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Fistula-in-ano is a chronic abnormal communication between the anal canal and the perianal skin, usually resulting from a previously drained anorectal abscess. It develops when infection of the anal glands leads to persistent epithelialized tracts that fail to heal. The condition is commonly associated with cryptoglandular infection, but it may also occur in systemic diseases such as Crohn's disease or following tuberculosis, trauma, or radiation therapy.

Clinically, patients present with recurrent perianal discharge, pain, swelling, irritation, and occasionally bleeding. Symptoms often worsen during episodes of secondary infection. External openings may be visible near the anal verge, and a history of abscess drainage is frequently reported.

Fistulas are classified according to their relationship with the anal sphincter complex (intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric), which guides management strategy. Diagnosis is based on clinical examination, digital rectal evaluation, and imaging such as MRI, fistulogram or endoanal ultrasound for complex tracts.

Definitive treatment is primarily surgical, including fistulotomy, seton placement, advancement flap procedures, or minimally invasive techniques like LIFT (ligation of intersphincteric fistula tract). The goal is complete eradication of the tract while preserving continence. Early and appropriate intervention reduces recurrence and improves long-term outcomes.