Last Updated on November 26, 2025 by Bilal Hasdemir

If you’ve noticed a small hole, swelling, or pain near the anus, it’s important to know the signs of a perianal fistula. This condition often shows up as a small hole near the skin around the anus. It can be red, swollen, and may have drainage.

Trust Liv Hospital’s expertise and patient-first care approach to guide you through the symptoms and images. This will help you recognize this condition early. Recognizing symptoms early can make a big difference in treatment.

Key Takeaways

• Perianal fistulas often appear as a small hole or red bump near the anus.
• Symptoms can include swelling, pain, and discharge.
• Early recognition is key for effective treatment.
• Liv Hospital offers expert care for diagnosing and treating anal fistulas.
• Understanding the warning signs can help you seek medical attention promptly.

Understanding Perianal Fistulas: What They Are and Why They Form

Perianal fistulas are abnormal tunnels between the anal canal and the skin around the anus. They cause discomfort and often result from an infection or abscess in the anal glands.

Definition and Anatomy of Perianal Fistulas

A perianal fistula is a chronic connection between the anal canal and the skin. The anal glands can get blocked, leading to infection and abscesses. When these abscesses drain, they create tunnels or fistulas.

The anatomy of perianal fistulas includes the anal glands, the anal canal, and the skin. Infections usually start in the anal glands, which are prone to blockage.

Common Causes and Risk Factors

Several factors contribute to the formation of perianal fistulas. These include:

• Infection or abscess in the anal glands
• Blockage of the anal glands
• Chronic inflammation or conditions like Crohn’s disease
• Previous anal surgery or trauma

A medical expert notes, “The development of a perianal fistula is complex. It involves infection, anatomical factors, and sometimes inflammatory bowel disease.”

This shows why understanding causes is key to managing and treating perianal fistulas.

Knowing the causes and risk factors is vital for diagnosing and treating perianal fistulas. This knowledge helps in creating effective management plans.

Types of Perianal Fistulas: Classification and Characteristics

Perianal fistulas are divided into simple and complex types. This division is based on their structure and how complex they are.

Simple vs. Complex Fistulas

Simple fistulas have one tract and are easier to treat. They have one opening outside and a direct path to the anal canal. Complex fistulas, on the other hand, have many tracts and openings. They are harder to manage because of their complex structure.

Knowing if a fistula is simple or complex is key. Simple ones might need a simple surgery. But complex ones might need more advanced treatments, like setons or flaps.

Rectoanal Fistulas and Other Variations

Rectoanal fistulas connect the rectum to the anal canal or skin. They are tricky because of their location and the muscles involved. Other types, like horseshoe fistulas, are complex and wrap around the anal canal.

It’s important to know the type of fistula for the right treatment. Knowing if it’s simple or complex, or if it’s a special type like rectoanal or horseshoe, helps doctors plan the best treatment for each patient.

Perianal Fistula Pictures: Visual Guide to Identification

Knowing what perianal fistulas look like is key for early detection. They can show up in different ways, making it important to be able to spot them.

External Appearance and Common Presentations

A perianal fistula is usually a small hole near the anus. It often has redness and swelling. The area might be sore and could have discharge.

Common signs include:

• A small opening or hole near the anus
• Redness and swelling around the opening
• Possible discharge or drainage from the fistula
• Tenderness or pain when touched

What Does a Perianal Fistula Look Like?

A perianal fistula can look like a small, red bump or an opening near the anus. The area might be inflamed and have pus or discharge. The look can change based on the fistula’s complexity.

Small Perianal Fistulas: Easy to Miss Signs

Small perianal fistulas are hard to spot because they don’t always show clear signs. Yet, they can cause discomfort and serious problems if not treated.

Signs to watch for include:

1. Mild pain or discomfort near the anus
2. Occasional discharge or leakage
3. A small, seemingly insignificant opening near the anus

It’s important to watch for these signs and get medical help if you think you have a perianal fistula.

15 Warning Signs and Symptoms of Perianal Fistulas

It’s important to know the warning signs of perianal fistulas early. These symptoms can range from mild discomfort to severe pain and discharge. Early detection is key for effective treatment.

Primary Symptoms to Watch For

Common symptoms include persistent pain around the anus, swelling, and redness. Pain during defecation is common, along with discharge or leakage from the fistula. Some people also notice bleeding during or after bowel movements.

