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Fistula after childbirth

Published 13 March 2026 ·Last reviewed 13 March 2026 by the editorial team ·How we create our content

At a glance

Anal fistulas after childbirth are uncommon but well recognised. They can develop from perineal trauma during delivery or from a postnatal abscess. This guide covers how they present, the treatment considerations for new parents, and what to expect.

How it happens

Perineal injury pathway

During vaginal delivery, the perineum — the tissue between the vaginal opening and the anus — stretches significantly. In some cases, tearing extends into or near the anal area. A third-degree or fourth-degree tear involves the anal sphincter, and if healing is incomplete, a fistula tract can develop.

Abscess pathway

Perianal abscesses can develop in the postnatal period. These may be related to local trauma, changes in immune function, or the physical stresses of delivery. If an abscess drains spontaneously or is surgically drained, a fistula tract may form between the abscess cavity and the surface.

How it presents

People describe becoming aware of a fistula in the postnatal period through:

Persistent discharge — pus or mucus from a small opening near the anus
A lump or swelling that does not resolve — may be an abscess or the external opening of a fistula
Pain — particularly if an abscess is present
Symptoms that are different from normal postnatal recovery — something that does not seem right

The challenge is that the postnatal period involves many bodily changes, and symptoms near the perineum can be difficult to distinguish from normal healing. If something does not seem right, it is worth getting checked.

Treatment considerations

Timing

Treatment (usually surgery) does not need to happen immediately for a stable fistula. The timing can often be adjusted to allow for:

Initial recovery from childbirth
Establishment of breastfeeding if applicable
Practical arrangements for childcare during surgery and recovery

An abscess, however, needs prompt treatment — it will not wait.

Breastfeeding

If surgery is needed while breastfeeding, discuss medication safety with both your surgeon and your midwife or lactation consultant. Anaesthesia and post-surgical pain relief can usually be managed with breastfeeding-compatible options, but this needs advance planning.

Recovery with a newborn

Recovery from fistula surgery typically requires rest, sitz baths, and wound care. With a newborn, this is logistically challenging. People describe:

Needing a partner, family member, or friend to handle the baby during the first few days
Combining wound care with feeds and nappy changes in a practical (if unglamorous) routine
Accepting that recovery will be messier and less restful than it would be without a baby
Asking for and accepting help

Emotional impact

A fistula on top of postnatal recovery adds significant emotional burden. People describe:

Feeling that their body has failed them
Guilt about not being able to care for their baby at full capacity
Frustration at dealing with a surgical condition during what should be a bonding period
Isolation — fistulas are private conditions, and the postnatal period already reduces social support

These feelings are valid and common. They do not mean you are not coping — they mean you are dealing with a lot.

Common questions

How does childbirth cause an anal fistula?

An anal fistula after childbirth typically develops through one of two pathways: a perineal tear during delivery extends into the anal area and does not heal properly, or a perianal abscess develops in the postpartum period (possibly related to immune changes or local trauma) and creates a fistula tract. Both pathways are uncommon but well recognised.

Is treatment different when you are caring for a newborn?

The treatment itself — typically surgery — is the same. However, the timing and practical considerations differ. Surgery needs to be balanced with the demands of caring for a newborn. Recovery requires rest, which is difficult with a baby. Breastfeeding may affect medication choices. These factors need discussion with both your surgeon and your maternity care provider.

Can a fistula from childbirth heal on its own?

Most anal fistulas do not heal without surgical treatment. In rare cases, a very simple, superficial tract may close, but the general clinical expectation is that surgical intervention will be needed. The timing of surgery can often be adjusted to suit the postnatal period, but the need for treatment should be assessed by a specialist.

How soon after childbirth should I seek treatment?

If you notice persistent discharge, pain, or a lump near the anus that is not resolving in the postnatal period, see your GP or midwife promptly. An abscess needs urgent treatment. A fistula is less urgent but should be assessed by a specialist. The sooner it is identified, the sooner you can plan treatment at a time that works for your situation.

