Management of anal fistula.

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 commonmanagement pathways that their patients might experience. What is an anal fistula?