What are Anal Fistulas?

An anal fistula is an abnormal, tunnel-like connection that forms between the inner lining of the rectum or anal canal and the skin just outside the anus. It often begins as an infected gland or abscess that creates a tract as the infection drains. Once formed, a fistula usually has two openings—one inside the rectum or anal canal and one on the outer skin near the anus. In some cases, there may be a single tract, while others develop multiple branches, making treatment more complex and spontaneous healing unlikely.

Because the fistula remains open to the outside environment, it can lead to persistent discharge, irritation, discomfort, and recurring infections. Without medical or surgical intervention, an anal fistula rarely resolves on its own and may continue to cause symptoms or worsen over time. Understanding this condition is the first step toward finding effective relief and long-term healing.

Anal Fistula Symptoms

While the below symptoms can help you sort out the likelihood that you have an anal fistula, it is always important to seek the care of a professional colorectal surgeon. This way, your diagnosis can be 100% accurate, leading to anal fistula treatment in Los Angeles that can help you find relief.

Anal fistula symptoms include:

Painful swelling around the anus
Painful bowel movements
Anal bleeding
Discharge from an opening next to the anus
Irritated skin around the anus
There may also be more general symptoms, such as fever, fatigue and chills

Anal Fistula Causes

In most cases, untreated anal abscesses are the primary cause of anal fistulas. An anal abscess is an infected pocket of pus that develops in or around the anorectal area. When an abscess doesn’t heal completely or drains improperly, it can leave behind a small channel (known as an anal fistula) connecting the infected gland inside the anus to the skin surface.

While anal abscesses can often be managed with antibiotics, some require surgical drainage or other advanced treatments to fully eliminate the infection. Statistics show that about 50% of anal abscesses will eventually develop into an anal fistula. Other factors that may contribute to anal fistula formation include Crohn’s disease, trauma to the anal area, radiation therapy, or prior surgery in the region.

Prompt and proper treatment of an anal abscess can prevent the development of an anal fistula. To help you recognize when medical attention is needed, we’ve listed common anal abscess symptoms below. If you experience any of these signs, please schedule an appointment with Dr. Murrell for a professional diagnosis and expert anal fistula treatment in Los Angeles.

Anal abscess symptoms may include:

Throbbing pain in the anus, which worsens when sitting
Visible irritation of perianal skin, including swelling and redness
Pus emission
Constipation
Pain during bowel movements

Causes Linked to Other Conditions

Anal fistulas can also develop as a complication of certain underlying medical conditions, particularly those that cause chronic inflammation or infection in the anorectal area. These conditions can increase the risk of fistula formation and may make treatment more complex. Common associated conditions include:

Anal Fistula Treatments

In treating anal fistulas, Dr. Murrell will use one of several techniques in the effort to provide total relief. His surgical approaches to anal fistulas are designed to treat the fistula while preventing any muscular damage to the sphincter. After a thorough exam to determine the extent and nature of the fistula, Dr. Murrell will thoroughly discuss your options.

If you are suffering from severe rectal pain, it may be time to seek what patients are calling the most effective anal fistula surgery Los Angeles has to offer.

Fistulotomy

As the most common procedure for those suffering from anal fistulas, a fistulotomy is used in 85-95% of anal fistula cases. Its purpose is to fully expose the fistula, allowing it to properly heal. This is done by making an incision from one end of the fistula to the other. From there, Dr. Murrell can fully flush out the infection and pus, leaving a clean wound. Next, he will use sterile packing to ensure the fistula heals from the inside out. Over the following weeks, Dr. Murrell will see you through the healing process, ensuring you have a full, comfortable recovery from your anal fistula surgery.

Seton Technique

Sometimes a fistula will be large enough that treating it with a fistulotomy presents a high risk of incontinence, or the inability to control one’s sphincter. In this case, the seton technique is less invasive and can preserve as much muscle as possible. It is done by inserting a surgical thread through the fistula. With the thread in place, the fistula can be allowed to drain properly before healing. Over time, the seton helps to gradually loosen and promote healing, while Dr. Murrell monitors progress to ensure the fistula is properly draining and closing without compromising muscle function.

