Patients with anal fistula usually appear in distress due to throbbing rectal pain. 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 like high-grade fever, Tachycardia, Tachypnea, low blood pressure. On rectal examination, there is redness, tenderness and discharge is seen.

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

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 pressuree with normal pulse pressure

• Patient with anal fistula usually have throbbing rectal pain. The examination is usually done under sedation.^[1][2]
• On inspection perianal skin is red 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.

On palpation, inguinal lymph nodes are usually enlarged.