Is a Fistula Always Open? Understanding Recurrence and Healing

September 30, 2025 •

5 min read

A fistula is an abnormal tunnel or passage that connects two parts of the body that do not normally connect. While this tunnel may seem to close on its own, the answer to "Is a fistula always open?" is not a simple yes or no, as many can temporarily seal over before recurring with painful symptoms.

Quick Summary

A fistula is a tunnel that can temporarily close before re-emerging, leading to a cycle of recurring infections and discomfort. Effective treatment, often requiring medical intervention, is needed to address the underlying cause and ensure permanent healing.

Key Points

No, a fistula is not always open: The external opening of a fistula can temporarily close, leading to a false sense of healing.
Recurrence is common without treatment: When a fistula's external opening closes, the internal tract can become blocked, causing a painful abscess to form and eventually break through again.
A fistula rarely heals on its own: Proper medical intervention, most often surgery, is required for a permanent cure because the tract is lined with cells that prevent it from closing completely.
Underlying conditions play a role: Chronic inflammation, especially from conditions like Crohn's disease, increases the likelihood of a fistula developing and recurring.
Effective treatment addresses the entire tract: Depending on the type and complexity, treatments like seton placement, fibrin glue, or various surgical procedures (e.g., fistulotomy, LIFT) are used to clear or remove the entire fistula path.

The Misconception of a Fistula's Constant Openness

Many people mistakenly believe that if the symptoms of a fistula, such as drainage and pain, subside, the problem has resolved. However, a fistula is not always open. A fistula tract, especially in the anal region, is a path that has been established by an underlying infection or inflammation. When the pressure from the infected fluid decreases or drains, the external opening may appear to close. The deeper, internal tract remains, and it is lined with cells that prevent it from healing completely.

This temporary closure is a critical part of the cycle of fistula recurrence. The internal tract can get blocked again, causing a buildup of pus and forming a painful abscess. This abscess will eventually need to drain, often by reopening the old fistula tract or creating a new one. This recurring cycle of pain, swelling, drainage, and temporary relief is a hallmark of a chronic, untreated fistula. It highlights the importance of seeking proper medical evaluation, as a fistula rarely heals on its own and requires targeted treatment to resolve permanently.

Types of Fistulas and Their Openings

Fistulas can form anywhere in the body, connecting various organs, blood vessels, or surfaces. The nature of the opening often depends on the type and location of the fistula.

Anal Fistulas

An anal, or perianal, fistula is the most common type, typically connecting the anal canal to the skin near the anus. The external opening may drain pus, blood, or fecal matter and is often surrounded by irritated skin. In many cases, the opening is consistently active and draining, but as mentioned, it can appear to close intermittently.

Enterocutaneous Fistulas

This type of fistula connects a part of the intestine to the skin. These are often consistently open and drain intestinal contents, leading to significant skin irritation and fluid loss. They are frequently a complication of abdominal surgery or underlying conditions like Crohn's disease.

Arteriovenous (AV) Fistulas

An AV fistula connects an artery and a vein. Some form due to injury, but they are also surgically created for kidney dialysis to provide easy, high-volume access to the bloodstream. A dialysis fistula is deliberately kept open and maintained for long-term use.

Vaginal Fistulas

These are abnormal openings that form in the vaginal wall, connecting it to nearby organs like the rectum or bladder. They may result from childbirth, surgery, or inflammation and can cause leakage of urine or stool from the vagina. Depending on the cause and location, the opening and its associated symptoms can be continuous.

The Cycle of Temporary Closure and Recurrence

The persistence of a fistula, even when the external opening seems to close, is linked to the chronic inflammatory process that created the tract in the first place. This is especially true for those with conditions like inflammatory bowel disease (IBD).

The Recurrence Cycle

Infection and Abscess Formation: An anal gland becomes blocked and infected, leading to an abscess, which is a collection of pus.
Drainage and Tract Formation: The abscess either spontaneously ruptures or is surgically drained, creating a tunnel (the fistula tract) to the skin.
Temporary Closure: The external opening may scab over or heal superficially, and symptoms like drainage and pain temporarily subside.
Re-infection and Abscess Recurrence: The internal tract remains and becomes blocked again, trapping infected fluid and causing a new abscess to form.
Re-opening and Continued Cycle: The pressure from the new abscess causes the tract to reopen, repeating the cycle of swelling and drainage.

