Perianal fistulas are small tunnels that connect the skin around the anus (perianal skin) with the inside of the anal canal

They are usually preceded by a perianal abscess, i.e. a suppuration of the perianal skin that opens to the outside, either spontaneously or through a surgical incision.

They usually do not heal spontaneously although there is a possibility of healing without intervention (10-15 % of cases).

Causes of perianal fistulas and abscesses

Not completely clarified.

Perhaps the primary cause is an infection of the glands of the anal canal, which become abscessed for unknown causes.

From abscess to fistula the step is short, as the pus seeks a way out through the skin around the anus.

Symptoms of fistulas and abscesses

The abscess, as mentioned, is the initial phase.

The patient experiences pain in the anus that gradually increases.

Within hours or days, a reddened, hard and very painful area forms near the anus, almost always accompanied by high fever.

The fistula is the next stage, when the abscess ruptures, either spontaneously or through an incision.

Symptoms are:

• Secretion of pus or blood from a small hole located near the anus.
• Itching
• Pain and fever when the fistula becomes infected and causes an abscess again.

What to do

As soon as the abscess forms, consult a surgeon, preferably a proctologist.

When the fistula has formed, surgery is required, which is usually painless and requires a few days’ hospitalisation.

Unfortunately, there are complex fistulas (10%), which are not superficial but deep, and which require more laborious and sometimes longer operations.

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