When to seek care Heavy bleeding or feeling faint? Get emergency help now. Emergency: 911

Not sure how urgent it is? Get help today.

Emergency
Heavy bleeding, black tarry stools, feeling faint, severe pain or trouble breathing.

Call 911 or go to the ER.
Today
Fever, pain getting worse, a hot swollen lump, or trouble passing urine.

Call your doctor or go to urgent care.
Soon
Bleeding or bowel changes nobody has checked, or anything lasting 3 weeks.

Book a doctor’s appointment.

Feeling overwhelmed? Call or text 988, any time.

See all the signs

For this topic, get medical advice if you notice:

Increasing pain, swelling, or redness near the anus
Fever or chills
Pus or foul-smelling discharge
New or worsening symptoms after surgery

Recording how you feel is not the same as being checked. These are the signs that need a doctor’s attention.

Call 911 or go to the emergency room now if you have:

bleeding that will not stop, a lot of blood (the toilet water turns red, or you pass large clots), or any bleeding with feeling faint or dizzy
fainting, a racing heart or trouble breathing
confusion or slurred speech, extreme shivering, no urine in a day, or blotchy skin
sudden severe belly pain, or a swollen, hard belly with vomiting or not passing stool or gas
you cannot pass urine at all, or your bladder feels full and painful and you can’t empty it
redness, swelling or severe pain spreading quickly around your anus, genitals or groin, especially with a fever or feeling very ill
a fever with a painful swelling near your anus if you have diabetes or a weakened immune system (for example, from chemotherapy or transplant medicines)
black, tarry stools

Call your doctor or go to urgent care today (or the ER if you can’t be seen today) if you have:

a temperature of 100.4°F (38°C) or higher, chills, vomiting, or feeling generally unwell
pain that is getting worse over days, or severe pain that stops you sitting or sleeping
a hot, swollen or very tender lump near your anus or at the top of the crease between your buttocks, or foul-smelling discharge
trouble urinating
bleeding that is getting heavier or more frequent, or blood mixed into your stool
feeling much more tired than usual, looking pale, or getting out of breath more easily than you used to
not passing stool for several days, or new belly pain

Make an appointment with your doctor if:

you have never had these symptoms checked by a doctor or nurse — whatever your age
you have had rectal bleeding for more than 3 weeks
your bowel movements have been looser, thinner or more frequent than usual for 3 weeks or more, or you have lost weight without trying
symptoms have not settled after a week or so, or keep coming back
you notice a new lump near your anus, between your buttocks or in your belly, or an itch or discharge that does not clear
you have new leakage or trouble controlling your bowels
you are 45 or over, or have a family history of bowel cancer or inflammatory bowel disease, and any of these symptoms are new for you

If you are unsure, it is always reasonable to ask. If things feel overwhelming, call or text 988 (Suicide & Crisis Lifeline) or chat at 988lifeline.org, any time. If you don’t feel safe, call 911.

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Related symptoms

Bleeding Pain during bowel movements Swelling or lump Discharge

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Symptoms that come and go? Keep track, day by day.

For hemorrhoids, fissures, fistulas and other anal and rectal problems. A short, discreet email asks how things have been, and saves each answer, so you can look back at every flare and every good week in your own words. If you haven’t had your symptoms checked, see your doctor first.

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Each Sunday, a link to your week, ready for your next appointment.

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Related guides

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Recovery after fistulotomy

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Perianal abscess: patterns and care

Learn what a perianal abscess is, what people commonly experience, why it typically needs drainage, and when to seek urgent medical care.

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Discharge after fistula surgery

The different types of wound discharge people experience after fistula surgery — what is expected at each stage, what changes to watch for.

Pus after fistula surgery: healing?

What people describe about discharge after fistula surgery — the difference between normal healing drainage and signs of infection.

Fissure after childbirth

A composite experience of developing an anal fissure after giving birth — the shock, the struggle of caring for a newborn while in pain.

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