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Anal Abscess and Fistula — Expert Diagnosis, Sphincter-Sparing Surgery

An anal abscess is one of the most acutely painful conditions in colorectal care. A fistula — the tunnel that often follows — is one of the most technically demanding to treat. Dr. Karmina Choi offers same-visit office drainage for abscesses and individualized sphincter-preserving surgical repair for fistulas, with a focus on protecting your continence for life.

ANORECTAL CONDITION

Expert Colorectal Care | Fort Lee, NJ

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Common questions

~50%

of anal abscesses develop into a fistula without definitive treatment

Zero

compromise on sphincter protection — continence preserved

Same

office visit drainage — no ER needed for most abscesses

Understanding the abscess-fistula connection

Anal abscess

An anal abscess is a collection of pus in the tissue surrounding the anus or rectum. It almost always begins with infection of one of the small anal glands that open into the anal canal — bacteria enter, the gland becomes blocked, and an abscess cavity forms in the surrounding soft tissue. The result is rapid-onset, severe pain and swelling that does not resolve without drainage. Antibiotics alone rarely clear the infection.

Anal fistula

An anal fistula is an abnormal tunnel lined with infected granulation tissue, connecting the original infected gland inside the anal canal to an opening on the skin around the anus. It forms when an abscess drains — either surgically or spontaneously — but the original infected gland source is not eliminated. The fistula tract persists, causing chronic drainage, recurrent infections, and discomfort until surgically treated.

Acute phase

Chronic phase

Think of them as a single disease in two stages. The abscess is the acute emergency — drain it quickly. The fistula is the chronic consequence — treat it definitively with the right surgical technique. Dr. Choi manages both stages with continuity of care.

Don't wait it out — and don't go straight to the ER. An anal abscess causes severe pain precisely because the infection is under pressure in enclosed tissue. It will not resolve on its own and antibiotics cannot drain the pus. Dr. Choi performs incision and drainage in the office under local anesthesia at your first visit — faster, more comfortable, and less costly than an emergency room. Call us as soon as symptoms begin.

Symptoms to recognize

Severe throbbing pain

Constant, intense pain near the anus — often worse with sitting, walking, or bowel movements. May come on over hours to days.

Swelling and redness

A visibly swollen, tender, warm lump near the anal opening — the abscess cavity under pressure beneath the skin.

Persistent drainage

After an abscess drains — surgically or on its own — ongoing discharge of pus, blood, or fluid from a small opening near the anus signals a fistula has formed.

Fever and malaise

Systemic signs that the infection is spreading — seek evaluation promptly if fever accompanies anal pain.

Skin irritation and moisture

Chronic fistula drainage causes persistent wetness and skin breakdown around the anal opening — uncomfortable and often embarrassing.

Recurring infections

Repeated abscesses in the same area — a cardinal sign that a fistula tract is present and reinfecting with each episode.

Low intersphincteric or low transphincteric fistula

The tract passes through little or no sphincter muscle. These fistulas are well-suited to FIPS — fistulotomy with immediate primary sphincteroplasty — achieving high cure rates while simultaneously reconstructing the sphincter for continence protection.

High transphincteric, suprasphincteric or extrasphincteric fistula

The tract passes through a significant portion of the sphincter complex. No single technique is right for every complex fistula — Dr. Choi selects among LIFT, BioHealx biologic repair, or endorectal advancement flap based on a careful individualized assessment of each patient's anatomy, fistula history, and prior treatment.

Perianal fistula in Crohn's disease

Fistulas in patients with Crohn's disease require a fundamentally different approach — aggressive surgery often worsens outcomes. Treatment focuses on long-term seton drainage for comfort and control, combined with medical management of the underlying Crohn's disease in coordination with a gastroenterologist.

Complex

Crohn's-related

Fistula types - complexity determines the right operation

The relationship of the fistula tract to the anal sphincter muscles is the critical factor in choosing the right surgical approach — it determines which technique cures the fistula while protecting continence. Accurate classification requires specialist examination, often with MRI or endoanal ultrasound.

Simple

Treatment - immediate relief and definitive repair

In-office incision and drainage - same-visit pain relief

When an abscess is active, drainage is the priority. Dr. Choi performs incision and drainage under local anesthesia right in her office — no hospital, no operating room, no ER wait. The procedure decompresses the abscess immediately, providing rapid relief. Most patients experience dramatic improvement within hours. Antibiotics are prescribed when surrounding cellulitis is present.

FIPS - fistulotomy with immediate primary sphincteroplasty

Dr. Choi's preferred technique for simple fistulas is FIPS. Rather than laying the tract open and leaving the sphincter divided, FIPS repairs the sphincter immediately in the same operation — restoring its structural integrity from the outset. This achieves high cure rates while actively protecting continence, and represents a meaningful advance over traditional fistulotomy alone.

LIFT, BioHealx or endorectal advancement flap - chosen for each patient

Complex fistulas — those passing through a significant portion of the sphincter — do not have a one-size-fits-all solution. Dr. Choi selects among three sphincter-sparing approaches based on a thorough individualized assessment:

Acute abscess | Office procedure

Complex fistula | Individualized

Simple fistula

LIFT (ligation of intersphincteric fistula tract) - divides and ligates the fistula tract within the intersphincteric plane, eliminating the fistula source without cutting through the sphincter itself.

BioHealx - uses a biologically derived matrix to support closure of the fistula tract. It is suited to appropriately selected primary complex fistulas where the anatomy and tissue environment make biologic repair a viable option.

