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Anal Fistula

An anal fistula is an abnormal passageway that develops from inside your anus to the skin outside. When anal glands become infected, drainage from the infection can create a fistula. This infection is called a perianal abscess. It’s more common in men.



  • Anal pain, often intense and throbbing, more while passing stool, cough, or sitting, and sensitive to touch.
  • Swelling and redness inside or around the anus.
  • Fluid drainage from somewhere around the anus. It may include pus, stool, or blood.
  • Fever.
  • Difficulty holding stool



  • When your tissues are inflamed for a long time, due to an injury or disease.
  • Chronic inflammation and infection can eventually erode into the nearby tissues, especially when pus needs to drain.
  • Perianal abscess
  • Inflammatory bowel diseases, such as Crohn’s disease.
  • Sexually Transmitted Diseases.
  • Tuberculosis of the anus.
  • A traumatic injury or previous surgery in the anus.
  • Radiation therapy for cancer in the pelvic region.
  • Actinomycosis
  • Inflammatory bowel disease (IBD) such as Crohn’s.



  • MRI magnetic resonance imaging
  • Endoscopic ultrasound.
  • Fistulography
  • Physical Examination



  1. Inter sphincteric anal fistula: Passes through internal anal sphincter muscle and then burrows out through the space between internal and external sphincter muscles.
  2. Trans sphincteric fistula: Travels through both layers of anal sphincter muscles.
  3. Supra sphincteric fistula: Passes through the internal sphincter and then goes around the external sphincter.
  4. Extra sphincteric fistula: Goes around both sphincter muscles. This less common type usually originates from the rectum rather than the anus, so it doesn’t come from an anal gland.
  5. Superficial anal fistula: Travels from the lower part of the anal canal, below anal glands, through the skin nearby, bypassing muscles. This type doesn’t come from an anal gland.