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Summary points Anal fistula is part of the spectrum of perianal sepsis. It is a chronic condition that may present de novo or after an acute anorectal abscess. Anal fistula causes a variety of prolonged or intermittent symptoms including pain, discharge, and social embarrassment. The goals of management are to eradicate the fistula and prevent recurrence while maintaining continence. Simple anal fistula may be easy to treat, but complex cases may require several procedures over months (or years). In some cases, treatment may result in a stoma formation or incontinence, which has a profound effect on the patient’s quality of life. This article aims to provide a pragmatic overview of this often poorly understood condition and enable primary care doctors and other non-specialists to appreciate the common management pathways that their patients might experience. #### Sources and selection criteria We searched PubMed and the Cochrane Library for clinically relevant studies using the search terms anal fistula and perianal sepsis. We consulted guidelines from the National Institute for Health and Clinical Excellence, in addition to both the Association of Surgeons of Great Britain and Ireland and the Association of Coloproctology clinical guidance. A fistula is defined as an abnormal communication between two epithelial surfaces. Anal fistula is a communication between the anorectal canal and the perianal skin that is lined with granulation tissue. It may be useful to consider it as a tunnel during … |
