An anal fistula can be simple or complex. One sign of a complex fistula is having more than one external opening near the anus. This can worry patients a lot. Many people search for a trusted Fistula Specialist in Pune once they notice more than one opening or wound near the anal area.
In this blog, we will explain what multiple external openings mean, why they happen, and what treatment options are available. This blog is written with guidance from Dr. Samrat Jankar, a well-known Colorectal Surgeon in Pune with over 17+ years of experience and more than 5,000 fistula surgeries to his credit.
What Is an Anal Fistula?
An anal fistula is an abnormal tunnel. It forms between the inside of the anal canal and the skin outside. It usually develops after an anal abscess (a pus-filled infection) does not heal properly.
A fistula has two parts:
- Internal opening – inside the anal canal
- External opening – on the skin outside, near the anus
Most simple fistulas have one internal and one external opening. But some fistulas are more complicated.
What Are External Openings in a Fistula?
The external opening is the point where the fistula tract comes out on the skin. It often looks like a small hole or a red bump. It may discharge pus, blood, or fluid on and off.
In simple cases, there is only one external opening. But in complex cases, a patient may have two, three, or even more openings around the anus. This condition needs careful evaluation by an expert.
Why Do Multiple External Openings Happen?
There are several reasons why a fistula can develop more than one external opening:
- Delayed treatment: If a fistula is left untreated for a long time, the infection can spread further under the skin.
- Recurrent infections: Repeated abscess formation can create new tracts and new openings.
- Underlying conditions: Diseases like Crohn’s disease or tuberculosis can cause complex fistula patterns.
- Previous incomplete surgery: If earlier surgery did not remove the full tract, the infection may return through a new path.
- Horseshoe fistula: This type wraps around the anal canal like a horseshoe. It often has two or more external openings.
Does Multiple Openings Mean the Fistula Is More Serious?
Yes, in most cases. Multiple external openings usually mean the fistula tract is more complex. This type of fistula is called a complex fistula or horseshoe fistula, depending on its shape and spread.
Complex fistulas need more careful planning before surgery. A general fistulotomy may not be enough. That is why it is important to consult an experienced Fistula Specialist who understands complex anal fistula patterns well.
Common Causes of Multiple External Openings in Anal Fistula:
Some common causes include:
- Recurrent anal abscess – repeated infections create new tracts
- Delayed treatment – untreated fistulas spread over time
- Crohn’s disease – can cause multiple, complex fistula tracts
- Tuberculosis – TB fistulas often have unusual branching
- Previous incomplete surgery – if the main tract was missed earlier
Understanding the exact cause helps the doctor plan the right treatment.
Symptoms of Multiple External Openings in Anal Fistula:
Patients with multiple external openings often notice:
- More than one wound or opening near the anus
- Constant or on-and-off discharge of pus or blood
- Pain while sitting or passing stool
- Swelling around the anal area
- Fever during active infection
- Skin irritation due to constant discharge
If you notice any of these signs, it is best to consult a specialist early. Delay can make the fistula more complex.
How Is a Complex Fistula Diagnosed?
Correct diagnosis is very important before planning treatment. Doctors usually use:
- Clinical examination – checking the openings and tracts
- MRI Fistulogram – gives a detailed picture of the tract and its branches
- Endoanal ultrasound – helps locate the internal opening
- Examination under anaesthesia (EUA) – used during surgery for confirmation
Accurate mapping of the tract helps avoid repeat surgeries and improves success rates.
Treatment Options for Multiple External Openings:
Treatment depends on how complex the fistula is. At Kaizen Fistula Care, Dr. Samrat Jankar offers a range of advanced options based on each patient’s condition.
- Fistulotomy Treatment: For simple, low-lying tracts, Fistulotomy Treatment in Pune is often enough. In this procedure, the tract is opened up and allowed to heal naturally. It works well when the tract does not involve too much of the sphincter muscle.
- Advanced Flap or LIFT Procedures: For complex or high fistulas, sphincter-saving surgery is important. Advanced Flap or LIFT Procedures help remove the tract while protecting the anal muscles. This lowers the risk of incontinence. Dr. Jankar has special training in these techniques and has performed thousands of such surgeries.
- Fistula Plug Treatment: In select cases, a biodegradable plug can seal the tract from inside. Fistula Plug Treatment in Pune is a good option for patients who want a less invasive approach with quicker recovery.
