A fistula is a condition that many people ignore in its early stages because the symptoms may seem minor or similar to a simple infection. However, when left untreated, it can become chronic, painful, and recurrent.
Early recognition plays a crucial role in preventing repeated infections and complicated surgery. Understanding the different types of fistula helps patients seek timely medical advice and avoid long-term discomfort, as shared by Dr Amita Jain, a Senior General and Laparoscopic Surgeon and one of the most experienced fistula surgeons in Delhi and India.
What Is a Fistula?
A fistula is an abnormal tunnel-like connection that develops between two body structures that normally do not connect. In the anorectal region, it usually forms after a gland infection leads to an abscess. When the abscess drains but does not heal completely, a small tract remains, connecting the internal passage to the outer skin.
This condition rarely heals permanently with medicines alone. In most cases, proper surgical treatment is required to remove the tract and prevent recurrence.
Types of Fistula
Fistulas in this region are classified according to how they pass in relation to the sphincter muscles, which are responsible for controlling bowel movements. The exact path of the tract determines the complexity of treatment, explains anorectal specialist Dr Amita Jain.
Intersphincteric Fistula
This is the most common type. The tract runs between the inner and outer sphincter muscles and opens near the surrounding skin.
Because it remains confined between muscle layers, it is usually simpler to treat compared to other types. Patients often notice persistent pain, mild swelling, or intermittent discharge from a small opening near the affected area. Recurrent abscess formation is common if not treated early.
Transsphincteric Fistula
In this type, the tract passes through both sphincter muscles before reaching the outer skin.
Since more muscle tissue is involved, treatment becomes slightly more complex. Symptoms may include deeper pain, repeated swelling, discharge, and discomfort while sitting or during bowel movements. If the infection worsens, fever may develop. Early diagnosis is important to prevent muscle damage during treatment.
Suprasphincteric Fistula
This variety begins between the sphincter muscles but extends upward above the outer muscle before curving downward to the skin surface.
It is less common and generally more complicated. Pain may feel deeper and more intense. Swelling might not always be clearly visible externally. Repeated infections in the same region are a warning sign. Imaging studies are often required to accurately identify the course of this tract before surgery.
Extrasphincteric Fistula
This is the rarest and most complex type. The tract starts higher up in the rectal region and extends directly to the outer skin without passing through the sphincter muscles in the usual way.
It may develop due to trauma, inflammatory bowel conditions such as Crohn’s disease, or previous pelvic surgeries. Symptoms can include persistent discharge, deep pelvic pain, and an external opening located farther from the usual area. Management typically requires specialised surgical expertise because of its complex path.
How to Identify a Fistula Early?
Early signs should never be ignored. Common warning symptoms include persistent pain in the lower rectal area, recurrent abscess formation, continuous or intermittent purulent discharge, unhealing skin irritation, and occasional blood-stained discharge.
A key indicator is recurrence. If swelling and infection return in the same location even after treatment, a fistula may be present.
Medical evaluation generally includes a physical examination and may involve imaging tests such as an MRI to map the tract accurately.
When to Seek Medical Attention?
Consult a surgeon if pain becomes severe, fever develops, discharge continues despite medication, or infections keep recurring. Delay in treatment can increase complexity and prolong recovery.
A fistula is a structured abnormal tract that develops after infection and rarely resolves without proper treatment. Intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric types differ based on how they relate to the sphincter muscles. Recognising early symptoms such as persistent discharge, pain, and recurrent swelling allows for timely intervention and better outcomes.
Prompt medical care reduces complications, prevents recurrence, and ensures safer treatment with faster recovery.
Dr Amita Jain, one of the most experienced General and Laparoscopic Surgeons in Delhi, is widely recognised for her expertise in hernia, piles, gallbladder, fissure, and fistula surgeries. With an outstanding career spanning over 29 years, Dr Amita Jain has earned her place among the top General and Laparoscopic surgeons in Delhi and India, known for her precision, compassion, and consistent surgical excellence. She was the Professor of Surgery at the Army College of Medical Sciences and Base Hospital, Delhi Cantt. In 1994, she was commissioned as a surgeon under the United Nations Mission in Congo.
Dr Amita Jain currently serves as the Head of Department, Laparoscopic and Trauma Surgery at Artemis Lite Hospital (Delhi), Senior General and Laparoscopic Surgeon at Rosewalk – Luxury Maternity Hospital in Delhi and Rainbow Children Hospitals (at Malviya Nagar and Panchsheel Park, New Delhi)
Dr Amita Jain has successfully performed a wide range of complex general surgeries, including both open and minimally invasive procedures, with a strong focus on trauma care, onco-surgical techniques, and reconstructive surgeries. Her medical specialisation includes – Gallbladder surgeries, appendix removal surgeries, hernia repair surgeries, Pilonidal Sinus treatments, varicose vein and piles surgeries, fistula surgeries and fissure surgeries.
Dr Amita Jain has also authored some of the key medical journals and publications, like ResearchGate, IJSR
Note: the articles are written with Dr Amita Jain’s professional insights and referring to her medical publications.