Bioprosthetic Plug

This technique is an option for certain types of high or complex fistulas as it avoids cutting the sphincter muscle. A bioprosthetic plug is a cone-shaped device made from human tissue. It is inserted into the internal opening of the fistula, leaving the external side open so that it can drain properly. Over time, tissue heals over the external opening. During the healing process, Dr. Murrell will monitor the fistula closely to ensure an anal abscess doesn’t develop.

Endorectal Advancement Flap

This procedure is often used to treat complex fistulas and those that cross the sphincter muscle to protect the patient from incontinence. This procedure involves creating a flap of mucosal tissue around the internal opening of the fistula. Once this flap is made, the fistula is cleaned from the internal opening, which is then sutured shut. Next, the external opening of the fistula is cleaned and then sutured shut. As with a bioprosthetic plug, the healing process is closely monitored to ensure no further complications arise.

Amniotic Membrane (Stem Cell Recruiter)

For complex or hard-to-heal anal fistulas, Dr. Murrell may use an amniotic membrane, also known as a stem cell recruiter. This biologic membrane is placed directly into the fistula tract to promote tissue regeneration and encourage the body’s own stem cells to assist in healing. It can be especially useful for fistulas that have not responded to conventional treatments or are located in areas where surgery is more challenging. Dr. Murrell monitors the healing process carefully to ensure proper closure while preserving anal function and reducing the risk of recurrence.

Laser/Heat Treatment

For recurrent or persistent anal fistulas (often after prior treatments from another doctor), Dr. Murrell may use a laser or heat-based procedure to precisely close the fistula tract. The laser gently ablates the fistula from the inside, promoting tissue closure while minimizing damage to surrounding muscle. Laser treatment for anal fistulas can reduce postoperative pain and speed recovery compared to traditional surgery. Dr. Murrell carefully monitors the healing process to ensure the fistula heals fully and to reduce the likelihood of recurrence, preserving anal function and comfort throughout recovery.

Anal Fistula Surgery Risks

While surgery is essential for healing an anal fistula, as with any surgical procedure, there are potential risks and complications to consider:

Risk of Incontinence: For complex or large fistulas, a primary concern with some procedures (like a full fistulotomy) is the potential damage to the sphincter muscle, which can lead to difficulty controlling bowel movements (incontinence).
Fistula Recurrence: Fistulas can be complex, and there is always a risk that the initial procedure may not result in complete healing, potentially requiring follow-up treatment or a different surgical approach.
Anal Abscess Development: In rare cases or during the healing phase of certain procedures (like the Bioprosthetic plug), there is a possibility that a new pocket of infection (anal abscess) could develop, requiring close monitoring.
Healing Time and Monitoring: Procedures such as the Seton technique or Endorectal flap require careful monitoring and potentially a longer healing period to ensure the best long-term outcome.

Benefits of Anal Fistula Surgery

Surgical intervention aims to resolve the persistent channel and infection, offering several significant patient benefits:

Total Symptom Relief: Treatment provides the most effective way to eliminate chronic pain, discomfort, discharge, and irritation caused by the fistula.
Definitive Healing: Surgery allows the fistula tract to be properly cleaned, closed, or exposed, encouraging definitive, long-term healing that fistulas rarely achieve on their own.
Sphincter Muscle Preservation: Dr. Murrell utilizes advanced, muscle-sparing techniques (like the Seton or Endorectal flap) whenever possible to treat the fistula while protecting the patient’s ability to maintain bowel control.
Restoration of Quality of Life: Successfully treating the fistula allows patients to resume a normal, comfortable, and active life without the chronic burden of this condition.

Patient Testimonial

I was referred to Dr. Zuri Murrell in May, 2024 for a possible anal problem. I immediately felt comfort when Dr. Murrell came into the room, his friendly smile, caring personality and so knowledgeable, I know I was in excellent hands. But more importantly, he treated my problem, explained to me what was going on. I mean this doctor really cares. His staff, front desk and doctor assistant couldn't be nicer, very professional. I am looking forward to my follow up appointment.

