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Anal Abscess and Fistula

An anal abscess is an infected cavity filled with pus near the anus or rectum.

An anal fistula is a small tunnel that tracks from an opening inside the anal canal to an outside opening in the skin near the anus.  Anal fistulas often result from a blockage of the anal glands, which secrete into the anal canal via anal ducts. The glands are located at varying depths in the anal canal wall, some in between the layers of the internal and external sphincter. If these blockages occur, these glands may become painful and develop pus-filled abscesses (anorectal abscess) and result in anal fistulas. A fistula can occur anywhere in the vicinity of the anal opening, including the vagina (recto-vaginal fistula). Women with a rectovaginal fistula will present with the passage of flatus and or stool in the vagina. This presentation requires an extensive work up for the source of the fistula. 




























Small glands inside the anus are part of normal anatomy. If the glands in the anus become clogged, this may result in an infection. When the infection is serious, this often leads to an abscess. Bacteria, feces, or foreign matter can also clog the anal glands and cause an abscess to form.  In addition to anal gland infections, there are other significant causes that can increase the risk of abscesses and fistulas for example, inflammatory bowel disease such as Crohn’s disease or ulcerative colitis, localized skin infections such as a condition referred to hidradenitis supparativa, trauma, and radiation. Also, there are infections caused by sexually transmitted diseases or a form of rectal/anal cancer.







A patient with an abscess may have pain, redness or swelling in the area around the anal area or canal.  Other common signs include feeling ill or tired, fever and chills.  Patients with fistulas have similar symptoms to other anorectal conditions and may be misdiagnosed if not examined. Treatments for anorectal conditions differ significantly.  It is important that you be evaluated by a colon-rectal surgeon for an accurate diagnosis.









The goal of treating anal abscess and fistulas is to lessen the pain, stop their reoccurrence by clearing the blockages, and preserve muscle control.  Therefore, it is important that symptoms be evaluated by a colon-rectal surgeon.  A colon-rectal surgeon will perform a thorough examination and recommend treatment. The physicians at Connecticut Colon & Rectal Surgery, LLC have a goal to preserve muscle function while effectively treating the fistula by developing individualized treatment plans based on the type of abscess and fistula.

Under most circumstances, the treatment of an abscess is surgical drainage.  For most patients, an abscess can be drained surgically through a simple procedure.  An incision is made in the skin near the anus to drain the infection.  Typically, this can be done at the surgeon’s office with a local anesthetic but under certain circumstances, this may need to be done in an operating room under anesthesia.  Some patients may require multiple surgeries to take care of the problem. 

Surgery is recommended to treat an anal fistula that does not close or recurs.  In many patients, if the fistula is not too deep, a fistulotomy is performed. During this surgery, the fistula track will be opened to allow healing from the inside out. The surgery may require dividing a small portion of the sphincter muscle. If a large amount of sphincter muscle is encountered during surgery, the it is not divided, as this could lead to problems with bowel control such as fecal incontinence.  In some cases, a fistulotomy involves the insertion of a drainage tube known as a seton, which is thread through the fistula track.  This allows the inflammation to settle by draining the infection.  This can stay in place long term but is frequently used for a short period of time.  Once the infection resolves and the tissue begins to heal a second procedure is performed to remove the seton drain and close the fistula track.  

If the fistula track does involve a large portion of the sphincter muscle, it may require other more advanced surgeries, such as an advancement flap, that are done to treat the fistula without harming the sphincter muscle. More difficult cases may require multiple surgeries.  

Antibiotics alone are not effective in treating abscesses or fistula. Antibiotics may be needed, in addition to surgery, if a patient has immunity issues, specific heart valve conditions or widespread cellulitis (a bacterial infection of the skin and tissues under the skin). Providing your physician with an accurate medical history and undergoing a physical exam are important steps in deciding if antibiotics are required.

To schedule an appointment, please call our office at (860) 826-3880 or request an appointment online.  If appropriate and availability allows, a consultation appointment will be scheduled for you to be seen by one of our experienced physicians, generally, within a two-week timeframe of contacting the office.  Procedures are generally scheduled shortly thereafter.

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Anal Abscess 1.png

What causes Anal Abscesses and Fistulas?

What are the Symptoms of Anal Abscesses and Fistulas?

How are Anal Abscesses and Fistulas Treated?

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