Anal fistula physical examination

Anal fistula Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

Appearance of the Patient

• Patients with anal fistula usually appear in distress due to throbbing rectal pain.

Vital Signs

Patient presents with anal fistula is having normal vital signs but if anal fistula gets infected, it will lead to the formation of an abscess. Patient with an abscess presents with unstable vitals:

• High-grade fever
• Tachycardia with regular pulse
• Tachypnea
• Low blood pressure with normal pulse pressure

Rectal Exam

• Patient with anal fistula usually have throbbing rectal pain. The examination is usually done under sedation.
• On inspection perianal skin is inflamed and excoriated.
• On palpation, there is tenderness and fluctuation due to abscess.
  • The external opening can be palpated if it is just beneath the skin.
  • The external opening is felt like a cord and discharge is seen.
• Bidigital rectal examination is usually done under the local anesthesia due to severe pain.
• Internal opening is seen clearly with an anoscope.
• Sigmoidoscopy is used to visualize opening in the rectum.
• Fistula track is explored by fistula probe.

Lymph Node Examnination

On palpation, Inguinal lymph nodes are usually enlarged.