50% of Patients With an Anal Abscess Develop a Fistula


Can an anal abscess develop in to a fistula?

Are you a person who was suffering from an anal abscess recently and now scared as to whether it can lead to some other complications?

Yes, untreated anal abscess which is not treated in a timely manner may often result in anal fistula.

What is an anal abscess?

Anal abscess, defined as an infected cavity filled with pus found near the anus or rectum is commonly caused by bacteria and viral agents, due to the possible contamination or clogging with fecal materials.

Signs and symptoms

Patients with this condition will usually present with anorectal pain, swelling, perianal cellulitis associated with redness of the skin and fever where rectal bleeding or urinary symptoms (hesitancy and difficulty in initiating the stream) are rarely possible.

Diagnosis and treatment

Anal abscess which is diagnosed by a complete clinical examination, analyzing the signs and symptoms and a thorough physical examination will be treated with incision and drainage followed by antibiotics. However, improperly incised abscesses can result in fissure formation, complicating the condition and worsening the pain on bowel movements.

Traditional two-dimensional and three-dimensional endo-anal ultrasound scan is known to be a very effective method of diagnosing a deep perirectal abscess.

What is an anal fistula?

Also known as fistula-in-ano, this usually arises as a complication of previous or current anal abscess by connecting the infected anal gland to the external skin. Accounting for around 50% of patients with anal abscesses, this can also present without any such prior conditions. Read more at:

Signs and symptoms

Patients affected by anal fistula will generally have a history of previously drained anal abscess associated with symptoms including anorectal pain, drainage from the perianal skin, irritation of the perianal skin, and occasional rectal bleeding.

Anal fistulas are usually confirmed by revealing a horseshoe extension of the abscess, delineating the path of a fistula tract with the help of a CT scan.

Treatment of choice

At the moment, there are no effective medical treatments available for anal fistula whereas Anal Fistula surgery plays the gold standard intervention.

If the fistula is straightforward, involving a minimal degree of sphincter muscle, a fistulotomy may be performed which involves the unroofing of the fistula tract, thereby connecting the internal opening within the anal canal to the external opening. This will eventually create a groove, improving the process of healing from the inside out.

Fistulectomy , dissecting and removing the whole tract is effective and with less recurrence.

However it should be done carefully since some patients might end up having fecal incontinence as a result of damage to anal sphincter muscle, which is divided in the course of surgery.

Endoscopic treatment VAAFT for Fistula– Dr Nitish Jhawar-Proctologist and Head of colorectal Clinic at Fortis Hiranandani Hospital, Vashi, Navi Mumbai, has recently done training from Germany in endoscopic treatment of Fistula- VAAFT from the inventor of the technique.

The latest addition to the treatments- fistula laser treatment in Mumbai

Fistula LASER Closure (FiLaC) is a novel sphincter-saving method, done by a laser diode which is safe, effective and minimally invasive. Primary closure of the fistula track will be achieved by laser energy released by a radial fiber connected to the diode, resulting in a shrinkage of the surrounding tissue, thus closing the tract.

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