Background Intestinal fistula is an irregular opening that enables the contents to flow out. Surgical procedures, diverticular illness, inflammatory bowel disease, cancer, radiation, and injury from trauma or foreign bodies are all common causes of intestinal fistulas. Aims The goal is to see if smoking is a risk factor for relapsing in patients with intestinal fistula, as well as to learn more about the most common cause of perianal abscess or fistula, which will provide us with more information about risk factors that can be avoided and early diagnostic investigations that will help us detect the disease early and limit its progression. Methods Patients who presented to Damascus Hospital with complaints of intestinal fistula symptoms and were diagnosed and treated in the general surgery and gastroenterology divisions between 2015 and 2022 and met admission requirements were included in the retrospective analysis. Results Out of 104 cases of fistula, the average age was 34.96, with a male-to-female ratio of 67–33%. The overall percentage of smokers in the sample is 59%, and the pathological history includes 43 cases of Crohn's Disease and eight cases of colon cancer. A history of surgery was found in 63% of the participants. Surgical treatment was used on 53% of the fistulas, whereas conservative treatment was used on 47%. The proportion of patients who relapsed was 77% in smokers and 31% in nonsmokers, with a statistically significant difference. In addition, when we looked at the occurrence of perianal abscess or fistula in patients with Crohn's disease, we discovered that 96 percent of patients with perianal fistula have Crohn's disease, indicating a statistically significant relationship between these two conditions. Conclusion Smoking and Crohn's disease have a statistically significant relationship with relapsing and the development of a perianal abscess or fistula.