What Is a Fistula in the Buttocks Area
A fistula is an abnormal tunnel that forms between two areas of the body that should not be connected. When people refer to a “fistula in the buttocks,” they are most often describing an anal fistula, which connects the anal canal to an opening in the skin near the anus.
A related condition in the same region is pilonidal disease, which occurs higher in the buttock crease near the tailbone. While different conditions, both can cause chronic drainage, pain, and recurring infection.
Common Causes
Anal Fistula
Most anal fistulas begin as an anal abscess. When an infected gland near the anus fills with pus and drains incompletely, a tunnel can remain.
Common causes and risk factors include:
- Recurrent or untreated anal abscesses
- Chronic infection
- Inflammatory bowel disease such as Crohn’s
- Trauma or prior surgery
Pilonidal Disease
Pilonidal disease is strongly associated with:
- Dense or coarse hair
- Friction and pressure
- Prolonged sitting
- Hair and debris trapped in the buttock crease
Hair plays a much larger role in pilonidal disease than in anal fistulas.
Symptoms to Watch For
Symptoms vary but commonly include:
- Persistent pain or tenderness near the anus or buttocks
- Swelling or a lump
- Ongoing drainage of pus or blood
- Skin irritation or redness
- Recurrent “boils” or abscesses
- Fever or fatigue if infection is present
Symptoms that repeatedly return rarely resolve without treatment.
Diagnosis
Diagnosis usually involves:
- Physical examination
- Identification of external openings
- Imaging such as ultrasound or MRI to trace the tract
Proper diagnosis is essential, as treatment differs significantly between fistulas and pilonidal disease.
Treatment Options
Anal Fistulas
Most anal fistulas require surgical management. Treatment may include:
- Fistulotomy
- Seton placement
- Advanced closure techniques
Medication alone is rarely sufficient.
Pilonidal Disease
Treatment ranges from:
- Drainage of infection
- Surgical removal of chronic sinus tracts
- Ongoing management to prevent recurrence
The Role of Hair and Hair Removal
How Hair Contributes
Hair can trap bacteria, moisture, and debris in deep skin folds, increasing irritation and infection risk, especially in pilonidal disease.
Hair Removal Methods
- Shaving: Temporary and often irritating. Can worsen ingrowns and inflammation.
- Laser Hair Reduction: Reduces hair density over time and may lower recurrence risk in pilonidal disease.
- Electrolysis: Permanently removes individual follicles and may help prevent repeated hair related irritation in high risk areas.
Hair removal does not treat or close a fistula. It only supports hygiene and reduces contributing factors, mainly in pilonidal disease.
Final Thoughts
Fistulas near the buttocks are not cosmetic issues. They are medical conditions that often require imaging, specialist evaluation, and sometimes surgery. Hair removal can play a supportive role in reducing irritation or recurrence in hair driven conditions, but it is not a treatment for a fistula itself.
If you suspect a fistula, have persistent drainage, pain, swelling, or repeated infections, you should always see your dermatologist or an appropriate medical specialist for diagnosis and treatment.