Quick answer: An anal fistula is a small tunnel between the anal canal and the skin around the anus, usually left behind by an abscess that never fully healed. It does not close on its own, but sphincter-sparing options — including laser closure (FiLaC) — can seal the tract without conventional surgery in suitable patients. At Avrupa Cerrahi in Istanbul, most patients are examined, treated, and discharged the same day, without general anesthesia.
Medically reviewed by Op. Dr. Yasir Gözü · General Surgery and Proctology · Last updated: July 20, 2026
What Is an Anal Fistula?
An anal fistula (sometimes called a perianal fistula) is a chronic condition in which an abnormal tunnel develops between the anal canal and the skin near the anus. In most cases, it begins with an infection of one of the small glands inside the anal canal. The infection forms an abscess — a painful, pus-filled pocket — and when that abscess drains, the channel it leaves behind can fail to heal and gradually turns into a fistula.
Because the tunnel connects the bowel to the outside skin, it continuously carries bacteria and secretions — which is why a fistula never truly "settles down" on its own. One point deserves emphasis from the outset: an anal fistula does not heal by itself. Left untreated, abscesses recur, the tunnel widens and branches, and a simple fistula can gradually evolve into a complex one that is far harder to treat.
Symptoms of an Anal Fistula
The symptoms of an anal fistula are often persistent and, for many patients, socially distressing. Typical signs include:
- Continuous or intermittent discharge of pus or blood-stained fluid near the anus
- An unpleasant odor caused by bacteria and secretions collecting in the tract
- Persistent moisture or staining of the underwear
- Itching and skin irritation around the anus
- A small opening or "hole" visible on the skin near the anus
- Swelling and tenderness that comes and goes in cycles
- Recurrent anal abscesses — painful lumps that fill, drain, and return
- Pain, particularly during flare-ups or when an abscess is forming
Many patients live with these complaints for months or years, assuming they have hemorrhoids or a simple skin problem. If you notice ongoing drainage, odor, and a visible opening near the anus, a fistula should be at the top of the list.
Anal Fistula or Hemorrhoids?
The two are frequently confused because both cause discomfort and swelling around the anus. Hemorrhoids typically cause bleeding and a bulging sensation, while a fistula announces itself with chronic discharge, odor, and repeated abscesses. A proctology examination distinguishes them quickly.
Anal Fistula or Anal Fissure?
Despite the similar names, these are entirely different conditions. A fissure is a painful tear in the lining of the anal canal, usually causing sharp pain during bowel movements; a fistula is a tunnel whose hallmark is drainage. Because each is treated differently, accurate diagnosis matters.
What Causes an Anal Fistula?
The great majority of anal fistulas develop from a previous anal abscess: an infected anal gland forms an abscess, the abscess drains, and the channel between the gland and the skin remains open. The abscess is the acute phase of the disease; the fistula is its chronic continuation.
Less commonly, fistulas can be associated with:
- Inflammatory bowel disease, particularly Crohn's disease
- Previous surgery or trauma in the anal region
- Chronic infections
- Radiation therapy to the pelvic area
Patients with Crohn's disease deserve special mention, because their fistulas tend to be more complex and carry a higher risk of recurrence, which influences the choice of treatment.
Types of Anal Fistula
Not all fistulas are alike, and classification directly shapes the treatment plan. In broad terms:
- Simple (low) fistulas follow a short, straightforward path and involve little or none of the sphincter muscle. They respond well to a wide range of treatments, including minimally invasive options.
- Transsphincteric fistulas pass through the sphincter muscles — the muscles responsible for bowel control. Treating them safely requires techniques that seal the tract without cutting through muscle.
- Complex fistulas may have multiple branches, deep extensions, or a long history of failed treatment.
- Horseshoe fistulas are a particularly challenging complex type in which the tract curves around the anal canal in a horseshoe-shaped arc. Because the tunnel spreads so widely, classic cutting operations become more difficult and more damaging — which is precisely why sphincter-sparing, minimally invasive approaches offer a real advantage here. With current techniques, many horseshoe fistulas can be treated successfully without conventional open surgery.
How Is an Anal Fistula Diagnosed?
Diagnosis begins with a careful proctological examination. In many patients, the external opening is visible on inspection, and gentle examination allows the physician to trace the direction of the tract while ruling out conditions such as hemorrhoids or fissures that mimic fistula symptoms.
For deeper or more complex tracts, imaging may be used to map the tunnel's course and its relationship to the sphincter muscles. This mapping is essential: it determines whether a fistula is simple or complex, and therefore which treatment will close it safely while fully protecting bowel control.
At our clinic, patients are awake, informed, and involved throughout. Before any procedure, the physician explains the findings and the plan, and all patient information is kept strictly confidential.
