A fistula generally starts as an abcess and it tunnels to the outside to release the pus. It can tunnel from inside the bowel to the vagina, to another section of bowel or to the outside beside the anus or other areas. You can have one and not know it but they do eventually become very painful. They are usually treated with anti-biotics first and if that doesn’t heal it, surgery is next.

A pocket of infection that tunnels its way to the outside. I had one and we think that it came from one of the Botox injections. It was in the anal canal and tunneled over into my buttock and then continued on to the outside. There was a tiny hole next to my anus about 1/2 inch over, beside it and it drained yellow pus. It had a foul odor. I never ran any fever or felt bad. It was just annoying and smelled. My CRS tried Cipro and Flagyll. Neither worked and I had
to have it surgically fixed. Any drainage should be investigated to see where it is coming from. Also once you have a fistula, they can spread and make more and then you really have a mess.

I  had surgery on the first fistula that I had. A fistulotomy (I think that is what they called it) and when she was in there she cut into the rectum muscle a tiny bit to try to relieve the pressure on the fissure. It worked ……both for the fistula and the fissure (no fissure pain since 2004). About a year after the surgery I got another abscess and that developed into another fistula. My surgeon suggested that if I thought I could live with the fistula then I might want to consider that instead of more surgery. Because the surgeries are so invasive I chose to keep my fistula for the time being. Since the fissure was not bothering me anymore I was inclined to leave well enough alone!!!!!

The problem with the existing fistula is that it has a pocket in it and over time (about twice a year lately) the pocket seems to fill up with fluid and then needs to drain. Everytime this happens I get an abcess and then I go through that whole process (daily trips to the hospital to change packing), it then heals and eventually the fistula stops draining
and then about six months later I get another abscess.

I saw a new colo rectal guy in Feb and he told me I had to come back when I have an abscess so next time I get an abscess I will go and see him to see if he has any new ideas.

All of this seemed minor to my fissure and because it hadn’t bothered me since my surgery (2004) I was ok to just leave everything be, but my fissure has come back to life since my visit to the colo rectal guy in Feb so right now I am trying really hard not to aggrivate the fissure if at all possible. I have actually been off work for the last two weeks
as a result of the abscess and then the awakening of the fissure.

  An anal fistula is an abnormal communication or tunnel between your rectum towards your anus, it is commonly caused by an anal abscess. Even though the abcess may have healed, there is now a skin tract or tunnel from your rectum, towards your anus. This tract will stay there until you have surgery done. What is done is usually called a fistulectomy, or fistulotomy. Tracts can course either to the front or towards your back. Tracts towards the front are straight while tracts towards the back are curved. If it really is a fissure, I recommend you see a surgeon and get your answers from them. The tract might get infected and will lead to more pain and suffering on your part, not to mention possible complications.
An anal fissure on the other hand is simply a nick or wound in your anal area,usually superficial but still painful and very prone to infection. Usually it is caused by trauma or passing of hard stools.
The ano-rectal region has a rich blood supply and veins, these veins sometimes get inflamed, enlarge and form what we call hemorrhoids. Men has anal fissures as well, but pregnant women are the majority of the sufferers. There are external hemorrhoids, which are superficial, and internal hemroids which are deeper. Hemroids usually present as painful masses which come out during a trip to the toilet. some hemorrhoids go back in by themselves, some don’t.  Some of them bleed, and some of them do not. In any case, a surgical consult is warranted.
So, what do you have?
If you feel that you have a superficial wound in your anus, it might be a fissure.
If there is a small hole beside your anus that may or may have no secretions, it may be an anal fistula.
If you feel a mass that seems to be attatched to your anus or it seems coming from inside, it may be a hemorrhoid.
Go see a doctor so that you can get treated before it gets worse.