Medicines and Products for Fistula

For an established fistula, medicines do not usually close the tunnel. They help with pain, infection and underlying disease. The definitive treatment is usually a procedure.

Medicines that may be used

• Pain relief, such as paracetamol, for comfort
• Antibiotics. Used when there is an abscess, cellulitis or a high risk of infection, usually alongside drainage. They do not cure a fistula.
• Stool softeners and fibre supplements, to prevent constipation and straining
• Topical comfort products, such as soothing creams, only as advised
• Medicines for the cause. For Crohn's disease, a gastroenterologist may use drugs such as immunomodulators or biologics, sometimes with seton drainage. For tuberculosis, a full anti-tuberculosis course is needed.

Procedures that treat fistula (surgical options)

• Fistulotomy. The tract is opened and left to heal. Often used for simple, low fistulas.
• Seton. A thread is placed in the tract to drain it, sometimes before definitive surgery or to protect the muscle.
• LIFT, advancement flap and similar sphincter-sparing operations for more complex tracts
• Fibrin glue, plugs and laser or stem-cell approaches, with lower or variable success rates

The choice depends on the tract and the risk to continence.