Treatment Options for Anal Fistula
The goal of every fistula treatment is the same: close the tunnel permanently while preserving the sphincter muscles. How that goal is reached varies with the type of fistula.
Laser Closure (FiLaC)
Laser treatment — known as FiLaC (Fistula-tract Laser Closure) — is the centerpiece of the minimally invasive approach used at Avrupa Cerrahi. A thin laser fiber is advanced into the fistula tract, and controlled laser energy seals the tunnel from the inside as the fiber is withdrawn. The tract collapses and closes without any cutting of the surrounding tissue or muscle.
The practical advantages for the patient are substantial:
- No general anesthesia, no fasting, and no extensive pre-operative testing required
- The procedure is short — comparable in comfort to a routine dental filling
- The sphincter muscles are fully preserved, protecting bowel control
- Same-day treatment: examination, procedure, and discharge in a single visit
- Suitable for patients with heart disease, high blood pressure, or diabetes, for whom general anesthesia poses added risk
- Effective in appropriately selected cases across the spectrum — from simple fistulas to advanced and horseshoe-type fistulas
Laser treatment closes the tract from within, and in suitable patients it can eliminate the need for conventional surgery altogether.
Video-Assisted Techniques (VAAFT)
In selected complex cases, a video-assisted approach lets the surgeon inspect the fistula tract from the inside with a fine camera, clean it thoroughly, and close the internal opening — again without dividing muscle. This is especially useful when the tract is branched or its anatomy uncertain.
Seton Placement
For certain complex or actively infected fistulas, a soft surgical thread called a seton may be placed through the tract as a first stage. It keeps the tunnel draining while inflammation settles, preparing the ground for definitive closure — often with laser — later.
Fistulotomy: The Classic Operation
Fistulotomy is the traditional operation, in which the tract is laid open with an incision and allowed to heal from the base upward. It remains effective for some low, simple fistulas, but it involves cutting tissue, an open wound, a longer recovery, and — when the tract involves the sphincter — a potential risk to continence. Fistulotomy is not mandatory for every fistula. For many patients, particularly those with transsphincteric or horseshoe fistulas, sphincter-sparing non-surgical methods are both safer and more comfortable, which is why they are our first preference whenever the anatomy allows.
An honest caveat belongs here: not every fistula can be treated without surgery. Some complex tracts still require a staged or operative approach, and the right plan can only be made after a proper examination.
Why Choose Avrupa Cerrahi for Anal Fistula Treatment?
Avrupa Cerrahi's proctology unit — a dedicated team of physicians, nurses, and patient consultants — focuses exclusively on diseases of the anal region: anal fistulas, perianal abscesses, horseshoe fistulas, and related conditions. That narrow focus, built on more than 20 years of experience, is what makes consistently minimally invasive care possible.
- One center, one team: examination, treatment, and follow-up under a single roof
- No general anesthesia, no fasting, no lengthy test protocols for laser procedures
- Same-day examination, treatment, and discharge for suitable patients
- Safe for patients with cardiac disease, hypertension, and diabetes
- Tissue-preserving, sphincter-sparing techniques as the default approach
- A multilingual consultant team serving international patients from around the world
Patients at our clinic are not simply anesthetized and operated on. They are examined awake, informed in plain language, and involved in every decision about their treatment.
Recovery After Laser Fistula Treatment
One of the strongest arguments for the laser approach is what happens afterward. Because no tissue is cut:
- Most patients return home the same day and resume daily activities quickly
- Pain is minimal and typically well controlled with simple measures
- Healing after laser closure is generally expected within one to two weeks, whereas recovery after classic open surgery can take considerably longer
- There is no large wound requiring prolonged dressing care
During recovery, patients are advised to keep the area clean and dry, avoid constipation with adequate fiber and fluids, and attend follow-up so the team can confirm the tract has closed fully.
What Happens If an Anal Fistula Is Not Treated?
Postponing treatment is the most common mistake, and it carries real consequences:
- Abscesses recur, each episode more painful than routine flare-ups
- The tunnel widens, deepens, and can branch into new tracts
- A simple fistula can progress into a complex or horseshoe fistula that demands far more extensive treatment
- Infection can spread into the surrounding muscle tissue
- In rare cases, fistulas neglected for many years have been associated with an increased risk of cancerous change in the tract
- Constant discharge and odor steadily erode confidence, comfort, and social life
The earlier a fistula is treated, the simpler the treatment tends to be. A tract that could be closed today in a brief, anesthesia-free session may require staged, complex management a year from now.
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Disclaimer: This content is for general information only and is not a substitute for professional medical advice, diagnosis, or treatment. Please consult a physician for guidance specific to your condition.
