At a glance
Fibrin glue is one of the less invasive treatment options for anal fistula. Rather than cutting tissue, the procedure involves injecting a biological adhesive into the fistula tract to seal it closed. The body is then expected to heal across the sealed tract.
The appeal of fibrin glue is its simplicity and safety — it carries no risk to the sphincter muscle, requires minimal recovery, and if it does not work, all other treatment options remain open. The trade-off is that its success rate is lower than surgical alternatives.
This guide covers how the procedure works, who it may be suitable for, and what people describe about the experience.
How the procedure works
The basics
Fibrin glue is made from blood clotting proteins — typically fibrinogen and thrombin. When mixed and injected into the fistula tract, these proteins combine to form a clot-like seal within the tract.
The procedure typically involves:
- Examination under anaesthesia — to assess the fistula anatomy
- Cleaning the tract — the fistula tract is flushed to remove debris and infection
- Injecting the glue — the adhesive is injected from the internal opening outward, filling the tract
- Closing the internal opening — sometimes a stitch is placed at the internal opening to help seal it
The procedure is usually quick — often 20 to 30 minutes — and is typically done as a day case.
What the glue does
The fibrin glue provides a scaffold within the tract. The idea is that the body’s healing processes will use this scaffold to grow new tissue across the gap, permanently closing the fistula. If successful, the tract seals itself with the body’s own tissue over the following weeks.
Who it may be suitable for
Fibrin glue is most commonly considered for:
- Simple fistulas with a short, straight tract
- First-line treatment when a less invasive approach is preferred
- Complex fistulas where surgical options carry higher risks — as a low-risk first attempt
- People with previous sphincter damage where further surgery could increase incontinence risk
- Recurrent fistulas where other approaches have not worked and a different strategy is needed
It is less likely to be recommended for:
- Long or branching tracts
- Fistulas with active infection or abscess
- Very wide tracts where the glue cannot effectively fill the space
Success rates
This is the important context. Fibrin glue has lower success rates than surgical options:
- Published studies report healing rates that vary widely, typically between 10 and 60 percent
- Simple, short fistulas tend to do better than complex ones
- Some studies show that initial success is followed by recurrence in a proportion of cases
- The procedure can be repeated, and some people describe success on a second or third attempt
The lower success rate needs to be weighed against the very low risk profile. For some people, a 30 to 40 percent chance of healing with zero sphincter risk is preferable to a higher success rate with some incontinence risk.
What people describe about the experience
The procedure
People describe fibrin glue as one of the least physically demanding fistula treatments:
- Short procedure under anaesthesia
- Waking up with minimal pain — very different from surgical fistula treatment
- Going home the same day
- Mild discomfort rather than significant post-surgical pain
Recovery
- Most people return to normal activities within a few days
- Some minor discharge from the external opening is common initially
- Pain is typically minimal compared to surgical alternatives
- The main restriction is avoiding straining
The waiting period
After the procedure, there is a period of uncertainty — similar to other fistula treatments but compressed. People describe checking for drainage or discharge as an indicator of whether the glue has held. The fistula either stays sealed or it reopens, and this usually becomes clear within the first few weeks.
When it does not work
People for whom fibrin glue was unsuccessful describe disappointment but not devastation. Because the procedure is minimally invasive, it does not feel like a major setback. The conversation shifts to alternative treatments, and people describe feeling that at least they tried the lowest-risk option first.
After the procedure
What to expect
- Days 1 to 3: Mild discomfort, possible minor discharge
- Weeks 1 to 2: Monitoring for signs that the glue is holding — reduced drainage is a positive sign
- Weeks 3 to 6: Gradual clarity on whether the treatment has been successful
- Follow-up appointment: Typically scheduled for a few weeks after the procedure
What to do
- Keep the area clean and dry
- Avoid straining — maintain good bowel management with fibre and hydration
- Watch for signs of infection — fever, increasing pain, significant discharge
- Attend follow-up appointments as scheduled
- Report any concerns to your surgical team
Context within fistula treatment
Fibrin glue sits alongside several other fistula treatment options. Understanding where it fits can help when discussing treatment plans:
- Fistulotomy — higher success rate, but carries sphincter risk for some fistula types
- Seton placement — manages drainage and prepares for definitive treatment
- Advancement flap — higher success rate than glue, moderate complexity
- LIFT procedure — moderate success rate with lower sphincter risk
- Fibrin glue — lowest intervention, lowest risk, lower success rate
The choice depends on fistula anatomy, previous treatments, sphincter function, and personal preference — a conversation best had with your colorectal team.