Intersphincteric Fistula and Adductor Area Pain
No, an intersphincteric fistula does not typically cause adductor area pain. The pain pattern from intersphincteric fistulas is anatomically confined to the perianal region, not the thigh adductors.
Typical Pain Distribution of Intersphincteric Fistulas
Intersphincteric fistulas cause perianal pain localized to the anal region, as the fistula tract runs between the internal and external anal sphincter muscles without extending beyond the sphincter complex 1, 2.
Deeper anorectal abscesses may present with pain referred to the perineum, low back, and buttocks, but adductor pain is not part of the recognized pain referral pattern 3.
The anatomical location of intersphincteric fistulas—between the two sphincter layers—does not involve neural pathways that would refer pain to the adductor compartment of the thigh 1.
Why Adductor Pain Would Be Atypical
The obturator nerve innervates the adductor muscles, and this nerve runs through the obturator foramen and along the lateral pelvic wall, anatomically distant from the intersphincteric space 3.
Ischiorectal fistulas penetrate through the external anal sphincter into the ischioanal space and could theoretically cause more lateral pain, but even these do not typically involve the adductor region 1, 2.
Supralevator abscesses are located superior to the intersphincteric plane and would present with palpable masses or induration above the levator ani, potentially causing deeper pelvic pain, but not adductor-specific symptoms 1.
Alternative Diagnoses to Consider
If a patient presents with both perianal symptoms and adductor pain, consider:
Separate pathology: The adductor pain may represent an unrelated musculoskeletal condition, hip pathology, or groin strain.
Obturator internus abscess or pyomyositis: This rare condition could cause both pelvic/perianal symptoms and adductor pain due to proximity to the obturator nerve, but this would be a deep pelvic abscess, not an intersphincteric fistula 3.
Crohn's disease with complex fistulizing disease: Extensive perianal Crohn's with multiple fistula tracts could theoretically cause more widespread pelvic pain, though adductor involvement would still be unusual 3, 1.
Clinical Pitfall
Do not attribute adductor pain to an intersphincteric fistula without investigating other causes. The presence of both symptoms should prompt evaluation for concurrent hip pathology, obturator nerve involvement from a separate process, or deep pelvic infection extending beyond the typical fistula anatomy 3.