This cycle can continue indefinitely without proper medical treatment that addresses the entire tract, not just the external opening. Medications can help manage underlying inflammatory conditions, but surgery is typically needed to permanently eliminate the tract.

Comparison: Open vs. Temporarily Closed Fistulas


Feature	Open Fistula	Temporarily Closed Fistula
Symptom Profile	Consistent drainage of pus, blood, or fluid; constant skin irritation; persistent pain.	Intermittent symptoms; periods of reduced or no drainage, followed by a sudden increase in pain and swelling.
Appearance	Visible external opening, often red and inflamed, with active drainage.	External opening may appear healed or as a small, less noticeable scar.
Patient Experience	Daily management of drainage, discomfort, and hygiene issues.	False sense of healing; sudden, intense pain when the tract blocks and an abscess forms.
Diagnosis	Easily diagnosed via physical exam due to visible opening and drainage.	May be more difficult to detect on initial exam; often requires imaging like MRI or ultrasound to confirm presence and full anatomy.
Risks	Chronic infection; skin damage; potential for tract extension.	Acute abscess formation; potential for sepsis if untreated; difficult diagnosis.

Comprehensive Treatment for Fistulas

A fistula will not permanently heal by itself. The most effective approach involves medical intervention to address the entire tract and the underlying cause. Treatment depends on the fistula's complexity and location.

Non-Surgical Options

Seton Placement: A surgical thread (seton) is placed through the tract to keep it open and allow for continuous drainage. This can help the area "cool off" and prepare for future surgery. It may also be a long-term solution for complex cases.
Fibrin Glue or Collagen Plug: The fistula tract is cleaned and sealed with a biological adhesive or a cone-shaped plug. While less effective than surgery, it's a minimally invasive option for simpler fistulas.
Medication: For fistulas caused by Crohn's disease, anti-inflammatory medications and biologics are used to manage the underlying condition, which can help promote fistula healing.

Surgical Options

Fistulotomy: A common and effective procedure for simple fistulas where the surgeon cuts open the entire tract to allow it to heal from the inside out.
LIFT Procedure: Ligation of the Intersphincteric Fistula Tract is a sphincter-preserving technique where the fistula is tied off and cut without disrupting the muscle, reducing the risk of incontinence.
Advancement Flap: A flap of healthy tissue is used to cover the internal opening after the tract is cleaned and removed. This procedure is also designed to spare the sphincter muscles.

Conclusion: The Need for Medical Expertise

It is clear that a fistula is not always consistently open, and periods of symptom reduction can be misleading. A fistula is a chronic condition that requires proper diagnosis and treatment to ensure permanent closure and prevent recurrence. Ignoring a fistula, even if it appears to close, risks repeated abscess formation, increasing pain, and potential complications like sepsis. Consulting a specialist, such as a colorectal surgeon, is the only way to get an accurate diagnosis and a tailored treatment plan that addresses the entire fistula tract, rather than just the symptoms.

For more detailed information on treatments and recovery, resources from authoritative sources like the Cleveland Clinic are available: Anal Fistula: What It Is, Symptoms, Treatment & Surgery.

Frequently Asked Questions

A fistula often seems to heal because its external opening temporarily closes or scabs over when the underlying abscess has drained. However, the internal tunnel remains, and it can become blocked again, leading to another abscess and causing the fistula to reopen.

It is extremely rare for a fistula, particularly an anal fistula, to heal permanently on its own without medical intervention. The tract is typically lined with cells that prevent full closure, leading to a cycle of recurring infection.

Signs of a temporarily closed fistula include a reduction or cessation of visible drainage and pain. However, this relief is often followed by a sudden increase in localized pain and swelling as an abscess re-forms.

Diagnosing a temporarily closed fistula can be more challenging than an open one. A doctor may use a physical exam to feel the cord-like tract under the skin, and may also order advanced imaging like an MRI or endoanal ultrasound to visualize the complete path.

If a fistula's opening becomes blocked, the pus and infected fluid can build up inside the tract, leading to a new, painful abscess. This can increase the risk of more serious infections, including sepsis.

For recurring fistulas, treatments often include surgical options like a fistulotomy for simpler tracts or seton placement, the LIFT procedure, or advancement flaps for more complex ones. In some cases, managing underlying conditions like Crohn's disease with medication is also necessary.

No, it is not safe to ignore a fistula just because it isn't currently draining. The underlying problem remains and will likely cause recurring abscesses. Untreated chronic fistulas can also lead to complications like tract extension or, in rare cases, an increased risk of cancer.