An anorectal fistula is a tube-like tract with an opening from the anal canal to a hole in the skin around the opening of the anus. A postoperative anorectal fistula occurs after surgery to drain an anorectal abscess.

Anorectal fistulas may occur following drainage of an anorectal abscess that has eroded a new pathway to the skin, or they may occur spontaneously. Some conditions that may predispose an individual to anorectal fistulas include: Crohn's disease; diverticulitis; previous surgery of the lower colon; tumors; or trauma.

After drainage of an anorectal abscess or surgical repair of an anorectal fistula, fecal incontinence may occur. Other typical symptoms associated with a postoperative anorectal fistula may include pain in the affected area, and an abnormal discharge, such as pus, mucus or blood, through the skin near the anus.

An anoscope and a probe may be used to determine the path of the anorectal fistula after surgery. Endoanal ultrasonography may be used to determine the fistula's proximity to the anal sphincters. Diagnostic measures postoperatively may also include examination of the site of the fistula opening, or site of repair.

Surgery is the only effective treatment for anorectal fistula. The surgical treatment consists of converting the primary opening and the entire tract into a "ditch" (fistulotomy). Partial division of the sphincters may also be necessary. The "ditch," formed following fistulotomy, is left open to allow healing from the inside out (secondary intention) which may take approximately 4 to 6 weeks. Medications such as analgesics for pain may be necessary. Sitz baths may relieve discomfort. Antibiotics may also be needed if there are symptoms of infection. The postoperative wound will need frequent examination to assess for proper healing and to identify signs and symptoms of infection. Careful attention must also be given to the postoperative bowel pattern as the individual may suppress the urge to defecate due to the potential for pain, which leads to constipation and increased pressure at the wound site. Stool softeners may be necessary.

If the surgery required partial division of the sphincter, there may be some residual impairment or loss of control of defecation. Other postoperative residuals may include anorectal stricture, stenosis, or contracture due to scarring or inflammation. Rectal abscesses may recur causing recurrence of anorectal fistulas.

Rate as for impairment of sphincter control.