Anorectal abscesses and fistulas are common surgical conditions. Most often these are idiopathic and caused by cryptoglandular infections. Diagnosis relies on focused history and physical examination findings as well as imaging studies to determine the extent of sphincter involvement and exact location. Treatment of an abscess is prompt surgical drainage. Surgical management of a fistula is focused on preservation of continence while achieving healing. Optimal surgical treatment is based on anatomy of the fistula tract. Surgical options include fistulotomy, seton placement, advancement flap, LIFT, and VAAFT. Emerging therapies, such as mesenchymal stem cell injections, show promise but require further study.