Yes, your surgeon's current approach is a standard and appropriate initial step, but it is meant to manage the acute infection rather than provide a permanent cure. A Grade 4 fistula is considered complex because it passes through the sphincter muscles and is accompanied by an active infection (abscess). The gold-standard clinical principle for treating this is to resolve acute inflammation and active infection before attempting definitive repair.

Take surgeon openion after clinical examination.

Yes it’s a genuine approach

I have reviewed the MRI findings you mentioned. Your MRI suggests fistula-in-ano, which is an abnormal tract connecting the anal canal to the surrounding tissues. In your case, the tract passes through the anal sphincter muscles and is associated with a small abscess (collection of pus). This is classified as a Grade IV fistula according to the St. James's classification. Antibiotics and sitz baths may temporarily reduce pain, inflammation and discharge, but they generally do not permanently cure an established fistula. Since your MRI also mentions an abscess, I would advise an early in-person reassessment by a colorectal or general surgeon, rather than relying on sitz baths alone for another 15 days without reassessment. If an active abscess is present, surgical drainage may be necessary. Definitive fistula treatment can then be planned depending on the tract's relationship to the sphincter muscles. Treatment options may include seton placement or sphincter-preserving procedures, depending on the findings. If you develop fever, increasing pain, swelling, redness or difficulty passing urine, please seek urgent medical attention. Also, please clarify whether you currently have pain, swelling, fever or pus discharge from the perianal region.