Blood usually is not mixed into stool. Occasionally, blood is found on toilet paper after wiping. Patient may report no bleeding. Mucoid discharge Pruritus Patients with an anal fistula may complain of recurrent malodorous perianal drainage, pruritus, recurrent abscesses, fever, or perianal pain due to an occluded tract. Pain occasionally resolves spontaneously with reopening of tract or formation of new outflow tract.
Pain occurs with sitting, moving, defecating, and even coughing.
Pain usually is throbbing in quality and is constant throughout the day. Place patient in left lateral decubitus position with knees drawn up toward chest. Examine patients carefully to avoid infliction of further pain or sphincter spasm. Examination may be facilitated by application of a topical anesthetic. Most fissures are visible externally when patient bears down as if having a bowel movement.