• Persistent anal pain
• Swelling and redness around the anus
• Discharge or leakage
• Bleeding during bowel movements

As

“The presence of a fistula can lead to significant discomfort and affect a patient’s quality of life.”

Knowing these symptoms is important for seeking medical help quickly.

Secondary Symptoms and Complications

Perianal fistulas can also cause secondary complications if not treated. These include fever, fatigue, and abscess formation. In severe cases, the infection can spread, leading to serious health problems.

How Do You Know If You Have a Fistula?

If you have persistent anal pain, discharge, or swelling, see a doctor. A doctor can check and test to see if you have a fistula. Early diagnosis is important for effective treatment and preventing complications.

Seeking medical attention quickly can greatly improve your outcome. If you notice any symptoms, don’t hesitate to see a specialist.

The Mystery of “Two Holes”: Understanding Fistula Tracts

Perianal fistulas can cause an extra opening near the anus, leading to worry. This is often called having “two holes” near the anus. It might mean you have a fistula tract. Knowing this is key for the right diagnosis and treatment.

Why Do I Have Two Holes in My Anus?

A two holes near the anus usually comes from a fistula. This is an abnormal link between the anal canal and the skin around the anus. The extra opening is part of the fistula tract, a tunnel from inside the anal canal to the skin.

The external opening can be seen on the skin near the anus. It might drain pus or fluids, causing pain and worry. The internal opening is inside the anal canal and can’t be seen without a doctor’s check.

Small Hole Near Anus: Is It Always a Fistula?

Not every small hole near the anus is a fistula. But, it could be a sign of one. Other issues like anal abscesses or skin lesions can look similar. If you see a small, lasting hole near your anus, see a doctor.

A doctor will check you and might use tests like an MRI or ultrasound. They’ll see if the hole is part of a fistula. If it is, they’ll talk about how to treat it.

It’s important to know about fistula tracts and their signs. If you have two holes in your anus or a small hole, get medical help.

Perianal Fistula Pain: What to Expect and When to Worry

Knowing about perianal fistula pain is key to handling it well. These fistulas can be quite painful. The pain’s intensity and type can change.

Characteristics of Fistula-Related Pain

The pain from perianal fistulas can be constant. It often gets worse during bowel movements or when sitting for a long time. Doctors say the pain can feel sharp or dull, depending on the fistula’s details.

Pain characteristics can include:

• Sharp or stabbing pain during bowel movements
• Dull ache or soreness around the anus
• Increased pain when sitting or applying pressure

Are Fistulas Always Painful?

Not every perianal fistula hurts, but many do. The pain’s presence and how bad it is can depend on the fistula’s size, where it is, and if it’s infected. A gastroenterology expert says some people feel little pain, while others have severe pain that makes daily life hard.

Pain Management Strategies

Managing perianal fistula pain needs both medical help and changes in daily life. Effective pain management can greatly improve life for those with fistulas.

Some strategies include:

1. Using pain relief medications as prescribed by a healthcare provider
2. Applying warm sitz baths to reduce discomfort and promote healing
3. Avoiding activities that make the pain worse

Talking to a healthcare professional is vital to create a pain management plan that works for you. By understanding the pain and using good management strategies, you can deal with this tough condition better.

Discharge and Drainage: Understanding Anal Fistula Secretions

It’s important to know about the discharge from anal fistulas to manage them well. The discharge can be uncomfortable and worrying for those affected.

Types of Discharge from Perianal Fistulas

The discharge from perianal fistulas can look different. It might be pus-like, showing an infection, or bloody or clear with a bad smell. The type of discharge can tell us a lot about the fistula’s condition.

Anal Leakage and Fistula Discharge: What’s Normal?

It’s key to know what’s normal and what’s not with discharge. Some discharge is okay, but too much or that keeps coming back might mean a problem. Looking at how much, how it looks, and how often it happens helps figure out if things are getting worse.

When Drainage Indicates a Worsening Condition

More discharge, a change in how it looks, or blood means things might be getting worse. It’s important to watch your symptoms and see a doctor if they change a lot.

In short, knowing about and managing anal fistula discharge is key for those with perianal fistulas. By understanding the types of discharge and when to get help, people can handle their condition better and avoid serious problems.

