• patient has perianal pain and/or palpable induration consistent with an abscess. Patients with an acute abscess should be evaluated and treated in the emergency department prior to being referred to clinic. If the abscess spontaneously ruptures and drains, referral should still be made as the cavity may not be completely drained. 50% of such patients will go on to develop a fistula.
• patient has persistent and/or recurrent anal fistula characterized by drainage, skin excoriation, and pain. External opening can generally be found on the perineum.

Colonoscopy should be performed to assess for underlying inflammatory bowel disease if patient has not been diagnosed. This need not be done prior to the clinic visit.

If colonoscopy and biopsy are performed outside of the UMHS system, reports should be mailed or faxed at or before the time of the clinic visit. Receiving these prior to the clinic visit is preferable.