anal-fistula-anal-fissure-frequently-asked-questionsAnal fissures and anal fistulas are painful conditions that account for almost 1 out of every 6 visits to the colorectal surgeon. Find out more about how we treat them at the Fissure/Fistula Surgery Center of Excellence in this list of frequently asked questions (FAQ). Additional information on anal fissures and anal fistulas can be found here.

Anal Fistula FAQs

Q: What is a perianal abscess?

A: A perianal abscess is an infection in a mucous-secreting gland in the anal canal around your anus.

Q: What causes an abscess?

A: An abscess is formed when a small gland just inside the anus becomes infected from bacteria or when stool is trapped in the gland. Certain conditions — constipation, diarrhea, colitis, or other inflammation of the intestine, for example — may make these infections more likely.

Q: What is a perianal fistula?

A: A perianal fistula (almost always the result of a previous abscess) is a small passage connecting the anal gland from which the abscess arose to the skin where the abscess was drained.

Q: What causes a fistula?

A: After an abscess has been drained, a passage may remain between the anal gland and the skin, resulting in a fistula. If the gland does not heal, there will be persistent drainage through this passage. If the outside opening of the fistula heals first, a recurrent abscess may develop.

Q: What are the symptoms of an abscess or fistula?

A: Perianal abscesses are generally manifested by intense anal pain and swelling. Fever is possible. Drainage of the abscess, either on its own or with an incision, relieves the pain and pressure. Fistulas are associated with drainage of blood, pus, or mucus, but they are generally not painful.

Q: Does an abscess always become a fistula?

A: No, a fistula develops in about 50 percent of abscess cases. There is no way to predict if this will occur. If drainage persists for two to three months, the diagnosis of perianal fistula is made.

Q: How is an abscess treated?

A: An abscess is treated by draining the pus through an opening made in the skin near the anus. Often this can be done in the doctor’s office using a local anesthetic. A large or deep abscess may require drainage in the operating room. Hospitalization may be necessary for patients susceptible to more serious infections, such as diabetics or people with decreased immunity.

Q: How is a fistula treated?

A: Surgery is generally necessary to treat a perianal fistula. This usually involves cutting a small portion of the anal sphincter muscle to open the passage, joining the external and internal opening, and converting the passage into a groove that will then heal from the inside out. Most fistula surgeries can be performed on an outpatient basis. If the fistula involves too much sphincter muscle, a two-stage procedure or more complicated repair may be necessary.

Q: What can I expect after fistula surgery?

A: Discomfort after fistula surgery can be mild to moderate for the first week and can be controlled with pain medication. The amount of time lost from work or school is usually minimal. There will be no limitation on activity. Soak the affected area in warm water three or four times a day. Stool softeners may also be recommended. You may need to wear a gauze pad or mini-pad to prevent the drainage from soiling your clothes. Bowel movements will not affect healing.

Q: Will an abscess or fistula recur?

A: If proper healing occurs, the problem usually will not return. If your bowels are otherwise normal, you are probably not at higher risk for developing another abscess.

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Anal Fissure FAQs

Q: What is a fissure?

A: An anal fissure is a narrow tear that extends from the muscles that control the anus (anal sphincter) up into the anal canal.

Q: When do I need to see a doctor about rectal symptoms?

A: If you are experiencing rectal pain, bleeding or itching, you should schedule an appointment with one of our doctors.

Q: How are growths, polyps and tumors in these areas removed?


Q: What are some first-step treatment options for fissures that I can do at home?

A: Conservative treatments include laxatives, dietary modifications, and sitz baths. These are safe and should be considered first-line therapy for acute anal fissures

Q: What is nitroglycerin ointment?

A: Nitroglycerin is usually the first medicine used to treat a chronic anal fissure. An application of a 0.2% nitroglycerin ointment may help heal a long-term (chronic) tear, or fissure, in the anus.

Q: How is BOTOX used to treat an anal fissure?

A: Botulinum toxin temporarily paralyzes the internal anal sphincter. This reduces the spasm and allows the fissure to heal.

Q: What surgery is done to heal a fissure?

A: The preferred procedure is lateral internal sphincterotomy. A doctor makes a small incision in the internal anal sphincter, one of two muscles that control the anus. The incision reduces the resting pressure, allowing the fissure to heal. This can be done as outpatient surgery under local anesthesia or general anesthesia.

Contact Our Fissure and Fistula Specialists

Our surgeons at the Fissure & Fistula Center of Excellence are highly experienced and knowledgeable in the treatment options for anal fissures and anal fistulas, and patients are treated in a very comfortable and technologically advanced surgical facility. To schedule a consultation at our state-of-the-art facility, contact us at (888) 512-2312 or fill out our online contact form.

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