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What causes a fistula? After an abscess has been drained, a passage may remain between the anal gland and the skin, resulting in a fistula. If the gland does not heal, there will be persistent drainage through this passage. If the outside opening of the fistula heals first, a recurrent abscess may develop.
Occasionally, bacteria, fecal material or foreign matter can clog an anal gland and tunnel into the tissue around the anus or rectum, where it may then collect in a cavity called an abscess. An anal fistula (also commonly called fistula-in-ano) is frequently the result of a previous or current anal abscess. This occurs in up to 50% of patients with abscesses. Normal anatomy includes small glands just inside the anus. The fistula is the tunnel that forms under the skin and connects the clogged infected glands to an abscess. A fistula can be present with or without an abscess and may connect just to the skin of the buttocks near the anal opening.