Oh ok, I have a fistula down there also, and yes it can and does hurt sometimes. Maybe it's a abscess. Just know one thing, be real careful about your game plan. If you have surgical intervention, just know those muscles down there control your bowels. I had a seton that did not work, and to make a long story short, I lost my control over my bowels. I did have that repaired but it was quite the journey to trust the Doc again! But since yours is external maybe that will not be a issue. Have they not tried Remicade or Humira to close it? I hope it all works out! I soaked in hot baths every day, some times 2 times a day just to get pain relief, it helped.