We, the undersigned, including those living with anal fistulas, their families, friends, healthcare professionals, and all who believe in the right to compassionate, timely, and effective medical care united by a shared commitment to improving care for people living with anal fistulas, urgently call on NHS England and the Department of Health and Social Care to comprehensively revise and enhance national guidelines governing the diagnosis, treatment, and long-term management of this often debilitating condition.

Anal fistulas are not only physically painful but profoundly distressing and frequently life-altering. Though relatively common—especially as a complication following perianal abscesses—they remain widely misunderstood, frequently misdiagnosed, and inconsistently managed within the NHS. This systemic failure has left thousands of people across the UK enduring unnecessary suffering due to prolonged delays in diagnosis and treatment, fragmented and inadequate care plans, lack of transparent and informed consent, and insufficient post-operative support.

The consequences are severe and far-reaching: chronic pain, recurrent infections, physical disability, emotional trauma, social isolation, and a devastating impact on quality of life. Many patients are trapped in a cycle of repeated surgeries, preventable complications, and psychological distress, often without clear guidance or empathetic communication from healthcare providers.

It is imperative that the NHS adopt a patient-centred, evidence-based approach that ensures timely, consistent, and compassionate care for all those affected by anal fistulas. This includes standardizing diagnostic protocols, expanding access to specialist multidisciplinary teams, improving surgical and non-surgical treatment pathways, and establishing robust post-treatment support systems to prevent avoidable harm and improve outcomes.

We demand that the NHS recognise the urgent need to address this neglected condition and commit to delivering equitable, high-quality care that restores dignity and hope to thousands of patients across the country.

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📣 We are calling for the following urgent changes to NHS guidelines:

 1. Faster Diagnosis and Referral Pathways

• Ensure that perianal abscesses are properly followed up, with mandatory imaging (e.g., MRI or endoanal ultrasound) for unresolved or recurring cases.

• Clear national referral timelines to colorectal specialists for suspected fistulas.

 2. Standardised, Patient-Centred Treatment Protocols

• Guidelines that prioritise both physical and mental wellbeing in treatment choices.

• Mandatory pre-operative discussions of all surgical and non-surgical options, including risks such as incontinence or chronic pain.

• Timely access to reparative surgery for eligible patients (e.g., advancement flap, LIFT, VAAFT) within clinically appropriate timeframes.

 3. Integrated Aftercare and Mental Health Support

• Access to psychological support for patients living with long-term fistulas.

• Standardised aftercare plans and follow-up appointments post-seton or surgery.

• Better training for GPs and nurses to understand the ongoing impact of fistulas on quality of life.

 4. Data Collection and Accountability

• NHS trusts must collect and publish data on fistula care outcomes, delays, and re-admission rates.

• A national audit of anal fistula treatment to identify gaps and best practices.

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💬 Why this matters:

People living with anal fistulas endure far more than just physical pain—they suffer relentless, debilitating symptoms that severely compromise every aspect of their lives. Chronic pain, persistent infections, uncontrollable discharge, and the risk of incontinence create an unbearable daily reality. Many are forced to withdraw from work, social activities, and family life, trapped in a cycle of suffering that erodes mental health and dignity. Anxiety, depression, and trauma are common, yet their struggles are too often dismissed or ignored.

Anal fistulas affect thousands of people, yet the healthcare system routinely fails them through delayed diagnoses, fragmented care, and inadequate treatment options. Patients are left in limbo—waiting months or even years for surgery, enduring repeated infections and complications that could have been prevented with timely intervention. The lack of standardised, compassionate, and evidence-based care condemns many to unnecessary pain, prolonged disability, and, in some tragic cases, permanent impairment.

Such systemic neglect is unacceptable. It represents a profound failure of duty by the NHS to uphold the basic standards of care and compassion every patient deserves. The emotional and physical toll inflicted by this neglect is devastating, stripping away quality of life and hope.

The time for complacency is over. The NHS must urgently listen—not just to clinicians, but to the lived experiences of patients—and commit to transforming care pathways. Every person suffering with an anal fistula has the right to timely, respectful, and effective treatment that minimizes harm and maximizes recovery. This is a public health imperative and a moral obligation.

We cannot continue to allow thousands of people to suffer in silence, invisible and voiceless. The NHS must act now to end this cycle of neglect, reduce preventable harm, and restore dignity to those affected by this profoundly life-altering condition.

✍️ Add your voice.

Sign this petition and stand with us as we demand meaningful change. Together, we can end the silence and improve care for all those living with this misunderstood condition.