a contrast dye into the fistula tract and taking X-rays to outline the path of the fistula. While less commonly used today, it can still be employed in certain situations.

Endoanal Ultrasound

Endoanal ultrasound may be used to assess the anal sphincters and detect the presence of fistulas. It involves the use of a small ultrasound probe inserted into the anus.

Colonoscopy or Flexible Sigmoidoscopy

In some cases, a colonoscopy or flexible sigmoidoscopy may be performed to rule out other gastrointestinal conditions and assess the health of the colon.

Classification and Staging

Based on the gathered information, our colorectal specialists will classify the type of fistula (e.g., intersphincteric, transsphincteric) and assess its complexity. This information is crucial for determining the most appropriate treatment approach.

Anal Fistula Treatment Options

Once an anal fistula is diagnosed, the appropriate treatment plan depends on factors such as the type of fistula, its location, and the severity of symptoms. Midlands Colorectal offer a range of treatment options tailored to each individual’s unique situation:

Medical Management

In cases where an infection is present or associated with an abscess, antibiotics may be prescribed to control the infection. Over-the-counter or prescription pain medication can also help manage pain and discomfort.

Incision and Drainage

For simple anal abscesses associated with fistulas, a minor surgical procedure may be performed to drain the abscess and alleviate symptoms.


A common surgical procedure where the entire fistula tract is opened and drained. This approach is suitable for certain types of fistulas, especially those that are straightforward and superficial.

Seton Placement

A seton is a piece of material (commonly a thread or rubber band) that is placed through the fistula tract. It helps to keep the tract open, allowing for continuous drainage and preventing abscess recurrence. This is often used for complex or deep fistulas.

Fistula Plug

A biocompatible material, such as a collagen plug, is inserted into the fistula tract to promote healing. This option is suitable for selected types of fistulas.

LIFT Procedure (Ligation of Intersphincteric Fistula Tract):

A minimally invasive surgical technique that involves identifying and ligating the fistula tract, promoting healing. LIFT is particularly suitable for complex or high fistulas.

Advancements in Minimally Invasive Techniques

Newer techniques, such as Video-Assisted Anal Fistula Treatment (VAAFT) or Endoanal Minimally Invasive Therapy (e.g., Laser or Radiowave Therapy), offer less invasive alternatives for selected cases and may be considered as part of our treatment plan.

Treatment of Underlying Conditions & Ongoing Treatment

If the anal fistula is associated with an underlying condition like Crohn’s disease, addressing the primary condition is crucial for comprehensive care.

Regular follow-up appointments will be scheduled to monitor healing, assess symptoms, and make any necessary adjustments to the treatment plan. Unfortunately, some patients are predisposed to the occurrence and reoccurrence of anal fistula, however, there are lost of lifestyle adjustments that can be made to help this.

We emphasise patient education, providing information on post-surgical care, dietary recommendations, and lifestyle modifications to support optimal healing.

Midlands Colorectal offers a comprehensive range of treatment options for anal fistulas, ensuring that each patient receives personalized care based on their unique needs.

Lifestyle and Self-Care for Anal Fistula Management

Effective management of anal fistula involves not only medical interventions but also lifestyle modifications and self-care practices. Adopting a holistic approach to care can contribute to symptom relief and support the healing process. At Midlands Colorectal, we emphasise the following lifestyle and self-care recommendations for individuals managing an anal fistula:

Maintain Good Anal Hygiene

Gentle cleaning with mild, fragrance-free soap and warm water after bowel movements is essential. Avoid the use of harsh or perfumed wipes, as they may irritate the anal area.

Warm Sitz Baths

Taking warm sitz baths can help soothe the anal area and promote relaxation. Soaking for about 15-20 minutes after bowel movements or as needed can provide relief.

Avoid Straining During Bowel Movements

Straining during bowel movements can worsen symptoms and potentially disrupt the healing process. Ensure an adequate fibre intake to promote regular and softer bowel movements.

Dietary Considerations

A high-fibre diet can help prevent constipation and contribute to softer stools. Foods rich in fibre include fruits, vegetables, whole grains, and legumes. Staying hydrated is crucial for maintaining soft stools.

Topical Pain Relief

Over-the-counter creams or ointments containing ingredients like witch hazel or aloe vera may provide relief from irritation and discomfort.

Comfortable Clothing

Choose loose-fitting, breathable underwear made from natural fabrics to minimize friction and irritation.

Regular Exercise

Engaging in regular, moderate exercise can promote overall well-being and help manage stress, which may indirectly contribute to symptom relief.

Mindful Stress Management

Stress can exacerbate symptoms of anal fistulas. Practicing stress management techniques such as deep breathing, meditation, or yoga may contribute to overall well-being.

Avoiding Irritants

Avoid using harsh soaps, scented products, or any potential irritants around the anal area. Be cautious with certain types of toilet paper; consider using softer, unscented options.

Follow Medical Advice

Adhering to the prescribed treatment plan and attending follow-up appointments is crucial for monitoring progress and adjusting the approach as needed.

Seeking Emotional Support

Living with an anal fistula can be challenging emotionally. Seeking support from friends, family, or joining support groups can provide valuable encouragement and understanding.

Understanding the condition, treatment options, and potential challenges empowers individuals to actively participate in their care.

Seeking Professional Help: When to Consult a Specialist

Guidance on when to seek medical attention for anal fistula symptoms encourages individuals to prioritize their health. Consulting a colorectal specialist ensures accurate diagnosis and personalized treatment plans.

Midlands Colorectal stands ready to provide expert care for anal fistulas. Our commitment to personalized care and support ensures patients receive the attention and expertise needed throughout their treatment journey.

Understanding anal fistulas is crucial for prompt diagnosis and effective management. By addressing the causes, symptoms, and treatment options, Midlands Colorectal aims to empower individuals with knowledge and support. If you or someone you know is experiencing symptoms related to anal fistulas, don’t hesitate to seek professional help. Your health is our priority, and we are here to guide you every step of the way.

Please email us at or enquire online to learn more.