The patient with a perianal fistula complains of intermittent discharge in the perianal region, pain or discomfort in the perianal area, and chronic irritation.
On examination, the external opening of the fissure is generally seen lateral to the anus. The external opening may be seen as a small papilla of granulation tissue. Note that though this clinical picture is diagnostic of an anal fistula, often the apparently trivial skin lesion may be diagnosed as a pustule. The internal opening to the fistula may be felt on rectal examination.
Examination with a proctoscope may allow direct visualisation of the internal opening. It may be possible to pass a probe along the course of the fistula to chart its pathway.
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