An anal fistula may develop following a perianal abscess – an infected spot, just next to the anus. The ‘spot’ actually represents the external opening of a tract or tunnel that runs all the way to the inside of the anus. One analogy I use is that it is a bit like having a piercing in your cheek, just next to your mouth – there is a hole in the skin and a hole in the mouth, with a tunnel connecting the two. The main symptoms of a fistula are of recurrent discharge and infections, just next to the anus. Fistulas rarely heal by themselves and almost always need surgery. The most effective form of surgery is to ‘lay the fistula open’. This means cutting into the fistula (under general anaesthetic) and then allowing it to heal up by itself. Unfortunately, this is often not possible as the fistula tract may involve some sphincter muscle, and by cutting into the muscle a degree of incontinence may develop with time. In order to minimize the risk of this, various other options are available such as the use of setons, collagen paste and the LIFT procedure. All of these can be discussed during your consultation.