June 23, 2022

An anal fistula, or fistula-in-ano, is a chronic abnormal communication, usually lined to some degree by granulation tissue, which runs outwards from the anorectal lumen to an external opening on the skin of the perineum or buttock.

Fistula-in-ano is defined as a track lined by granulation tissues, which connects deeply in the anal canal or rectum and superficially on the skin around the anus.

Fistulas may occur in many several parts of the body. They can form between:

  1.  The surface of the skin and bile ducts.
  2.  An artery and vein
  3. The neck and throat
  4. The cervix and vagina
  5. The bowel and vagina
  6. The stomach and exterior of the skin
  7. The colon and surface of the body
  8. The space inside the skull and nasal sinus
  9. The uterus and peritoneal cavity
  10. An artery and vein in the lungs
  11. The gut and navel
  12. The area inside the head and nasal sinus

Inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis, can lead to fistulas between one loop of the intestine and another. In addition, injury can cause fistulas to form between veins and arteries.


  1. Blind: These are open on one end only but connect to two structures.
  2. Complete: This has openings both inside and outside the body.
  3. Horseshoe: This connects the anus to the surface of the skin after going around the rectum.
  4. Incomplete: In this, a tube from the skin is closed on the inside and does not connect to any internal structure.


  • Frequent anal abscesses.
  • Pain and swelling around the anus.
  • A foul-smelling liquid that oozes from a hole near your anus.
  • Skin irritation around the anus.
  • Painful bowel movements or urination.
  • Bleeding
  • Chills and fever
  • A general feeling of fatigue.
  • A constant throbbing pain that may worsen when you sit down, move around, poo or cough.
  • Smelly discharge from near your anus.


The major causes of a fistula-in-ano are anal abscesses and clogged anal glands. The following are the other causes of fistula-in-ano:

  • Trauma
  • Sexually transmitted diseases
  • Crohn’s Disease
  • Tuberculosis
  • Diverticulitis
  • Cancer
  • Radiation from the treatment of cancer


There’s no medication to cure fistula-in-ano, so surgery is done. The procedure can generally take place in a doctor’s clinic or in his office. There’s no need to go to the hospital.

  • The doctor will cut and open the skin and muscle surrounding the tunnel for a non-complicated fistula that is not too close to your anus. This allows the opening to heal from the inside out.
  • They will make use of a plug to close the opened fistula.
  • For a more complicated and serious fistula, the doctor might put a tube, which is called seton, into the opening. This helps to drain the infected fluid before surgery. It may take six weeks or more.

Depending on where the fistula is located, your doctor may have to cut into the sphincter muscles that open and close your anus. They’ll try not to damage them, but it may be harder to control your bowels after the procedure.


Fistulotomy: A fistulotomy is the most common surgery for anal fistulas. This involves cutting along the whole length of the fistula to open it up, so it heals as a flat scar.

A fistulotomy is the most successful treatment for anal fistulas. However, it’s usually only suitable for fistulas that do not pass through much of the sphincter muscles, as incontinence is the lowest in these cases.

If the surgeon or doctor has to cut a small portion of the anal sphincter muscle during the procedure, they’ll try to reduce the risk of incontinence.

In cases where incontinence is considered too high, another procedure may be recommended.

Laser Surgery: Radially emitting laser fiber treatment involves using a tiny laser beam to close up the fistula.

There are few uncertainties around how well it works, but there are no major safety concerns.


Al Hilal Hospital is the largest and fastest-growing chain of private healthcare providers in Bahrain, with five branches. Al Hilal Healthcare Group is committed to providing high-quality healthcare services at an affordable price to the people of Bahrain through a combination of superior medical technology and excellent clinical services. Its vision is to be the largest healthcare service provider in the region by catering to the needy at the most affordable rates.

Al Hilal Healthcare Group now offers advanced surgical solutions for major surgeries. We now introduce Laparoscopic and Laser Surgeries as well. In addition, Al Hilal has specialist surgeons who do the Fistulotomy successfully.


Al Hilal Healthcare group is equipped with high surgical excellence and the best and most experienced surgeons. Al Hilal provides all these surgeries at an affordable price to the patients. We also offer the utmost care before, during, and after the surgery. We have General Surgeons who are well-experienced in Fistulotomy and laser surgeries for Fistula-in-ano.