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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.
In developed countries, Crohn disease is the most common cause of spontaneous fistula formation. In their lifetime, as many as 40% of patients with Crohn disease develop a fistula, most often an external or a perianal one.