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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, the majority of women with OF suffer rectovaginal fistula (RVF). This is caused by episiotomy and forceps/vacuum extraction of the baby from the vagina. Over 80% of RVFs in the USA are obstetric and either preventable or treatable, followed in frequency by Crohn's disease and radiation. A fistula is almost entirely preventable.