Anal Fissures, Abscesses and Fistulas – Oh My!

Medically reviewed by: Gary H. Hoffman, MD

Many people see blood when they wipe after a bowel movement, and they immediately panic. While this is reason for concern and you should see a doctor, it is likely a relatively minor condition that your doctor can help you work through. Pain in addition to the bleeding may indicate hemorrhoids, an anal fissure, an abscess, a fistula, or another issue.

A doctor who sees these conditions regularly can usually diagnose them quickly and offer an effective treatment to help you heal quickly. We recommend making an appointment with us or discussing your symptoms with your primary care physician as soon as possible to get started.

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What Is the Difference?

Anal fissures, abscesses, and fistulas have similarities, but they also have some major differences. Understanding what each of these conditions is and its symptoms may reduce your anxiety about talking to your primary care physician or a colorectal specialist about it.

Anal Fissures

An anal fissure is a tear in the skin at the anal opening. Constipation is a major contributor to fissures, although chronic diarrhea can also cause an issue. Infants and toddlers who have hard stools regularly often develop fissures, but they can occur in any age group. The symptoms of an anal fissure include:

  • Pain during bowel movements
  • Stinging at the anus immediately following bowel movements
  • Blood on the stool or toilet paper
  • Itching or other irritation
  • A split in the skin evident during an exam by your doctor


An abscess is a pouch of pus, usually related to bacteria and infection. Because of the bacteria that is present in stool, abscesses near the anus and in the anal canal are common. The anal canal has glands that can become infected, leading to an abscess. Symptoms of an anal abscess may include:

  • Pain
  • Swelling
  • Drainage of pus from the abscess
  • Fever and chills
  • Other typical signs of an infection


A fistula is an opening in the skin near the anus. They often occur to allow an anal abscess to drain, but can occur on their own without an infection as well. Frequently, they stretch all the way from the rectum through the skin.

Symptoms of a fistula include all the symptoms of an anal abscess, plus redness and irritation of the skin near the anus.

Getting a Diagnosis

Especially when it comes to fissures and abscesses, a skilled specialist may recognize these conditions by talking to you about your symptoms and visually examining the area. With fissures specifically, your doctor will likely avoid an examination with an anoscope to prevent you from suffering additional pain.

In some cases, your doctor will need to perform this type of exam, though. This takes only a few seconds and allows your doctor to examine your rectum by inserting a small tube into your anus. This is more common if your doctor believes you have an anal abscess or fistula.

Occasionally, your doctor may recommend you undergo a colonoscopy to rule out more serious causes of rectal bleeding.

Your Treatment Depends on Your Diagnosis

Depending on your diagnosis, your doctor will recommend a treatment plan to help you heal as quickly as possible. In general:

  • Anal fissures usually heal without additional treatment, although your doctor will be able to recommend some tips to ease your symptoms or offer treatment if they do not heal within a few days.
  • An anal abscess needs to be drained, ensuring the infection is clear. This quick procedure will almost instantaneously relieve the pain associated with an abscess, and it should heal completely within a week or two.
  • Anal fistulas require more extensive treatment, in most cases. We perform a surgery known as a fistulotomy to close this tunnel and eliminate the symptoms as well as the chance of additional complications from the fistula. We do this procedure as an outpatient surgery.

Talk to Your Doctor or Call Our Office About Your Symptoms

As specialists who only deal with colon, rectal, and anal conditions, we see fissures, abscesses, and fistulas regularly. We can help you get the treatment you need to heal as quickly as possible. We also know how to put you at ease, making talking about your symptoms easier. There’s no reason to feel embarrassed or put off getting treatment because your dread the doctor’s visit. We can help you get an accurate diagnosis and effective treatment quickly.

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