Fistula Cysts: Formation, Appearance, and Complications

Fistula cysts are a serious issue that can come from perianal fistulas. They greatly affect the life quality of those who have them. These cysts form when an infection spreads and creates an abscess.

Formation of Fistula Cysts

Fistula cysts form when an infection from a perianal fistula spreads. This leads to pus buildup and a cyst forms. It can be very painful and may cause more problems if not treated right.

Recognizing a Bum Fistula with Cyst Formation

Spotting a bum fistula with a cyst means looking for certain signs. These include pain, swelling, and discharge around the anus.

• Pain during bowel movements or when sitting
• Swelling or redness around the anus
• Discharge or pus from the fistula tract

Managing and Treating Fistula Cysts

It’s key to manage and treat fistula cysts well to avoid more problems and ease symptoms. Treatment can include antibiotics, draining the cyst, or surgery.

Handling fistula cysts needs a full plan. This includes medical care and changes in lifestyle. It helps prevent them from coming back and helps them heal.

Diagnosis of Perianal Fistulas: From Self-Examination to Medical Tests

Diagnosing perianal fistulas involves both checking yourself and getting a doctor’s opinion. It’s important to get it right for the best treatment.

Self-Assessment: How to Tell If You Have a Fistula

Start by checking yourself for signs of a fistula. Look out for ongoing pain, discharge, or swelling near the anus. Noting these symptoms and how long they last helps doctors a lot.

Looking closely and feeling gently around the anus might show signs of a fistula. But, it’s best to see a doctor for sure.

Professional Diagnostic Methods

Doctors use a mix of checks and scans to diagnose. They first look at the anus for signs of a fistula. They might also do a digital rectal exam to check for tenderness.

To get a clearer picture, they use scans like MRI or endoanal ultrasound. These scans show the fistula’s path and any connections to other areas.

• MRI is great for complex fistulas, showing detailed images of the tract and tissues.
• Endoanal ultrasound gives live images and helps during surgery.

They might also do fistulography or proctoscopy/sigmoidoscopy. Fistulography uses dye to show the fistula on X-rays. Proctoscopy and sigmoidoscopy let them look inside the rectum and sigmoid colon.

Getting a correct diagnosis is key to creating a treatment plan that works for you.

Treatment Options for Perianal Fistulas

Perianal fistula treatment varies based on the fistula’s specifics. The main goal is to close the fistula, prevent it from coming back, and avoid complications.

Conservative Management Approaches

For some, starting with conservative management is best. This might include:

• Antibiotics: To fight infection and ease symptoms.
• Drainage: Simple procedures to manage symptoms.
• Fibrin glue injection: A small procedure to close the fistula with a glue-like substance.
• Seton placement: A rubber or silicone drain is placed to drain infection and aid healing.

Surgical Interventions

For more complex or lasting fistulas, surgery might be needed. Surgical options include:

1. Fistulotomy: Opens and drains the fistula, then sews it to heal.
2. Fistulectomy: Removes the fistula tract.
3. Advancement flap procedure: Uses a tissue flap to cover the fistula’s internal opening.
4. Ligation of the intersphincteric fistula tract (LIFT): A procedure that ties off the fistula tract in the intersphincteric space.

Recovery and Follow-up Care

After treatment, whether it’s conservative or surgery, follow-up care is key. This includes:

• Pain management: Managing pain after the procedure.
• Wound care: Proper care of the wound or fistula site to aid healing.
• Follow-up appointments: Regular check-ups with a healthcare provider to monitor healing and address any issues.

Knowing the different treatment options for perianal fistulas is important for effective management. Healthcare providers can choose the best conservative management or surgical intervention based on the fistula’s complexity and severity.

Conclusion: Importance of Timely Recognition and Treatment

It’s key to spot and treat perianal fistulas early to avoid problems. Quick action makes treatment work better and cuts down on risks.

Getting medical help fast is important for perianal fistulas. Knowing the signs helps people get treatment sooner. This boosts the chance of a good outcome.

Treating perianal fistulas well means using both non-surgical and surgical methods. Starting treatment right away helps manage symptoms and stops complications. This way, people can live better lives.

FAQ

References

Andrews, S., et al. (2013). Gallstone size e related to the incidence of post-cholecystectomy retained bile duct stones. Surgery Journal, 5(3), 143-147. Retrieved from https://www.sciencedirect.com/science/article/pii/S1743919113000484