Which bidigital rectal exam findings indicate anal fistula?

Updated: Nov 09, 2018
  • Author: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Bidigital rectal examination in a patient with a fistula-in-ano may reveal an indurated tract or cord. A fistula can be identified by small circles of granulation tissue, which exude pus when compressed if tissue is patent. A fistulous tract that opens internally can be visualized with the aid of an anoscope. Inguinal lymph nodes may be enlarged and painful.

If an abscess is also present with an anal fistula, cardinal signs of inflammation, rubor, dolor, calor, and tumor (eg, erythema, pain, increased temperature, edema) may be found.

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