Endorectal advancement flap - mobilizes healthy rectal tissue to close the internal fistula opening from within the rectum, preserving the sphincter entirely. Reserved for carefully selected complex cases where it offers the most favorable outcome.

The right choice depends on fistula anatomy, the status of surrounding tissue, prior surgical history, and other patient-specific factors — all evaluated in detail before a recommendation is made.

Seton placement - staged control for complex and Crohn's fistula

A seton is a soft surgical thread passed through the fistula tract and tied loosely. It allows controlled drainage, prevents abscess recurrence, and keeps the tract open while the optimal definitive approach is planned. In Crohn's disease, long-term seton placement is often the safest and most compassionate management strategy, maintaining quality of life without risking sphincter damage from aggressive surgery.

Staged / Crohn's

Dr. Choi's commitment to individualized, sphincter-preserving care

Prior surgical history factored into every decision

LIFT, BioHealx, or advancement flap chosen per patient anatomy

FIPS for simple fistulas — cure with immediate sphincter repair

Pre-operative MRI or endoanal ultrasound for complex cases

Second opinion welcomed for complex or recurrent cases

Crohn's fistulas managed conservatively first

No two fistulas are identical — and no single surgical technique is right for every patient. For simple fistulas, FIPS repairs the sphincter immediately at the time of fistula treatment. For complex fistulas, Dr. Choi carefully weighs LIFT, BioHealx, and endorectal advancement flap against each patient's specific anatomy, tissue quality, and surgical history before recommending an approach. This individualized decision-making — rather than defaulting to a single technique — is what distinguishes specialist colorectal care from general surgical management.

Why choose Dr. Karmina Choi?

Same-visit office drainage

Acute abscesses handled in the office under local anesthesia — no ER, no hospital admission needed for most patients.

FIPS for simple fistula

Dr. Choi doesn't just divide the sphincter — she repairs it immediately in the same operation, protecting your long-term continence.

Fellowship trained specialist

Complex fistulas require the expertise of a dedicated colorectal surgeon — not a general surgeon seeing these cases occasionally.

Individualized complex fistula care

LIFT, BioHealx, and advancement flap are each applied where they work best — not as a default, but as a tailored decision for your specific anatomy.

Urgent cases seen quickly

Anal abscesses are emergencies. We work to see patients in pain as promptly as possible.

Female physician option

A sensitive environment for a painful, personal condition — especially important for patients with complex or recurrent fistulas.

Common Questions

Can an anal abscess go away on its own?

Rarely, and not safely. Some abscesses spontaneously rupture through the skin, providing temporary relief — but without drainage and treatment of the source, the infection typically recurs and the risk of fistula formation remains high. Antibiotics alone cannot drain pus. Prompt surgical drainage is the correct treatment and prevents the condition from worsening or spreading.

Will I definitely develop a fistula after an abscess?

Not necessarily — but the risk is significant. Approximately 30–50% of anal abscesses lead to a fistula, particularly if the original infected gland source was not addressed at drainage. Dr. Choi carefully evaluates the abscess at the time of drainage for evidence of fistula involvement, and follows patients after drainage to monitor for fistula development early.

What makes FIPS different from a regular fistulotomy?

A traditional fistulotomy lays the fistula tract open and leaves the sphincter muscle divided, relying on secondary healing. FIPS — fistulotomy with immediate primary sphincteroplasty — goes further by repairing the divided sphincter in the same operation. This means the muscle is reconstructed right away rather than left divided, actively reducing the risk of continence problems. Dr. Choi uses this approach for simple fistulas where anatomy permits safe reconstruction.

How does Dr. Choi choose between LIFT, BioHealx, and advancement flap for complex fistulas?

The decision is made individually for each patient based on several factors: the fistula's relationship to the sphincter, the quality and condition of surrounding tissue, whether there has been prior fistula surgery, and the overall clinical picture. LIFT, BioHealx, and endorectal advancement flap each have specific indications where they are most likely to succeed — and Dr. Choi's recommendation reflects a careful evaluation of which approach is best suited to your situation, not a default to a single technique.

Will fistula surgery affect my bowel control?

Protecting continence is central to every surgical decision Dr. Choi makes. FIPS repairs the sphincter immediately for simple fistulas. For complex fistulas, the technique is chosen specifically based on which approach best preserves the sphincter for your anatomy and history. No approach is applied indiscriminately — and protecting your long-term quality of life is always the guiding priority.

I have Crohn's disease and a fistula. Can Dr. Choi help?

Yes. Perianal Crohn's fistulas require a tailored, conservative approach that prioritizes symptom control and quality of life over aggressive surgical cure. Dr. Choi has experience managing this challenging condition, typically with long-term seton drainage and close coordination with your gastroenterologist for medical optimization before any surgical intervention is considered.

Related conditions

Pilonidal cyst or sinus

Crohn's disease

In pain now? Don't wait — and don't go to the ER.

Same-visit office drainage is available for acute abscesses. For fistulas, Dr. Choi will map the anatomy and recommend the safest, most effective repair for your specific situation.

Book an Appointment

Call (551) 321-1388

1625 Anderson Avenue, Suite 203, Fort Lee, New Jersey 07024

This page is for informational purposes only and does not constitute medical advice. Individual results vary. Please consult Dr. Choi for a personalized evaluation and treatment plan.

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1625 Anderson Ave, Ste 203

Fort Lee, New Jersey 07024

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