Silver Nitrate Treatment of Anal Fistulas
Allen Kamrava, MD, MBA, FACS, FASCRS· Board-certified in Colon & Rectal Surgery and General Surgery· Published · Reviewed
- Setting
- In office
- Anesthesia
- Local anesthetic
- Back to work
- A quick office visit with little downtime
- Pain relief
- Most patients report only a mild burning sensation that settles within a day
Silver nitrate is one of the newer methods utilized to treat anal fistulas. It has proven to be a safe, minimally invasive, and effective way to treat anal fistulas while minimizing downtime and providing no risk of fecal incontinence.
Dr. Kamrava continues to develop and study the available and effective treatments for complex anal diseases.
What is Silver Nitrate Treatment of Anal Fistulas?
Silver nitrate is injected in the anal fistula. It irritates the inner wall of the fistula tract, forcing a reaction that leads to scarring and closure of the fistula. The advantage of this procedure is that it does not require you to undergo anesthesia in the operating room, there is no risk of fecal incontinence, and there is little downtime.Q: When is it used?
A: Silver Nitrate injections have been used for the treatment of mild to moderate anal fistulas and for patients seeking minimally invasive treatment options.Q: How successful is it?
A: Studies have shown that, on average, patients will need 4 treatments, with success rates approaching 80%.Q: Is it painful?
A: Most patients report a mild burning sensation that subsides within a day and requires no pain medications.Q: How many treatments does it typically take?
A: The procedure is repeated every other week, with a maximum number of 10 treatments. If it has not worked by the tenth treatment, Dr. Kamrava typically suggests another strategy.Q: What is the treatment like?
A: The treatment will be in Dr. Kamrava’s medical office. Utilizing a single-use catheter, silver nitrate solution is injected into the fistula tract. Dr. Kamrava places a single-use device within the anal canal to protect the rectum and anus from irritation from the silver nitrate.Q: What is the recovery time?
A: Most patients are back at work the same or the next day.Q: Complications to consider?
A: The most frequent adverse event is abscess formation from the fistula partially but not completely healing and this would need to be drained. This could also cause irritation to the surrounding skin from the silver nitrate that drains out. Typically, these burns are well managed with simple application of antibiotic ointments.How it's done
- 1A small single-use protective device is placed in the anal canal so the silver nitrate reaches only the fistula tract — not the surrounding skin or rectum.
- 2Using a fine single-use catheter, silver nitrate solution is applied inside the tract.
- 3The solution irritates the tract's inner lining, which responds by scarring — gradually sealing the tunnel shut.
- 4The visit takes minutes, in the office. No incision, and no sphincter muscle is touched.
What to expect
Same day
A mild burning feeling that usually settles within a day. The visit itself takes minutes.
Every other week
The application is repeated at office visits, typically every two weeks, until the tract closes.
Over the course
Most people need a series of treatments rather than one — in a published series, the median was four sessions.
If it isn't closing
After a full course without healing, it's time to change strategies. Nothing about this treatment burns a bridge — the operative repairs remain fully available.
Sources
- Should we consider topical silver nitrate irrigation as a definitive nonsurgical treatment for perianal fistula? Diseases of the Colon & Rectum. 2014.
- Steele SR, Hull TL, Hyman N, et al., eds. The ASCRS (American Society of Colon & Rectal Surgeons) Textbook of Colon and Rectal Surgery. 4th ed. Springer; 2022.
Conditions this treats
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