Treatment for Anal Fistula
Anal fistulas do not heal on their own and almost always require surgical treatment for anal fistula. The goal of treatment is to remove the infected tract, promote healing, and preserve bowel control (continence).
1. Fistulotomy (Most common procedure)
- The surgeon cuts open the entire fistula tract and leaves it to heal from the inside out.
- Used for simple, low fistulas that don’t pass through much of the anal sphincter.
- Healing takes 4–6 weeks, with regular wound care.
2. Seton Placement
- The surgeon places a thread or rubber band through the fistula to keep it open and allow continuous drainage.
- Often used in complex or high fistulas to avoid cutting muscle.
- The surgeon may leave it in for weeks or months to allow gradual healing.
3. Advancement Flap Surgery
- Used when cutting the fistula risks damaging the anal sphincter.
- The surgeon covers the internal opening with a flap of healthy tissue.
- More common in patients with Crohn’s disease or recurrent fistulas.
4. LIFT Procedure (Ligation of Intersphincteric Fistula Tract)
- A newer technique to close the fistula tract without cutting muscle.
- Suitable for some complex fistulas.
5. Medical Treatment (for underlying causes)
- Antibiotics for infection
- Immunosuppressants or biologics (e.g. infliximab) for Crohn’s disease-related fistulas
Postoperative Care
- Sitz baths
- Pain relief
- Wound cleaning and dressings
- Regular follow-up to ensure healing
In South Africa, fistula surgery is available in most regional hospitals and private surgical centres. Doctors may consult specialist colorectal surgeons for complex cases.
Let’s now explore complications and long-term outlook.
👉 [Next: Complications of Anal Fistula]
