An anal fistula is an abnormal tunnel connecting the anal canal to the skin around the anus. Most begin as an infection in one of the small anal glands that sit between the sphincter muscles. The infection collects, forms an abscess, then finds its way out through the skin. Once that channel is lined with epithelium, it stays open.
Around 33-50% of people who have an anal abscess drained go on to develop a fistula. Other causes include Crohn’s disease, previous radiotherapy, obstetric injury, trauma and tuberculosis.
- Persistent or intermittent discharge of pus or blood
- An external opening that weeps
- Recurrent swelling and pain that eases when the abscess drains
- Skin irritation
- Occasionally passing gas or faecal matter through the opening
Assessment involves examination, and in most cases an MRI of the pelvis or endoanal ultrasound to map the tract before any decision around anal fistula management is made.
Types of anal fistula
These occur in the groin and account for the majority of abdominal wall hernias. They’re far more common in men, largely because of the anatomy of the inguinal canal. Symptoms often include a groin bulge that becomes more obvious on standing or straining, along with aching after physical activity.
Not every inguinal hernia needs immediate surgery. Guidelines support considering watchful waiting for men with minimally symptomatic hernias, though many eventually proceed to repair because symptoms progress. Repair is generally recommended for women with groin hernias, given the higher proportion of femoral hernias and associated complication risk.
These occur in the groin and account for the majority of abdominal wall hernias. They’re far more common in men, largely because of the anatomy of the inguinal canal. Symptoms often include a groin bulge that becomes more obvious on standing or straining, along with aching after physical activity.
Not every inguinal hernia needs immediate surgery. Guidelines support considering watchful waiting for men with minimally symptomatic hernias, though many eventually proceed to repair because symptoms progress. Repair is generally recommended for women with groin hernias, given the higher proportion of femoral hernias and associated complication risk.
This procedure involves excising the internal opening and covering the defect with a flap of healthy rectal mucosa and submucosa drawn down and sutured into place. Success rates fall broadly in the 60 to 80% range. It suits high transsphincteric and suprasphincteric fistulas, and preserves the sphincter, though minor changes in continence have been reported.
A draining seton is often placed first. This soft thread keeps the tract open, allows inflammation to settle and converts an infected tract into a mature one, improving results from the definitive procedure performed weeks or months later. Complex and Crohn’s-related fistulas frequently need this staged approach.
Recovery depends on which procedure you have. After fistulotomy, expect discomfort for 1-2 weeks, about a week off work, and an open wound that heals from the base upwards over 4-8 weeks. Daily showering, simple dressings and regular laxatives do most of the work, and some discharge is normal.
LIFT and advancement flap repairs tend to be more comfortable, with desk work resumed within a week and heavy lifting avoided for 2-3 weeks. Setons allow almost immediate normal activity. Dr Mirbagheri reviews every patient to confirm healing, since complex fistulas sometimes recur and need further surgery.
Dr Naseem performs surgical procedures, including anal fissure repair, at St John of God and the Epworth hospitals in Melbourne, as well as offering consultations from her offices in Richmond and Berwick. If you believe that Dr Naseem is the right surgeon for your particular case, please contact us today to book an appointment.
Alternatively, use our online referral page to fill in the form and attach your referral letter and Dr Naseem’s secretary will be in touch within 24-hours to book an appointment.
For non-urgent cases, a 1-to-2-week appointment time may apply.
This page provides general information only. It isn’t a substitute for individual medical advice. Any surgical procedure carries risks, and outcomes vary between patients. Discuss your own circumstances with a qualified health practitioner.