- Fistula Plugs or Biological Glue, Seton Placement: For very complex tracts with multiple openings, doctors may first place a seton. Fistula Plugs or Biological Glue, Seton Placement helps drain infection and prepare the area for final surgery. This staged approach often gives better long-term results in horseshoe or multi-tract fistulas.
- Laser Fistula Treatment: Laser technology is now widely used for treating fistula tracts with minimal tissue damage. It offers shorter recovery time and less post-operative pain compared to traditional open surgery.
Recovery After Fistula Surgery:
Recovery depends on the procedure chosen. In general:
- Laser-based and minimally invasive procedures allow faster recovery
- Most patients can resume light activities within a few days
- Proper hygiene and follow-up dressing are important
- Regular follow-up visits help track healing
- A high-fibre diet and good hydration support faster recovery
Following the doctor’s advice closely reduces the chance of recurrence.
When Should You See a Colorectal Surgeon?
You should not delay a visit to a Colorectal Surgeon in Pune if you notice:
- More than one opening near the anus
- Repeated pus discharge
- Recurring abscess in the same area
- Pain that does not improve with home care
- A previous fistula surgery that has not healed fully
Early consultation with an expert like Dr. Samrat Jankar can prevent the fistula from becoming more complicated.
About Dr. Samrat Jankar – The Expert Behind Your Treatment:
Complex fistula cases need careful planning. Wrong treatment can cause the fistula to come back. In rare cases, it can even affect bowel control. This is why expertise matters so much. Here is why patients across Pune trust Dr. Samrat Jankar for complex fistula care.
Experience
Expertise
Authoritativeness
Trustworthiness
Experience
Dr. Samrat Jankar has 17+ years of experience in GI and colorectal surgery. He has done more than 5,000 fistula surgeries and 3,000+ laparoscopic surgeries. He has treated almost every type of fistula, including difficult multi-tract and horseshoe fistulas.
Expertise
Dr. Samrat Jankar completed his MBBS from Grant Medical College, Mumbai, in 2007. He did his MS in General Surgery in 2012, and DNB in Surgical Gastroenterology in 2017. He also holds an FMAS fellowship and trained at GEM Hospital, a top centre for colorectal care in India. He also developed the PILTEC technique. It is known for high success rates in tough and repeat fistula cases.
Authoritativeness
Dr. Samrat Jankar work has been recognised at many national and international events. He won First Prize at FISTULACON 2021 for his LASER LIFT procedure video. He also won awards at AMASICON and ACRISICON for his surgical videos and research papers. He received the Gold Medal Fellowship from ACRSI for topping his colorectal surgery fellowship.
Trustworthiness
Dr. Samrat Jankar was named Best Doctor in Pune (2025) by Outlook Magazine. He is the Director and Head of GI Surgery at Kaizen Gastro Care. Patients from Pimpri-Chinchwad, Wakad, Baner, Aundh, and Hinjewadi trust him for honest advice and caring treatment.
At Kaizen Fistula Care, every patient gets a treatment plan made for their needs. We use modern equipment and ethical care. Our aim is always complete healing with less discomfort.
Conclusion:
Multiple external openings in a fistula simply mean the condition is more complex than a simple fistula. It needs careful diagnosis and expert surgical planning. Delaying treatment can make things worse. Seeking help early gives the best chance of complete recovery.
If you or your loved one is dealing with a complex fistula, do not wait. Book a consultation with Dr. Samrat Jankar at Kaizen Fistula Care today.
- Kaizen Fistula Care Shop no. 208/209, Oriana Crest Building, Datta Mandir Road, Wakad, Pune, Maharashtra 411057
- Phone: 79041 39064
- Email: kaizenfistulacare@gmail.com
Frequently Asked Questions (FAQs):
Yes. Some complex fistulas can have three or more external openings due to branching tracts.
Most complex fistulas do require surgical treatment, as they rarely heal on their own.
It depends on the tract pattern. Options like LIFT, FiLaC, VAAFT, or PILTEC may be suggested after proper evaluation.
Yes. Dr. Samrat Jankar has performed over 5,000 fistula surgeries and developed the PILTEC technique specifically for complex and recurrent cases.
You can call 79041 39064 or visit Kaizen Gastro Care, Shop no. 208/209, Oriana Crest building, Datta Mandir Rd, Wakad, Pune, Maharashtra 411057. Clinic hours are Monday to Saturday, 8 AM to 9 PM.
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