Is anal fistula surgery painful?

You will have some discomfort after surgery, particularly when opening your bowels. We provide effective pain relief including local anaesthetic injections and strong painkillers to take home. Warm salt baths can also be very soothing. Most patients find the pain manageable and improving over the first one to two weeks.

How long does it take to heal after a fistulotomy?

The wound from a fistulotomy is left open to heal from the base upwards, which typically takes four to eight weeks depending on the size of the wound. You will need to keep the area clean and may need dressings during this time.

Will I have problems with bowel control after surgery?

Protecting continence is a primary concern when planning fistula surgery. For simple fistulas treated with fistulotomy, the risk of any continence disturbance is low. For more complex fistulas, we use sphincter-sparing techniques specifically designed to minimise this risk.

Can the fistula come back?

There is a risk of recurrence with any fistula surgery, typically in the range of 5-20% depending on the complexity of the fistula and the technique used. Accurate pre-operative imaging and meticulous surgical technique help to minimise this risk.

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Anal Fistula Surgery

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An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. It usually forms as a result of an infection in a small gland inside the anus, which creates an abscess. When this abscess drains, it can leave behind a persistent connection to the skin.

Symptoms typically include persistent discharge near the anus, pain, and sometimes recurrent abscesses. An anal fistula will not heal on its own and requires surgical treatment. At Kinvara Private Hospital, we provide discreet, expert care for this sensitive condition, using techniques designed to cure the fistula while protecting the sphincter muscles that control bowel function.

Medically Reviewed By

Mr Vasu Karri, Medical Director • Updated 2026-01-25

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The treatment of an anal fistula requires a careful balance between healing the tract and preserving continence. Simple fistulas that involve only a small portion of the sphincter muscle can often be cured with a straightforward fistulotomy. More complex fistulas that involve a greater proportion of the sphincter require sphincter-sparing techniques such as a seton placement, the LIFT procedure, or an advancement flap.

Our experienced general surgeons will assess your fistula carefully, often using an MRI scan, to determine the precise anatomy and recommend the best surgical approach for your individual case.

Diagnosis and Pre-Operative Assessment

Diagnosis begins with a careful clinical history and examination. Your surgeon will examine the skin around the anus to look for the external opening of the fistula and will perform a gentle internal examination to try to identify the internal opening within the anal canal. This can often be done in the outpatient clinic.

To accurately map the course of the fistula and its relationship to the sphincter muscles, an MRI scan of the pelvis is usually the best investigation. This provides detailed images that help the surgeon plan the safest and most effective surgical approach. In some cases, an examination under anaesthesia is performed, where the surgeon probes the tract while the patient is asleep.

Understanding Anal Fistulas

Around the inside of the anal canal are small glands that produce mucus. If one of these glands becomes blocked, it can become infected and form a perianal abscess. In around 30-50% of cases, when the abscess drains, the infection leaves behind a small tunnel or tract that connects the gland to the skin surface. This is the fistula.

Fistulas are classified by their relationship to the anal sphincter muscles. Intersphincteric fistulas pass through the internal sphincter only. Trans-sphincteric fistulas pass through both the internal and external sphincters. Higher and more complex fistulas may have branches or involve more of the sphincter complex. Understanding the anatomy of the fistula is critical for planning surgery that will heal the tract without compromising continence.

Benefits of Surgery at Kinvara

Discreet private consultations for a sensitive condition
Expert assessment including MRI imaging for complex fistulas
A range of surgical techniques tailored to your individual anatomy
Strong focus on preserving bowel continence
Experienced consultant surgeons with expertise in colorectal conditions

What Causes an Anal Fistula?

The most common cause of an anal fistula is a previous perianal abscess. Even if an abscess heals after being drained, the underlying infected gland may not clear completely, leading to a chronic connection between the bowel and the skin. This explains why many patients with fistulas have a history of one or more painful abscesses in the same area.

Other less common causes include Crohn's disease, a type of inflammatory bowel disease that can cause fistulas to form in the anal area and elsewhere. Fistulas can also rarely be associated with previous surgery or radiotherapy in the pelvic area. Your surgeon will consider these possibilities during your consultation.

Surgical Treatment Options

Conservative Management

Anal fistulas do not heal spontaneously. Antibiotics may help control symptoms from an acute abscess but will not cure the underlying fistula. Surgery is required for definitive treatment.

Surgical Options

The choice of surgical technique depends on the complexity of the fistula. Fistulotomy is used for simple, low fistulas where the tract is laid open with a cut and heals from the bottom up over several weeks. Cure rates are over 90%. Seton insertion involves passing a piece of surgical thread through the fistula tract to allow chronic infection to clear before definitive surgery. The LIFT procedure is a sphincter-sparing technique that involves tying off the fistula tract between the two sphincter muscles. For complex fistulas, an advancement flap uses healthy tissue from inside the rectum to cover the internal opening.

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