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Fistula plug: does it work

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

At a glance

The fistula plug is a sphincter-preserving approach to treating anal fistulas. It involves placing a biological scaffold into the fistula tract, which the body’s tissue then grows into, potentially closing the tunnel. The appeal is straightforward: no cutting, no wound, no sphincter damage.

The reality is more nuanced. Success rates are variable and generally lower than other fistula procedures. This guide examines what the plug is, how it works, and what the realistic expectations are.

How it works

The fistula plug is a cone-shaped device made from biological material — typically extracellular matrix derived from porcine (pig) intestinal submucosa. It is biocompatible and designed to be gradually absorbed by the body as new tissue grows in its place.

The procedure

The fistula tract is cleaned and prepared
The plug is drawn through the tract from the internal opening
The wide end of the cone sits at the internal opening; the narrow end at the external
The plug is secured with sutures
The body’s tissue gradually infiltrates the plug, ideally closing the tract

The procedure is typically done as a day case. Recovery is usually quick, with minimal pain.

Success rates — the honest picture

The fistula plug has had a mixed reception in the surgical literature:

Early studies reported success rates of 60 to 80 percent or higher
Larger, more recent studies tend to report success rates of 20 to 50 percent
The most common reason for failure is plug extrusion — the plug falling out before the tissue has had time to grow into it

The variability in reported success rates makes this one of the harder fistula procedures to evaluate. Your surgeon’s personal experience with the plug is likely the most useful data point.

Advantages

Sphincter preservation: no muscle is cut, so continence risk is effectively zero
Minimal wound: no open wound to manage
Quick recovery: most people return to normal activities within days
No bridge burning: if the plug fails, the fistula is in its original state and all other surgical options remain available
Repeatable: the procedure can theoretically be attempted more than once

Disadvantages

Variable success rates: lower than fistulotomy and often lower than LIFT or advancement flap
Plug extrusion: the most common complication — the plug falls out before healing
Cost: the biological material adds cost to the procedure
Not universally available: not all surgeons offer or recommend it
Limited to certain fistula types: not suitable for very short, very wide, or actively infected tracts

Who it may be suitable for

The fistula plug is most commonly considered for:

Transsphincteric fistulas where sphincter preservation is a priority
Patients who want to try a low-risk option before considering more involved surgery
Simple fistulas with a well-defined, clean tract
Situations where other sphincter-preserving options have been tried or are not suitable

The balanced view

The fistula plug is an option — not the primary recommendation for most fistulas, but a reasonable consideration in specific situations. Its appeal lies in its low-risk profile and the preservation of future options. Its limitation is a success rate that is lower and less predictable than other procedures.

Discussing the plug with your surgeon in the context of your specific fistula — its anatomy, its history, and your priorities — is the way to determine whether it is worth trying.

Common questions

What is a fistula plug?

A fistula plug is a cone-shaped device made from biological material (typically derived from pig intestinal tissue) that is placed into the fistula tract. It acts as a scaffold for the body's own tissue to grow into, potentially closing the fistula without cutting any sphincter muscle.

What is the success rate of a fistula plug?

Published success rates vary widely — from around 20 percent to over 80 percent depending on the study. More recent, larger studies tend to report lower success rates than earlier studies. Your surgeon can discuss how these numbers relate to your specific situation.

What are the advantages of a fistula plug?

The main advantage is sphincter preservation — no muscle is cut. Recovery is typically quick, there is no open wound, and the procedure does not limit future surgical options. If the plug fails, the fistula is in the same condition as before.

What happens if the plug falls out?

Plug extrusion (falling out) is one of the more common reasons for failure. If the plug is expelled — often during a bowel movement — the fistula tract remains open. Contact your surgical team if this happens. Further treatment options remain available.

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 fever after the procedure
Return of discharge or drainage
Signs of new abscess formation
The plug falling out — contact your surgical team

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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