If you experience painful swelling around your anus, you may have an anal fistula. Albert Chung, MD, a double board-certified colorectal surgeon, provides expert diagnosis and personalized in-office treatment for anal fistulas at his practice in Santa Margarita, California. Prompt evaluation and treatment can quickly alleviate discomfort and prevent potential complications. Call (714) 988-8690 today to schedule your appointment and start your journey to relief.
An anal fistula is a small tunnel that forms between the skin near the anus and the anal canal. Fistulas typically develop from an infection that started in an anal gland, which then spreads and creates a channel filled with pus. This causes pain, swelling, drainage, and sometimes fever. Because fistulas don't close on their own and can lead to serious complications including recurrent abscesses and continence problems, timely treatment is essential.
Most anal fistulas start as anal abscesses. An abscess forms when anal glands become clogged and infected, producing a painful collection of pus. As the infection progresses, the body often creates a pathway to drain the pus, and that pathway is the fistula. Roughly half of people with an abscess end up developing a fistula.
While most fistulas come from abscesses, other causes include Crohn's disease (which can produce complex perianal fistulas), sexually transmitted infections, trauma, diverticulitis, tuberculosis, or radiation exposure. Identifying the underlying cause matters because it shapes treatment.
Fistulas are classified by their relationship to the anal sphincter muscles. The type determines which treatment approach will work and how carefully sphincter function needs to be protected.
Preserving sphincter function is a key priority in fistula surgery. Complex fistulas involving significant sphincter muscle are typically treated with sphincter-sparing techniques rather than direct division of muscle.
Fistula symptoms tend to be persistent and recurrent, which is one of the clearest signs you're dealing with one.
These can indicate an active abscess or spreading infection that may require urgent drainage.
During your initial consultation, Dr. Chung will thoroughly review your symptoms and medical history. A gentle physical examination often identifies the fistula directly. Additional testing helps characterize complex fistulas and their relationship to the sphincter muscles.
While professional treatment is ultimately needed to resolve a fistula, supportive home care can ease symptoms and keep you comfortable in the meantime. Warm sitz baths (soaking the anal area in warm water for 10 to 15 minutes, 2 to 3 times daily) reduce pain and inflammation. Good hygiene, gentle cleaning after bowel movements, and soft pads to absorb drainage all help. Dietary adjustments to keep bowel movements soft, along with over-the-counter pain relievers and stool softeners, can make a real difference while you wait for treatment.
Surgery is the primary treatment for anal fistulas. The specific procedure depends on the fistula type, complexity, and how much sphincter muscle is involved. Protecting continence is a core consideration in every treatment decision.
Dr. Chung also offers laser fistula treatment (FiLaC) as a minimally invasive option. For detail, see the laser treatment page.
Perianal fistulas in Crohn's disease are often more complex and recurrent than typical cryptoglandular fistulas. Treatment usually combines medical therapy (biologics like anti-TNF agents) with conservative surgical approaches (often a long-term seton to maintain drainage without aggressive surgery). The goal is controlling symptoms and preserving function rather than attempting definitive repair of every tract.
Recovery timelines depend on the procedure. Most patients resume normal activities within a few weeks. Sitz baths several times daily, careful hygiene, soft stools (supported by fiber and adequate hydration), and activity restrictions during initial healing are all part of the aftercare plan. Dr. Chung provides detailed post-operative instructions and schedules follow-up appointments to confirm healing and reduce the risk of recurrence.
A perianal abscess is a pocket of pus that forms when one of the small glands inside the anal canal becomes blocked and infected. It shows up as a hot, swollen, intensely painful lump beside the anus, often with fever, and it does not improve with antibiotics alone. The treatment is drainage: a small incision over the abscess, usually under local anesthetic in the office or under sedation for deeper abscesses, which relieves the pain almost immediately. The wound is left open to heal from the inside. Dr. Chung drains abscesses promptly, often the same day a patient calls, because delay lets the infection spread.
About one in three to one in two people who have an abscess drained go on to develop a fistula, because the tract the infection travelled along stays open. If drainage from the site continues for more than a few weeks after an abscess, or the abscess comes back in the same spot, a fistula is the likely reason and the next step is the evaluation described on this page.
An abscess is acute: a new, hot, swollen, very painful lump, often with fever, that developed over a few days. A fistula is chronic: a small opening in the skin near the anus that intermittently drains pus, blood, or stool, with less pain, and that has usually been present for weeks to months. Both need a colorectal surgeon. An abscess needs one quickly.
