Simple fistulas: fistulotomy
The fistula tract is laid open so it heals from the inside.
Reviewed by Dr. Patricia Tejedor · Updated: October 23, 2026
Coloproctology Madrid
Anal fistula and abscess: treatment in Madrid
An abscess is drained without waiting. A fistula is studied carefully before surgery, so it can be cured without damaging the sphincters.
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Clinical summary
An anal abscess causes severe pain, swelling and sometimes fever, and must be drained without delay. An anal fistula shows as an opening near the anus with repeated discharge of pus. Simple fistulas are treated with fistulotomy; complex ones with a seton or other sphincter-preserving techniques, such as LIFT or advancement flaps.
Anal abscess
An abscess is a collection of pus near the anus. It usually causes severe anal pain and swelling and, sometimes, fever.
It must be drained without delay, usually in the operating room. If you have severe pain, fever or the area gets worse quickly, you should be seen urgently.
Anal fistula
A fistula is a small tract that connects the inside of the anal canal with the skin around it. It shows as an opening near the anus with repeated discharge of pus or fluid, episodes of swelling and discomfort that keeps coming back.
How we study the fistula
Before surgery we need to know the path of the fistula and how it relates to the sphincters, the muscles that control continence. We do this with examination and, in complex cases, with endoanal ultrasound or MRI.
This study is what lets us choose the right technique and know whether the fistula can be laid open safely or whether a sphincter-preserving technique is needed.
Surgical treatment
Surgery is tailored to the type of fistula.
Complex fistulas: seton
A thread placed through the tract. It is usually part of a staged treatment for fistulas that cross a significant part of the sphincter.
Sphincter-preserving techniques
LIFT and advancement flaps. They are used in complex fistulas to cure them without cutting the sphincter muscle.
The aim is the same in every case: control the infection, cure the fistula and protect continence.
Our team
Who will see you
Dr. Patricia Tejedor
Colorectal surgeon
View doctor: Dr. Patricia TejedorFellow of the European Board of Surgery in Coloproctology (FEBS). She sees patients at Hospital Memorial Publio Cordón, in Pozuelo de Alarcón (Madrid).
Frequently asked questions about anal fistula and abscess
Can an anal abscess be cured with antibiotics?
It does not usually clear up with antibiotics. It usually has to be drained in the operating room, and without delay. If you have severe anal pain, swelling or fever, seek urgent care.
What is the difference between an abscess and a fistula?
An abscess is a collection of pus that causes severe pain and swelling. A fistula is a tract between the anal canal and the skin that repeatedly discharges pus or fluid, with discomfort that keeps returning.
Do I need an MRI before surgery?
For simple fistulas an examination is usually enough. In complex ones we study the tract and its relation to the sphincters with endoanal ultrasound or MRI.
Can the operation affect continence?
Protecting continence is one of the aims of surgery. That is why we study the tract first: in complex fistulas we use a seton or sphincter-preserving techniques, such as LIFT or advancement flaps.
Do I need to stay in hospital? How long is recovery?
In principle, no hospital stay is needed: surgery is done under spinal anesthesia (similar to an epidural) or general anesthesia, and the patient goes home the same day. After a fistulotomy we recommend about 3 to 5 days at home before going back to work, avoiding strenuous exercise for a while and keeping the wound dry at all times.
What is the LIFT technique?
It is one of the techniques we use in complex fistulas to cure them without cutting the sphincter muscle. The other option of this kind is the advancement flap.
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