R.B.

Why Choose Dr. Murrell for Anal Fistula Surgery?

Dr. Murrell is a highly regarded colorectal surgeon in Beverly Hills and Los Angeles, with extensive experience in the diagnosis and treatment of anal fistulas. Using advanced, minimally invasive techniques, he customizes treatment plans to meet each patient's specific needs, ensuring optimal results and a swift recovery. For difficult and recurrent anal fistulas, Dr. Murrell offers unique and advanced treatment options which provide excellent results even for complex cases. As a board-certified colorectal surgeon, Dr. Murrell has earned a reputation for excellence, being named one of the top doctors for colon and rectal surgeries in Los Angeles by Los Angeles Magazine from 2015 to 2020.

Dr. Murrell is committed to providing compassionate care and takes the time to fully explain diagnoses, answer patient questions, and offer personalized treatment options. His expertise also includes training future colorectal surgeons in innovative techniques for minimally invasive fistula treatment, ensuring that the latest advancements are available to his patients. and take the first step toward healing and restoring your quality of life.

Dr. Zuri Murrell Credentials

Named to Southern California Super Doctors® 2015-2017
Director of the Colorectal Cancer Program at Cedars-Sinai
Double board-certified and one of the surgeons in the west coast specifically trained in minimally invasive colorectal surgery
Magna Cum Laude graduate of Morehouse College
Medical Degree at the University of California, Los Angeles
Top Doctor for Colon and Rectal Surgeries in 2015-2018

Member of the American Board of Colon and Rectal Surgery
Member of the American Board of Surgery
Member of the American Medical Association
Fellowship in Colorectal Surgery From Cedars-Sinai Medical Center in 2008
Fellowship in Laparoscopic Colorectal Surgery from the University of California, Irvine in 2007

Anal Fistula FAQs

Will an anal fistula heal on its own without treatment?

Generally no. Once formed, because the tract is open and drains to the skin surface, the fistula is unlikely to heal fully on its own and may continue to cause symptoms or worsen over time.

What are the treatment options available with Dr. Murrell for anal fistulas?

Treatment options include a fistulotomy, seton technique, bioprosthetic plug, endorectal advancement flap, amniotic membrane fistula treatment (stem‑cell recruiter fistula), and laser/heat treatment. Each option is chosen based on the fistula’s complexity and location, with the goal of preserving muscular function

What is a fistulotomy, and when is it used?

A fistulotomy is the most common procedure for anal fistulas (used in about 85‑95% of cases), where the fistula tract is opened, infection and pus are removed, and the area is packed to heal from the inside out.

What if my fistula won't heal or keeps coming back?

In that case, advanced treatments like an amniotic membrane or laser/heat therapies are considered. These options are often reserved for complex or recurrent fistulas — for example, those that did not respond to previous treatments or are located in challenging areas. The amniotic membrane promotes tissue regeneration, and laser/heat therapy uses minimally invasive energy to close the tract while minimizing muscle damage.

What are the best recurrent anal fistula options if my first surgery didn’t succeed?

If you have a recurrent anal fistula—meaning the fistula has returned after prior treatment—the focus shifts to more advanced, tailored options. Key steps include thoroughly assessing the tract’s anatomy and any underlying causes before choosing treatment. Options often include placement of a seton for drainage, sphincter‑sparing procedures such as flap repairs or ligation techniques, biologic plugs or amniotic membrane to recruit healing, and laser or heat‑based therapies for difficult cases.

Schedule a Consultation Today

If you feel you have an anal fistula, it may be time to seek treatment. Dr. Murrell has a long record of helping patients find relief from anal fistulas, allowing them to resume a normal, burden-free life. The first step is a comprehensive consultation with Dr. Murrell, during which time he will determine the exact condition, followed by an effective treatment plan. His goal is to give you the smoothest and most effective anal fistula surgery Los Angeles has available. To get started, please call our office today.