Dr. Chung matches the operation to the fistula. This is the framework.
| Fistula | Usual recommendation | Why |
|---|---|---|
| Superficial or low intersphincteric | Fistulotomy | Little or no sphincter muscle involved, so laying the tract open is safe and heals more than 90 percent of the time |
| Transsphincteric, moderate muscle involvement | Seton first, then LIFT or FiLaC | Preserves the muscle that controls continence while still closing the tract |
| High or complex, significant muscle involvement | Seton, then advancement flap or FiLaC | Fistulotomy would risk incontinence; flap and laser close the internal opening without dividing muscle |
| Recurrent after previous surgery | MRI to map the tract, then FiLaC or flap | Laser closure does not burn bridges; every other option remains available if needed |
| Crohn's-related | Long-term seton plus medical therapy; FiLaC in selected cases | Goal is drainage and symptom control rather than aggressive repair of every tract |
Fistula surgery is one of the areas where the surgeon's judgment matters most, because the wrong operation can trade a fistula for a continence problem. Dr. Chung is fellowship-trained in colon and rectal surgery and offers every fistula technique, including FiLaC laser closure, which very few Orange County surgeons perform.
Dr. Chung sees patients at 30212 Tomas, Suite 365, Rancho Santa Margarita, CA 92688, off the 241 toll road in South Orange County. Patients come from Mission Viejo, Lake Forest, Irvine, Laguna Hills, Laguna Niguel, Aliso Viejo, San Juan Capistrano, Ladera Ranch, Trabuco Canyon, Santa Ana, and across Orange County. Most new patients are seen within days, and a first visit usually includes the exam, a plain-language explanation, and a treatment plan the same day.
Not ready for an in-person visit? Dr. Chung also offers online video consultations. Read what patients say on the reviews page.
Almost never. The tract is lined with tissue that keeps it open, so it may stop draining for a while and then flare again with a new abscess. Antibiotics treat the infection but do not close the tunnel. Surgery, or laser closure, is the only reliable way to resolve a fistula.
There is soreness for several days, most noticeable after bowel movements, and it is managed with sitz baths, stool softeners, and over-the-counter medication. Sphincter-sparing procedures such as FiLaC and LIFT are generally less painful than an open fistulotomy because there is no open wound.
Two to five days to return to desk work after FiLaC, about a week after fistulotomy or LIFT, and one to two weeks after an advancement flap. Complete healing of the tract takes six to twelve weeks, and Dr. Chung sees you during that period to confirm it.
Fistulotomy carries a small risk of minor changes in control, which is why it is reserved for fistulas that involve little or no sphincter muscle. Sphincter-sparing procedures (seton, LIFT, advancement flap, FiLaC) are used whenever a meaningful amount of muscle is involved, precisely to protect continence. Dr. Chung discusses this tradeoff with every patient before choosing an approach.
The one that matches the fistula. Simple fistulas are cured most reliably by fistulotomy. Complex fistulas are treated with sphincter-sparing procedures, and FiLaC is often chosen for recurrent fistulas or when preserving muscle is the priority. An MRI is used to map complex tracts before deciding.
See a colorectal surgeon promptly. Some abscesses do rupture and drain on their own, but many spread instead, and self-draining abscesses are more likely to leave a fistula behind. Prompt surgical drainage relieves pain quickly and lets the surgeon assess whether a fistula is already present.
Recurrence after fistulotomy for a simple fistula is low, under 10 percent. Sphincter-sparing procedures have higher recurrence, roughly 25 to 40 percent depending on the technique and the fistula, but they can be repeated. Recurrence is higher in Crohn's disease and in fistulas that have already recurred once, which is why mapping with MRI matters in those cases.
Whether you're dealing with a new fistula, a recurrent one, or complex Crohn's-related perianal disease, Dr. Chung can walk you through the right treatment for your situation.
Book a consultation Call (714) 988-8690Anal fistulas rarely heal independently and typically require surgical intervention to resolve fully and prevent recurrence.
Dr. Chung utilizes minimally invasive techniques and effective pain management strategies to minimize discomfort during recovery.
Recovery can vary but generally ranges from a few weeks to several months, depending on the complexity of the fistula and the chosen treatment method.
Prompt diagnosis and treatment greatly improve colorectal cancer outcomes. Call Dr. Albert Chung’s colorectal clinic in Orange County.
