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An anal fistula will not heal on its own. Although antibiotics may occasionally be effective, most persistent anal fistulas require a more aggressive approach. More aggressive approaches, such as surgery, seton and endorectal advancement flap, may require cutting the sphincters which can cause fecal incontinence.

The most common treatment for an anal fistula is a surgical procedure called a fistulotomy. In a fistulotomy, the surgeon makes an incision in the fistula tract, opening it up and merging it with the anal canal. This allows the tissues to heal from the inside out. For very small fistulas, a fistulotomy may be performed in a doctors office, using only local anesthesia. Larger fistulas, however, require surgery under spinal or general anesthesia, usually performed in a hospital or surgery center. Patients typically experience mild or moderate discomfort or pain following this procedure, with a recovery time of one to four weeks.

Fistulotomies work well for fistulas that are relatively close to the skin. For deeper fistulas, however, the physician may choose to use a seton.

A seton is a piece of suture material that is passed from the external skin opening, along the fistula tract, through the internal opening in the anal canal, exiting through the anus. The suture material is then tied in a loop, which is gradually tightened over a period of weeks. This ultimately has the same effect as a fistulotomy to open the fistula tract and allow it to heal.

Fibrin Glue

In some cases, an anal fistula is closed by the injection of fibrin glue solution of the clotting factors fibrinogen and thrombin. This glue results in the formation of a clot within the fistula, which helps promote healing of the tract.

Endorectal Advancement Flap

An endorectal advancement flap is a surgical procedure typically reserved for more complex fistulas. In the operating room, the doctor uses surgical instruments to dissect and lift a portion, or flap, of the rectal wall adjacent to the internal opening. The doctor pulls the flap down over that opening and sutures it into place to close the opening, allowing the fistula to heal.

Surgisis Biodesign Anal Fistula Plug

The Surgisis Biodesign Anal Fistula Plug is a unique, minimally invasive alternative to traditional fistula surgery. It is a conical-shaped device made from an advanced tissue repair graft that communicates with your body, signaling surrounding tissue to grow across and into the plug, allowing your body to restore itself. Fecal incontinence is unlikely, since the placement of the Anal Fistula Plug does not require cutting the anal sphincters.