Perianal fistulas are very common in the first year of life and are much more common in boys than in girls. The theory here is that the small oil producing glands just on the inside of the bottom become clocked and then subsequently infected, leading to perianal abscess. Some perianal abscesses can be successfully treated by drainage with or without antibiotics however a significant number of them persist as a perianal fistula. In this situation, the perianal abscess will continue to recur until the causative tract is excised. This is done as a day stay under general anaesthetic. The tract is excised and this leaves a raw surface which is then left to heal secondarily, usually taking about 2 weeks. During this time, clean the bottom after each bowel movement as per normal.