Understanding the Different Treatments for an Anal Fistula

Anal abscesses can be incredibly painful, typically occurring when an infection in an anal gland goes untreated or isn’t treated aggressively enough. Over time, a pus-filled abscess may cause changes in the skin around the anus, eventually leading to an even more painful problem called an anal fistula.

Michael H. Tarlowe, MD, provides patients with the most advanced treatment options for anal fistulas, tailoring every treatment to each patinet’s specific needs for relief of symptoms and optimal long-term outcomes. If you have an anal fistula, this post offers a brief review of the most effective treatments to help you feel better.

Why fistulas form

An anal fistula is an opening or “tunnel” that develops under your skin, typically linking an infected anal gland with the tissue surrounding your anus. Most fistulas form when an anal gland becomes infected and forms a pus-filled pocket called an abscess. 

As the abscess swells, bacteria and fluid wind up leaking outside the gland, invading the surrounding tissues and creating a tunnel-like pathway to the anus. Once the swelling reaches the anus, the abscess breaks open and drains, leaving behind the tunnel (or fistula) connecting the gland to the anus.

About half of all anal abscesses form fistulas. While anyone can develop an anal abscess, they’re more common among people with:

• Chronic diarrhea
• Colitis
• Crohn’s disease
• Radiation treatment in the anal area

Pain around the anus is one of the most common symptoms of an anal fistula, but you can also have symptoms like:

• Swelling around the anus
• Pus drainage near your anus
• Redness or bleeding near the anus
• Pain that intensifies with bowel movements

The infection may also cause fever and chills.

Treating anal fistulas

Anal fistulas don’t heal on their own, and there’s no medicine you can take to help the tunnel close or heal over. Dr. Tarlowe uses different techniques to treat anal fistulas, depending on your anatomy and other factors.

Fistulotomy

A fistulotomy is a medical procedure that opens up the fistula, allowing the area to heal “from the inside out.” Fistulotomies are one of the most common treatments for anal fistulas, and the procedure can be performed on an outpatient basis using sedation. There is a limiting factor, however: In order to use this technique, the fistula needs to be located farther away from the anal sphincter to prevent potential complications, like fecal incontinence.

Seton

If the fistula is very close to the anal sphincter (or even includes it), Dr. Tarlowe may use a seton (sometimes called a seton stitch). A seton is a special type of suture that’s used to hold the fistula open so it can heal on its own, without having to cut through or damage the sphincter muscles.

LIFT

LIFT (Ligation of Intersphincteric Fistula Tract) is a two-stage treatment for more complex fistulas. LIFT allows the surgeon to access the fistula between the sphincter muscles and avoid cutting them. A seton is first placed into the fistula tract, forcing it to widen over time. Several weeks later, Dr. Tarlowe removes infected tissue and closes the internal fistula opening

Fistula plug

A fistula plug procedure uses a slightly different approach to close off the tunnel opening. This technique uses a plug composed of a biologically-engineered material. Once the plug is placed inside the fistula, it triggers natural healing responses that signal your body to grow new, healthy tissue across the plug, sealing off the opening. 

The plug can be placed during an outpatient procedure, and like the other techniques, plug placement doesn’t damage the sphincter muscle. 

At his offices in White Plains, New York, and Manhattan in New York City, Dr. Tarlowe uses a patient-centered approach to care, tailoring every treatment to the unique needs of the individual patient. To learn more about fistula treatment or to find out what’s causing your painful symptoms, call the office or book an appointment online.