What Causes Anorectal Fistulas and What Are My Treatment Options?

Most of us have some type of temporary rectal pain from time to time. Often, painful symptoms are caused by passing a large or very dry stool that stretches the anal sphincter beyond its normal limits. Other times, pain is due to hemorrhoids either inside or outside the rectum. 

But sometimes, pain can be due to a deep infection or abscess that winds up developing into an anorectal fistula. Like any deep infection, an anal fistula needs prompt medical attention to prevent the infection from spreading. 

Michael H Tarlowe, MD, is skilled at both diagnosing and treating anal fistulas at his offices in New York City and White Plains, New York, relieving painful symptoms while also preventing the condition from becoming worse. 

Here’s what you should know about anorectal fistulas.

The underlying causes of anorectal fistulas

A fistula is “an abnormal connection between two body parts” that forms as a result of injury, infection, or even surgery. Anorectal fistulas most commonly develop between an infected anal gland and the skin surrounding your rectum. The fistula serves as a tunnel to drain pus and bacteria from the gland abscess. 

Normally, your anal glands produce lubricating fluids to help you move your bowels. If a gland gets blocked, bacteria and pus collect and the gland swells, forming an abscess. Without treatment, the abscess will continue to grow until it bursts and drains, creating the small tunnel to the outside of your skin. 

Anorectal fistulas are a relatively common complication associated with anal abscesses, developing in 50% of patients. 

The most common symptom of an anorectal abscess or fistula is pain in and around the rectum. Pain can be constant, and it’s often worse when sitting down and when having a bowel movement. 

Other symptoms can include:

Rectal pain and painful bowel movements are also common with hemorrhoids and anal fissures, which is why fistulas sometimes go undiagnosed. As a colorectal specialist, Dr. Tarlowe is experienced in diagnosing fistulas, so treatment can be provided before the infection has a chance to become widespread.

Treating an anorectal fistula

A fistula creates an opening between your anal gland and the outside of your body, and it needs prompt medical treatment to heal properly. Dr. Tarlowe offers several treatment options, depending on your specific condition.

Fistula plug

This treatment uses a special material to plug or block the fistula. The plug triggers a natural healing response that helps the body “seal up” the tunnel.


In a fistulotomy, the tunnel is surgically opened up, allowing it to heal and recover. Fistulotomies are performed when the fistula is located away from the anal sphincter to avoid damaging this muscle that controls bowel movements.


If the fistula is near your anal sphincter muscle, Dr. Tarlowe may repair it using a special suture called a seton, which holds the fistula open and allows it to drain and heal.

Endorectal advancement flap

This procedure removes a flap of rectal tissue and sutures it in place over the fistula opening, promoting healing without harming the anal sphincter muscle.

What’s causing your painful symptoms?

Different problems can cause rectal pain, but one thing is certain: Any type of chronic or recurrent rectal pain is a sign that something’s not right. Having an exam and evaluation is the best way to make sure any underlying problem is corrected — not only to relieve those painful symptoms, but also to help prevent a more serious problem from developing later on.

If you’re having pain or other symptoms, don’t put off getting the care you need. Use our online form or call one of our offices in White Plains or Manhattan’s Upper East Side to schedule an appointment today.

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