Can My Anal Fistula Be Glued or Plugged Shut?

It is completely understandable to want a treatment for your anal fistula that avoids cutting. Fibrin glue and biological anal fistula plugs are minimally invasive options designed to seal the fistula tract without dividing any muscle ^[1]. While these treatments are generally very safe and protect your bowel control, their long-term success rates are significantly lower than traditional surgeries ^[2]. Because they frequently fail to heal the fistula or simply fall out, they are not always the first choice for treatment ^[3].

What Are Fibrin Glues and Biological Plugs?

Both of these treatments aim to heal the fistula by filling the tunnel rather than cutting it open. Because they do not cut the anal sphincter muscles, they are known as sphincter-sparing procedures ^[1].

• Fibrin Glue: This is a medical sealant, often made from proteins found in human blood. The doctor injects the liquid glue into the fistula tract. Once inside, it sets and forms a clot, which seals the tunnel and provides a scaffold for your body’s own tissue to grow and heal the area ^[1].
• Biological Plugs: An anal fistula plug is a cone-shaped piece of tissue—often made from animal collagen or other biological materials—that is pushed into the fistula tract ^[4]. The plug is stitched in place to block the tunnel. Like the glue, it is designed to encourage your body’s cells to grow into it and eventually replace the plug with healthy tissue ^[4].

The Two-Step Process: It is important to know that getting a plug or glue is usually a two-step process. To ensure the treatment has the best chance of working, your surgeon will typically place a draining seton (a thin surgical thread) in the fistula for several weeks or months beforehand ^[5]. This clears out any infection (sepsis) and prepares the tract before the plug or glue is inserted.

Success Rates: Why Aren’t They Always Used?

The appeal of a simple plug or glue is obvious, but their success rates explain why doctors don’t use them for everyone. For traditional surgery (called a fistulotomy, where the tract is cut open), success rates can be as high as 98% to 100% for simple fistulas ^[6][7].

In contrast, biological plugs and fibrin glues have much lower and more unpredictable success rates. Studies show that anal fistula plugs successfully heal the fistula about 50% to 60% of the time, though some studies report rates up to 83% in highly selected cases ^[2][4]. Fibrin glue also has highly variable success rates—often ranging from 40% to 60%, with some studies showing even lower long-term success, resulting in higher recurrence rates compared to traditional surgery ^[8][9].

These minimally invasive treatments often fail for a few key reasons:

• Extrusion (Falling Out): Because the anal canal is subject to pressure during bowel movements, plugs and glue can be pushed out of the body before the area has time to heal ^[3]. Even though a plug is stitched in place, the stitches can dissolve too quickly or tear through the soft, inflamed tissue. To help prevent this, doctors strongly recommend taking stool softeners and drinking plenty of water so you do not have to strain during bowel movements.
• Persistent Infection: If any bacteria or infection remains in the tract before it is sealed, the fistula will not heal and the plug or glue will fail ^[5]. This can sometimes lead to a new abscess if the outside of the tract seals while the inside is still infected.
• Fistula Complexity: These methods are often less successful in complex fistulas (those that are high up, involve a lot of muscle, or have multiple branching tunnels) ^[10].

Additionally, while these options are designed to preserve muscle function, a few studies have noted a potential minor decline in anal function for certain patients after plug placement ^[11][12]. This generally means experiencing minor issues like occasionally leaking gas or slight seepage, rather than a full loss of stool control. It is important to remember that these changes are often related to the underlying disease or prior surgeries, and plugs/glue are still vastly safer for preserving your bowel control than cutting the muscle.

When Might Your Doctor Suggest Them?

Because fistulotomy has such a high success rate, it is usually the first choice for a “simple” fistula that involves very little sphincter muscle ^[6].

However, if you have a complex fistula where cutting the tract would risk damaging a large portion of your sphincter muscle—leading to fecal incontinence (loss of bowel control)—your surgeon may recommend trying a plug or glue ^[13]. In these cases, the lower success rate is a calculated trade-off for the safety of preserving your muscle ^[13][1]. Even if a plug or glue fails, it rarely limits your future options, meaning you can still undergo other surgical treatments afterward ^[10].