At a glance
Being offered a fistulotomy and trying to decide whether to go ahead is a position many people find themselves in. It is a genuine decision, and it is normal to want to understand the trade-offs before committing.
This guide is not a recommendation to have or avoid surgery. It sets out the things people commonly weigh up, and the questions worth asking your surgeon, so you can make a decision that fits your situation. For the mechanics of the operation itself, see our guide on the fistulotomy procedure.
What a fistulotomy is meant to do
A fistulotomy opens the fistula tract along its length so it can heal from the inside out, rather than remaining as a tunnel that keeps re-infecting. The goal is to resolve the underlying problem — the ongoing drainage, discomfort, and recurring abscesses that a fistula can cause.
It is often described as the most direct and effective option when it is suitable. The key phrase is “when it is suitable”, because whether it is a safe choice depends heavily on the path of your particular fistula.
Why it may have been offered
Surgeons commonly suggest a fistulotomy when:
- The fistula is simple and low, involving little sphincter muscle
- Conservative measures are unlikely to close the tract on their own
- Symptoms are affecting daily life or abscesses keep returning
If your fistula is more complex, or passes through more of the sphincter, your surgeon may raise sphincter-preserving alternatives instead. Understanding why a fistulotomy has been suggested for you specifically is a useful starting point.
Trade-offs people commonly weigh up
Resolution versus recovery. A fistulotomy leaves an open wound that heals gradually over weeks and needs daily care. Many people feel the weeks of wound management are worth resolving a problem that has dragged on for months or years. Others want to be sure they understand what recovery involves first.
Continence. This is the trade-off people find hardest to raise but most want answered. Because the procedure divides tissue that can include part of the sphincter, there is a possibility of changes to continence — most often control of gas. For simple, low fistulas this risk is usually small, but it varies with your anatomy. Our guide on incontinence risk covers this in more depth.
Success versus alternatives. Fistulotomy tends to have high success rates for the fistulas it suits. Sphincter-preserving options may carry a lower continence risk but different success and recurrence rates. It is reasonable to ask how the options compare for your fistula.
Timing. Unless there is an active abscess, there is often no rush. Some people choose to proceed promptly to move on; others take time to get a second opinion. Both are valid.
Questions worth asking your surgeon
- What type of fistula do I have, and how much sphincter muscle is involved?
- Why are you recommending a fistulotomy rather than a sphincter-preserving option?
- What is the success rate, and the recurrence rate, for my type of fistula?
- What is the continence risk in my case, and is it temporary or lasting?
- What would recovery realistically look like for me?
- What happens if I wait, or if I choose not to have surgery for now?
Our questions to ask your surgeon guide has a fuller checklist you can take to your appointment. Writing your questions down beforehand helps — appointments are short, and it is easy to forget what you meant to ask.
Taking the decision at your pace
There is no single right answer here. The decision depends on your fistula, your priorities, and how symptoms are affecting you. It is entirely reasonable to ask for time, request a second opinion, or bring someone with you to talk it through. People who have been through it often describe the value of understanding their options clearly before deciding.
When to seek care
While you are weighing up your decision, some symptoms need prompt medical attention. Seek care if you notice:
- Increasing pain, swelling, or redness near a previous abscess or fistula site
- Fever or chills alongside perianal symptoms
- New or worsening drainage with an unpleasant odour
- A rapidly growing lump near the anus
- Difficulty passing urine alongside perianal pain or swelling
- Any symptoms that are getting worse rather than better